 Poster: A snowHead
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My wife has had some knee trouble, particularly in the last 12-18months. It appeared to result from gardening (kneeling) but she's struggled a bit with skiing and hill walking. Recently stairs have been a problem. Scans and specialist have revealed arthritis on the underside of the patella coupled with misaligned patella (pulled to the outside and inwards). We had been hoping that surgery to release the kneecaps might deal with it but advice is that the patellas are too damaged  The specialist believes that the arthritis is restricted to the patellas.
Just wondered if anyone has any experience. Treatment options seems to be:
injections to increase the fluid in the knee (lift the patella away) plus physio to strengthen around the knee (control the patella better) - this she will have, no regrets
arthroscopy to clean up the back of the knee (and perhaps, we're not sure, also to the tendon or ligaments to release the patella a bit)
relining the back of the patella
replacement of the patella
knee replacement
Reading around suggests that the failure rate on the patella relining / replacement is quite high, I think because often the rest of the joint is also arthritic. Might not be a problem in her case?
Any thoughts welcome. She is nearly 45 and quite upset as you can imagine.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@jedster, are you able to seek a second opinion from Jonathon Bell - our resident orthopaedic consultant?
Also others have reported good results from a ski mojo. I haven't tried it yet myself but I have read about it with interest on here for when my knees get worse
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Thank you Nicky - both good suggestions. Hopefully Jonathan will pop up before long.
BTW don't want to suggest we are unhappy with her current medical advice but thought it would be good to get more ideas.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Hello, I have some experience of this. Not much time at the moment so will maybe try to write again later but:
| jedster wrote: |
Treatment options seems to be:
injections to increase the fluid in the knee (lift the patella away) plus physio to strengthen around the knee (control the patella better) - this she will have, no regrets I presume they mean Hyalaurin which seems to have reasonable short term results but that's all. You might want to consider prolotherapy or PRP which also has the jury out on but some people report excellent results which should be longer term because it's re-growing the damaged parts. See https://www.nice.org.uk/guidance/IPG491/chapter/1-Recommendations for some info. Don't think you'll get it on the NHS.
arthroscopy to clean up the back of the knee (and perhaps, we're not sure, also to the tendon or ligaments to release the patella a bit) I've had this and it worked very well. However, it also found the REAL cause of the problem which was a lateral meniscus tear. Something two MRI's and multiple specialists had never picked up on.
relining the back of the patella - have heard very few good stories about this, suspect PRP is a better bet with much less risk attached. Met someone once who said it made everything much worse
replacement of the patella - last resort, won't last from what I've heard.
knee replacement - surely this is overkill for just a patella problem?
Reading around suggests that the failure rate on the patella relining / replacement is quite high, I think because often the rest of the joint is also arthritic. Might not be a problem in her case?
Any thoughts welcome. She is nearly 45 and quite upset as you can imagine. |
I REALLY want to try PRP but finding someone in Qatar is difficult. There are specialists in the UK if you google it. My knee problems consist of bone contusion inside the patella (I now believe because of added pressure from the lateral meniscus), probable torn medial meniscus, half torn ACL surrounded by scar tissue. I had the arthroscopy originally to clean up the scar tissue on the ACL and stop it catching inside the joint - they smoothed out the other bits at the same time. Was very good till I did my medial meniscus again.  Good luck.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@Raceplate,
thanks very much
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I presume they mean Hyalaurin
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yes I think so - think the idea is to reduce pain enough for her to do the physio. It's hard watching her climb stairs at the moment
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consider prolotherapy or PRP
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good suggestion. We're fortunate and have health cover through my work so should have a rage of options.
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knee replacement - surely this is overkill for just a patella problem?
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Certainly hope so. I was trying to lay out the spectrum. Particularly because it seems like the criticism of patella replacement and relining ops is that a significant minority (20-30%) still end up with knee replacements.
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You'll need to Register first of course.
You'll need to Register first of course.
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Can't comment much on the medical side as I have no personal experience of your wife's condition. Do have a fairly serious knee injury though and can say as @NickyJ, mentioned that The Ski Mojo is a great piece of kit and could be well worth your wife considering once the doctor's have done their stuff. Not cheap (about the price of a pair of good fitted boots with custom footbeds) but worth every penny as far as I'm concerned.
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Yes - definitely considering Ski Mojo, thanks. BTW do use it for anything else or just skiing?
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@jedster, you can't really use it for anything else. Brilliant bit of kit for old knees.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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@jedster,
Ive pm'd you but for others here is an outline to how to manage osteoarthritis of the patella femoral joint.
The key as always is to clarify the problem then provide a simple strategy.
1 Clarify the diagnosis and severity of the problem.
2 Reflect on what effect it is having upon you and focus on sorting out those as the goal. We assume you are in pain with it but is it having an effect on relationships
eg freedom to choose how you spend leisure time with family friends teammates etc. Is it having an effect on your health eg weight, cant exercise for stress control, fitness etc
3 Education on how to manage the knee and avoid flare ups.
4 Expert physio using a specialist in patella femoral pain.
5 Viscosupplementation can be helpful. PRP maybe.
6 If there is catching and mechanical problems - arthroscopy
7 If all else fails then partial or full knee replacement.
Jonathan Bell
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As @Frosty the Snowman, said you can't use it for anything else.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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@Jonathan Bell,
Thanks very much
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Interesting. Hope your wife progresses well. I am currently "shopping" for a knee injury because from last Saturday my left knee is definitely not what it used to be. Totally out of the blue. I had knee injuries in the past, though most of them to the right knee, but otherwise my knees never bothered me, not when skiing, not after skiing. I suspect something wrong in the patella region, because this is where it hurts with every other step or so, not all the time but frequently enough that I can't even imagine running for a tram. At the beginning even getting up from the sofa was very painful, after 3 days on Ibuprofen I walk a little better, can walk downstairs but still not upstairs. Having it checked on Monday. Definitely not something I wanted before the ski season, so really hope that whatever it is they can sort it fast.
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@never summer,
Certainly patella pain is typical on the stairs.
Bear in mind that the vast majority of people with patella pain have not got arthritis.
Get it looked at by a physio if not seen by anyone before.
Jonathan Bell
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You know it makes sense.
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@Jonathan Bell, yes, have already made an appointment, so hopefully this time next week I will know what's wrong and get a referral to a sports physio to address it. But overall it's worrying and unpleasant. I guess this is a part of getting older - aches and pains where they never were before.
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