OT: Knee (surgical) procedure question...

ZaneHickey

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Anyone on here ever had (or know someone who has) an allograft transplantation for the patella? My understanding is that it is a removal of a bad/missing section of patellar cartilage (and some of the bone) and the use of a cadaver portion of the same to fuse in that spot. I like to think of it as re-sodding a section of lawn under my knee cap. Just wondering about success of the procedure, the very slow recovery process, etc. Thanks, in advance.
 

dinglefritz

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Jan 14, 2011
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Anyone on here ever had (or know someone who has) an allograft transplantation for the patella? My understanding is that it is a removal of a bad/missing section of patellar cartilage (and some of the bone) and the use of a cadaver portion of the same to fuse in that spot. I like to think of it as re-sodding a section of lawn under my knee cap. Just wondering about success of the procedure, the very slow recovery process, etc. Thanks, in advance.
Man I think that's a pretty rare procedure and fairly radical. I would get a second opinion before I did that. After my most recent knee scope my orthopod wanted to schedule me immediately for a replacement. I just said, "let's see how taking out most of my meniscus goes for a little while". That was over 2 years ago. He has a really big house and a wife who loves to spend money...... I'm getting close to needed that knee done but I still bought a couple of years.
 

ZaneHickey

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Man I think that's a pretty rare procedure and fairly radical. I would get a second opinion before I did that. After my most recent knee scope my orthopod wanted to schedule me immediately for a replacement. I just said, "let's see how taking out most of my meniscus goes for a little while". That was over 2 years ago. He has a really big house and a wife who loves to spend money...... I'm getting close to needed that knee done but I still bought a couple of years.
My issue, at age 50, is a crater in my patellar cartilage. We are going to try injecting some WD-40 first, maybe steroid shot(s)...then MRI to see if the crater has grown since 2 years ago when I had the third scoping done. Quite a bit of mistracking and patellar/femoral contact has led to this point. I would be okay if all I desired to do is walk and climb stairs. Any more bend and force is a perpetual irritant, at this point. Too young for replacement. Thanks for weighing in.
 
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huskerfan66

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My issue, at age 50, is a crater in my patellar cartilage. We are going to try injecting some WD-40 first, maybe steroid shot(s)...then MRI to see if the crater has grown since 2 years ago when I had the third scoping done. Quite a bit of mistracking and patellar/femoral contact has led to this point. I would be okay if all I desired to do is walk and climb stairs. Any more bend and force is a perpetual irritant, at this point. Too young for replacement. Thanks for weighing in.
Not sure if this is the same but one of my daughters dislocated her knee cap in high school. Had to wear a brace after that. While in college they decided to do surgery because it wasn't improving and she dislocated it again

They put cadaver cartilage under the kneecap. They had to get it from a toddler for better results. Think it came from north carolina. Worked fairly well. She had the ice cooler pump for inflammation and pain mitigation and a motion machine to exercise it and keep it stretched. Not sure the latter was necessary. Went on the have a successful college track career and plays softball and volleyball and runs weekly today... she's 29 now.

Better than not getting it done
 
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schuele

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Has your doctor ruled out microfracture surgery? I had that in my 20s and I guess you would say it was successful, since that knee outlasted the other one.

Procedure is not bad at all, since it's done with a scope. Recovery was 7 months on crutches to allow for tissue regeneration. I was able to swim and ride a stationary bike, and move around the house without crutches, but otherwise I was on them the whole time. Could maybe have used one of those injury scooters, but those weren't around back then.
 

shine003

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50 years old? Injections, nsaids, and physical therapy. Physical therapy works surprisingly well for patella disorders. I would exhaust all options for signing up for a procedure. And if you’re symptoms only bother you from higher level activities, maybe consider giving those up. That said, if all else fails....it really depends on what the knee looks like. Is this a focal cartilage defect or patella-femoral arthritis? What’s the rest of the knee look like? Is there arthritis any where else in the knee?

its super hard for anyone to give you good advice on here because these decisions are very nuanced. That said...the allograft oats procedure you’re talking about is usually done in younger people (under 30). Unless there is something unusual (which there could be) going on, joint preservation isn’t very common in 50 year olds. Trying to replace cartilage at that age just doesn’t work reliably well. I’d be looking into patella femoral replacements if you have isolated patella arthritis and have exhausted all non-operative measures. If you have more extensive arthritis, 50 isn’t an outrageous age to get a full knee replacement done. Personally, I’d get a second or third opinion before signing up for that surgery.
 

Crazyhole

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I had work done on both of my knees about 25 years ago. My patella was tracking to the side and created some gouges that led to spurs. The surgeon ground down the underside of the patella and clipped both LCLs to help keep it tracking appropriately. Worked like a charm, and made it a heck of a lot easier to build muscle mass around my knees.
 
