Should I get knee surgery again?I am twenty years old and already have had two knee surgeries. My right knee has arthritis and has undergone a lateral release. The lateral release was unsuccessful and I am currently having joint fluid replacement shots every three months. They aren't working. Basically, my knee is misaligned and every time I bend it, it causes more wear and tear inside. My knee always hurts, especially when it is bent, and even driving is becoming unbearable.
The next option is a High Tibial Osteotomy, which is where they cut your bone in order to realign the knee. This is a much more intensive surgery and it prolongs the life of the knee by around nine years.
I'm not sure whether or not I should get this surgery because my doctor messed up the first time. Also, I'm not sure that this surgery will benefit my health in the long run. However, it seems that this surgery has enough benefit to outweigh the risks involved.
What do you think?
-Jacob
This is a very personal decision, as ultimately no one else is going to have to live with the decision but you. So, it is not one I would take lightly.
If it were me, I would speak with another doctor, perhaps several other doctors, before making a decision one way or the other. Especially if you are unsure as to the performance of your current doctor.
-gfeckle
Lateral Release is unsuccessful in many cases....just look it up online and you'll find several accounts of it not working for people. It is best for a titled patella due to a tight lateral retinaculum. It usually can't treat patella instabilty on its own.
You should determine why your kneecap is misaligned. Is it weak VMO muscles? (Try physical therapy for several months before getting any surgery) Is it loose medial structures or tight lateral ones? Do you have shallow femoral grooves? A kneecap that rides too high? Is your tibial tibercule too laterally placed? You should get xrays to show the alignment of your knee.
If you say your knee is misaligned, I think you are probably referring to the correlation between the femur, patella, patella tendon, and tibia. If where your patella tendon (which runs from your kneecap to tibia or shin bone) is too far to the outside then your kneecap is more likely to ride on the outside of the groove and cause wear and tear.
If lateral release failed, have you discussed or tried other procedures that would pull the kneecap more centrally by tightening the inside tissues like medial reefing or MPFL reconstruction?
Do you have bad tracking, instability (subluxations/dislocations), or just arthritis?
However, if your patella tendon and knee is misaligned, then the tibial surgery would probably be best. My surgeon, but it's what you and your surgeon are like, said that the two procedures (lateral release and medial reefing) that I would have has a success rate of 75%. He also mentioned that if in a year I'm still have problems, he will do the tibia bone breaking surgery and that works in almost all cases to help get rid of problems. They just like to start smaller because there is a 3/4 chance that he can help someone with a smaller surgery.
Also, he said recovery for lateral release could take up to 6 months and the bone breaking surgery you mentioned a full year.
Either procedure needs to be followed up by a diligent effort in physical therapy.
Good Luck :)
I had patella tracking and instability issues ever since I dislocated it last summer. I gave pt several months efforts as well as wearing a brace and have the pt tape my knee. I had arthoscopic surgery in which my surgeon performed the lateral release to make my patella stop tilting and medial reefing to get it back in the groove. I have very shallow femoral grooves for my kneecap (looks flat almost on xrays) and this can cause the kneecaps to slip out more. I also had some wear and tear on the back of my kneecap from it maltracking (grade/grade 3 out of a possible grade 4) and I'm only a teenager but since they realigned the way my patella is...they said that it shouldn't bother me because it won't be putting pressure on the cartilage.
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