trochlear replacement? anyinformation

Posted , 6 users are following.

Hello there,

I have posted before about my ongoing knee problems. Summary:

Ongoing knee pain form 2011, physio, steroid injections (no relief) knee arthroscopy, microfracture & chondroplasty in 2013 - not a good result, more steroid injections, repeat of surgery in 2015 - some relief then gradual deterioration to 2017, usual round of physio & steroids,

Have been diagnosed with pes ansurinus and a steroid injection would cure - it didn't

Bad alignment with the thought of tibial osteotomy - disregarded after repeat xrays and mri

Bad arthritis on patella and thought of knee cap replacement

Led to repeat arthroscopy in 2018 and chondroplasty again - no real results from this.

I didn't particularly like the last surgeon.

As no real result asked to see different consultant who said knee cap not too bad. It's the trochlear groove that is bad. Also I am very wobbly - not ligaments or muscle - they are as good as they can be (I have been doing my physio well since 2013!!) But my hips are slightly too far forward and I have some lower limb torsion (I think)

So he is offering the thought of a trochlear - no so much replacement but putting a shield over it - that's how I understand it anyway - to alleviate the patella and trochlear situation. Apparently it's reasonably rare - he does about 2 or 3 a year.

He said I would inevitably need a TKR in the future due to the arthritis - which is everywhere but not terrible in other places. I could carry on for another 10 years till I have a TKR or I could go for this in the meantime.

I am in constant pain - some days are bad. Driving is a real issue, Sitting with my knees at right angles is an issue. I've had a bad week this week - to the point of crying with pain, co-codamol, ibuprofen and voltarol gel to manage. Some weeks are not as bad.

So what to do? This week I would have happily gone in for any surgery to try to help. Maybe next week won't be as bad. Can I cope with another 10 or so years of this - I'm not convinced.

I do understand that there is no guarantee of success but should I give it my best shot

I've had 5 surgeries in 5 yrs - 2 for another problem - it's been a lot.

I'm in the UK and I'm 55 - have a job where I have to be able to drive and get up and down off the floor

Any thoughts appreciated, thank you

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11 Replies

  • Posted

    just get a total knee replacement . you are just going through other stuff that wont fix it . see another surgeon for second opinion .

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    • Posted

      Hello,

      This is my second opinion! I had the original surgeon who did the first two surgeries. Then saw another consultant for the possible osteotomy who then referred me to the next consultant for the possible patella replacement - he is the one who did the last surgery - the one I didn't particularly like. He offered to have me back in clinic but I said I wanted to see somebody else. I don't feel that he did the right thing - not that he did it badly but I think there was no point to the arthroscopic procedure - he just chopped out more "tatty bits" - his words - well that's 3 times stuff has been chopped out.

      I was advised to see this new consultant as I know a consultant anaesthetist through my work who works with all the knee surgeons. This one was certainly better and explained more thoroughly. He does more complex surgeries too - ligament reconstruction and replacements to is more of an all rounder - he has a world class reputation although younger than most (well that's to me - most doctors I see these days look like they're on work experience!)

      A TKR is not going to be done as the rest of the knee is not too bad. It will certainly get bad and it will need replacing but they will not justify it yet. Even if I went privately they would not do it (I'm in the UK). This would be something to get me through the next few years till a TKR.

      Looking up the procedure the companies that market the product say it is a good thing as it doesn't involve major cutting into the muscles/ligaments that TKR does so doesn't compromise a TKR later - but then they would say that wouldn't they as they want to sell the product.

      So no TKR till the rest degenerates - can I last 10 years with this level of pain that will get worse - no I can't. Do I want more surgery in the hope I can relieve the pain? Will it? Is it worth a go? It seems that this is an unusual surgery in that not many are done but is that because it is a relatively new procedure and there aren't long term case studies?

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    • Posted

      Hi sorry to hear you're in so much pain, it's not nice. Think I would be tempted to have the surgery, what have you got to lose? If you're knee is still bad after say 5 yrs, with a bit of persuasion maybe, you could have a tkr then, not necessarily have to wait 10 yrs. I've had 2 done 1st 1 bout 6-7 yrs ago, I'm 63. 1st 1 went well 2nd 1 20 months ago still not great. Luck of the draw! Good luck whatever you decide to do.

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    • Posted

      Thanks - yes thats my husband's thought. He says to go for it and up until the day I could pull out. I've got to work till I'm 67 before I get my pension - it's a long time. At present I get good sick pay from work - which is an added consideration if I'm honest.

      I think the wait for the TKR is the level of deterioration which obviously can't really be predicted.

      I'd love to be able to find someone who has had the procedure though...

      I did intrinsically trust this consultant more than the others. Whether I had a better consultation - it was through the nhs but at his private clinic - so was longer than the 5 minutes in and out in the nhs clinics. Though he did say he could only do the surgery through the nhs lists as the private hospital wasn't equipped for this particular surgery - not a problem as I can't afford to go private anyway

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  • Posted

    are you refering to a trochleoplasty ? i am 24 with two young kids and currently sitting at about 14 weeks after a trochleoplasty, i had an extremely traumatic experience with the recovery but the actual op itself is probably the best choice i ever made.