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LightningJack

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What shine003 said. Life is too short brother, get that other opinion. I'm 49 and got approved last week for a full knee replacement. Been buggin me ish for 2 years, now that my hip and back hurt too because my knee isn't in alignment (no cartilage) and started mowing the lawns again.

Just had my 3rd Cortisone shot and start PT next week and maybe some Aqua Therapy if need be. I am over the recommended BMI for the procedure. The PA gave me the too young, too big, a replacement only lasts 20-25 years yada speech and I believe his is right. Butt the Surgeon I got goes a case by case basis. He just wants me at a better BMI and I can have it done this fall if I want and lose the weight.

I've watched my sister & mom go through this and suffer for years and not go out and do much if at all because they were in too much pain. I'm not at the level of pain they were but I'm gonna get it done this year when I can get it worked out.

I'm not worried about the Redo in 20 years, those will most likely be the wheel chair kidney dialysis years for me anyways. Get it done Bro!
 

schuele

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Apr 17, 2005
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What shine003 said. Life is too short brother, get that other opinion. I'm 49 and got approved last week for a full knee replacement. Been buggin me ish for 2 years, now that my hip and back hurt too because my knee isn't in alignment (no cartilage) and started mowing the lawns again.

Just had my 3rd Cortisone shot and start PT next week and maybe some Aqua Therapy if need be. I am over the recommended BMI for the procedure. The PA gave me the too young, too big, a replacement only lasts 20-25 years yada speech and I believe his is right. Butt the Surgeon I got goes a case by case basis. He just wants me at a better BMI and I can have it done this fall if I want and lose the weight.

I've watched my sister & mom go through this and suffer for years and not go out and do much if at all because they were in too much pain. I'm not at the level of pain they were but I'm gonna get it done this year when I can get it worked out.

I'm not worried about the Redo in 20 years, those will most likely be the wheel chair kidney dialysis years for me anyways. Get it done Bro!
Use the time to also build up some leg strength, especially in your quads. Doing “pre-hab” was the best advice I could have gotten and it made the recovery go much better. It’s equally important to strengthen the non-surgical leg because you will be relying heavily on it until you regain strength in the other leg. Good luck to you.
 

ZaneHickey

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Dec 3, 2004
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50 years old? Injections, nsaids, and physical therapy. Physical therapy works surprisingly well for patella disorders. I would exhaust all options for signing up for a procedure. And if you’re symptoms only bother you from higher level activities, maybe consider giving those up. That said, if all else fails....it really depends on what the knee looks like. Is this a focal cartilage defect or patella-femoral arthritis? What’s the rest of the knee look like? Is there arthritis any where else in the knee?

its super hard for anyone to give you good advice on here because these decisions are very nuanced. That said...the allograft oats procedure you’re talking about is usually done in younger people (under 30). Unless there is something unusual (which there could be) going on, joint preservation isn’t very common in 50 year olds. Trying to replace cartilage at that age just doesn’t work reliably well. I’d be looking into patella femoral replacements if you have isolated patella arthritis and have exhausted all non-operative measures. If you have more extensive arthritis, 50 isn’t an outrageous age to get a full knee replacement done. Personally, I’d get a second or third opinion before signing up for that surgery.
The knees are both arthritic both only moderately so. I have had a decent amount of patellar/femoral mistracking and contact. 2 years ago, the surgeon (cleaning up meniscus tear) also did something akin to microfracture. He said he drilled a few holes in the patella to promote bleeding, etc. He just describes me as having a good sized crater in the patellar cartilage. I really only care to walk, hike and bike...along with body-weight squats (or light dumbbells and reps). What is concerning to me is that even biking, which used to be the cure, is now cause of irritation and a 'bad day' afterward. Two years ago, thanks to a DVT/PE incident, I started on Xarelto. So higher-strength anti-inflammatory drugs probably not on the table. He mentioned a stem cell procedure, but it sounds like insurance doesn't cover, so that (even if a proven treatment) is out. Thanks for the input.
 

ZaneHickey

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Dec 3, 2004
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Use the time to also build up some leg strength, especially in your quads. Doing “pre-hab” was the best advice I could have gotten and it made the recovery go much better. It’s equally important to strengthen the non-surgical leg because you will be relying heavily on it until you regain strength in the other leg. Good luck to you.
Pre-hab makes total sense. My good leg/knee is already in pretty good shape. I have been cheating to that side for quite awhile. I'm lopsided!
 