    I suffered from years of dislocations in both knees, i started dislocating at 10 and i dislocated both knees over 20 times each, eventually they said the only thing stopping my knees popping out daily was the strength of my muscles. the cartilage meant to protect my knee was long gone from damage done by the dislocations, my ligaments and tendons were over stretched and far to loose. finally i got diagnosed as having trochleodysplasia and i got refered to the 'best' trochleoplasty surgeon in the country dr john elridge he is usually private but takes on severe cases from the nhs, he said mine was very bad and actually instead of a groove there was a bump pushing the patella out. my knees were so unstable if you stand on one leg and your ankle is wobbling alot trying to stabilise you thats because the kneecap is not stable! so basically after about 10 months on a waiting list i managed to get my op.

    the op itself was a success the pain wasnt even too bad due to the nerve blocker mind you! i couldnt do anything for 4 weeks which was torturous being an extremely active mum usually and attending the gym 5 times a week usually! i was so drugged up on morphine didnt really have a clue what was going on and being confined to a bed for 4 weeks was no good for me, unfortunately my body doesnt react well to hard core pain relief and as a result of the co codomal and liquid morphine combined for a long period of time i actually ended up with an awful spell of drug induced pychosis ! thankfully i think im just about getting past it all now! anyway 14 weeks after the op and i am able to squat 80kg - more than i was able to squat before (as my knees now more stable despite being the weaker leg because its just been operated on!) deadlift 60kg again more than i could do before. and its actually the unoperated leg (awaiting an op) that is currently letting me down as its not as stable as the other leg yet! being a 5ft2 female and only weighing 60kg myself id say that having that much strength after what sounds like such an invasive procedure is fairly impressive. but without the procedure i was coming close to not being able to go to the gym because the pain in my knees and the grinding and clicking of them was getting worse by the day! they would swell too awfully. so basically id say go for it you have already had many and this one although the procedure sounds extreme it really is life changing! id say to go for it!

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  • Posted

    I did reply but it is being moderated - I cut and pasted some info but it contained a trade name so I'll have another go and edit the info.

    I don't think so - a trochleoplasty is for instability? I've just looked up what one of those is! I 'just' have arthritis. No mention has been made of instability.

    I think this is some information about my problem and the thought of helping

    This is an effective treatment for patients between the ages of 35 and 65 who have been diagnosed with a focal cartilage lesion on the femoral condyle or trochlea. These categories of patients are often too old to effectively undergo biological treatments like micro-fracturing, yet are too young and active to undergo knee replacement surgery. Therefore the XXX Femoral Condyle and Knee Trochlea implants for this group of underserved patients allow treatment of early stage focal cartilage damage by replacing the damaged area only. The ultimate goal is to save patients from years of pain by restoring the joint function, yet at the same time maintaining the possibility for future treatment options.

    The XXX Femoral Condyle and Knee Trochlea implants are designed to offer an alternative for patients who might have endured years of pain and loss of knee joint function while waiting to reach the appropriate age for joint replacement surgery.

    Individually customised implants and surgical tools – enabling high precision and predictable surgery for optimal positioning of the implant.

    Sounds like your surgery went well for you if you are back in the gym. I do understand recovery is long and drawn out and you have to work at it - it won't just heal. I am quite committed to doing physio. Since the first surgery I have kept up the exercises and my ligaments and muscles are as good as they can be. I'm pretty strong! I also have a good range of movement from 0 degrees on a good day - 2 on a bad to 140 degrees+ - physios says a bit too much! It's really the pain that is driving me mad and impacting on my life

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  • Posted

    Hi, I don't understand all the technical words you have used for various operations but it sounds horrendous to be dealing with all that pain and not knowing from day to day what amout of discomfort and pain your going to have..in my opinion you would be better to have the TKR and be done with it...otherwise your facing 10 years of uncertainty, I had TKR on 21st June this year and it takes a while to recover but at least you'll be finished with it then rather than going week to week and prolonging the inevitable....Rose...

    Ireland

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    • Posted

      Thanks you - alas a TKR is not on offer! All the consultants will say is that I will have deterioration and I will require a TKR in the future. All they will offer at the moment is this new-ish procedure or I put up with it.This week if they'd rung and said come in now (never going to happen - but just suppose) I would have been in quicker than it took me to drive there!

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    • Posted

      Rose, How is your recovery since your operation on 21st June.? I had my TKR on the same date but feel that i am many months away from recovery, another problem i have now encountered is a sore lower back which i guess has arisen from the way that i am attempting to walk

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    • Posted

      Hi climb, i guess your right about the pain in your back is coming from the strained way your walking at moment, .....to be honest I don't, feel well since this operation both physically and mentally, I can't climb the stairs with alternate steps as I feel I have no strenght in my knee....and mentally I've been feeing depressed, I can't do what I want , to do and how I use to be...I'm just fed up of the length it's taking to feel normal again, I was told it will take a whole year to feel back to normal again...🙄😟I wish I could be like I use to be before op....the pain of arthritis wasn't every day but the pain with TKR is chronic....

      Rose

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    • Posted

      Rose, thanks for your reply, the comments that you made mirrors my own thoughts!!! with the exception being that i have NOT allowed myself to be depressed by having ACCEPTED that it will take between 6 months to a year for complete recovery. All the best for the future!

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