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CT-NUred

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I just had my ACL reconstructed (9 weeks ago) and based on the MRI - they were also supposed to do exactly what you are describing - basically drilling little holes in the patella in hopes that the body would repair itself - in the end, when they got in there they opted out of the procedure but I know they had told me that I would be on crutches for 8 weeks after - since I only had the ACL reconstruction, I could walk within days.
 
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schuele

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Pre-hab makes total sense. My good leg/knee is already in pretty good shape. I have been cheating to that side for quite awhile. I'm lopsided!
As for the age factor, I ran out of options with my left knee and had it replaced at 48. They thought at the time that my right knee had 4-5 years left but it lasted only two. I didn’t bother with stopgap procedures the second time because I knew what I was getting into and decided to get on with it. I have absolutely zero regrets and I’m getting along great - most days I don’t even think about my knees. But every situation is different, and what worked well for me isn’t the right move for everyone. Good luck.
 

ZaneHickey

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Dec 3, 2004
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As for the age factor, I ran out of options with my left knee and had it replaced at 48. They thought at the time that my right knee had 4-5 years left but it lasted only two. I didn’t bother with stopgap procedures the second time because I knew what I was getting into and decided to get on with it. I have absolutely zero regrets and I’m getting along great - most days I don’t even think about my knees. But every situation is different, and what worked well for me isn’t the right move for everyone. Good luck.
Glad you're doing well. I think we have a pretty solid group of docs here, and I will trust their opinion. We have been playing small ball for awhile, and like you, I just want to get things fixed. My inability to take serious anti-inflammatory drugs, thanks to a lifetime prescription of Xarelto, doesn't help! Sounds like, if they do the graft, you have 6 months of nothing but walking. No real exercise. That would require a gross or 2 of Slimfast shakes, or I am in trouble.
 

salsa red

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Get some stem cells therapy. Some places in the states do it as well as other countries. Insurance doesn't cover it and it's expensive but I would try it out before any surgery.
 

shine003

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Get some stem cells therapy. Some places in the states do it as well as other countries. Insurance doesn't cover it and it's expensive but I would try it out before any surgery.

this is terrible advice, unless you have a few thousand dollars you need to burn. Zero evidence stem cell injections help and they don’t even make logical sense for arthritis.
 

dinglefritz

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this is terrible advice, unless you have a few thousand dollars you need to burn. Zero evidence stem cell injections help and they don’t even make logical sense for arthritis.
You are absolutely correct about stem cell injections. Any Orthopod that suggested I try that would be crossed off my list of Drs. It's quackery at best.
 
Jan 2, 2021
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Anyone on here ever had (or know someone who has) an allograft transplantation for the patella? My understanding is that it is a removal of a bad/missing section of patellar cartilage (and some of the bone) and the use of a cadaver portion of the same to fuse in that spot. I like to think of it as re-sodding a section of lawn under my knee cap. Just wondering about success of the procedure, the very slow recovery process, etc. Thanks, in advance.
Osteochondral allograft procedures are becoming far more common than they were even 5-10 years ago. In fact there are ortho fellowships that even specialize in cartilage preservation. Not sure where you are at but there are a couple surgeons in Omaha that are routinely performing these. Hopefully if you decide to go with this option it provides you relief and you can put off a total.
 
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dinglefritz

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Jan 14, 2011
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My issue, at age 50, is a crater in my patellar cartilage. We are going to try injecting some WD-40 first, maybe steroid shot(s)...then MRI to see if the crater has grown since 2 years ago when I had the third scoping done. Quite a bit of mistracking and patellar/femoral contact has led to this point. I would be okay if all I desired to do is walk and climb stairs. Any more bend and force is a perpetual irritant, at this point. Too young for replacement. Thanks for weighing in.
I had my hip replaced on my 50th birthday 13 years ago. I've done a LOT of high impact backpacking and other strenuous activities since then and have had zero problems with it. One of the biggest problems I think people have with joint replacements is that they're carrying WAY too much weight to begin with. I need a knee for sure and probably the other hip on that same side done now. I'm not quite ready yet but will be soon.

The biggest mistake I made was limping around on that first bad hip for 5 years before I had it done. The decider was when I was laying in bed and if felt like somebody was jabbing me in the hip even though I had several high test Tylenol and 4 Alleve on board. I could sleep sitting up or laying down.
 

salsa red

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Dec 25, 2019
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Stem cells are too dangerous. How about you get cut open, saw off your joint, shove a metal joint in, screw it in with hardware, and have months-years of therapy. That sounds much safer..

Heres some research on stem cells for you boomers.


Lots of professional athletes are using stem cells. Not 100% but worth looking into if you have the money. Your health is the most valuable asset.
 

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