Each month, we like to highlight a case that might help other people who experience similar symptoms understand their surgical options. Please consult with your doctor as this is not considered medical advice. This patient has agreed to share their story. *Names have been changed to protect their privacy.
Knee Pain & Osteoarthritis
Sharon* was a 67-year-old female with a long history of right anterior (front) knee pain. She came to TJN Orthopaedics for a second opinion, since her last doctor recommended total knee replacement. She had also exhausted all of her non-surgical options, including anti-inflammatories and cortisone injections. Sharon was eager to find a solution to her pain.
What Sharon was suffering from was osteoarthritis. Osteoarthritis is fairly common, and usually affects the major joints of the body – the hips, knees, shoulders, and back. The statistics were stacked against her, though. Osteoarthritis most commonly affects the knees and is present in women more than men. A relatively active person, Sharon had suffered disabling pain that began to affect her daily activities.
As is common with osteoarthritis, Sharon experienced start-up pain, which refers to the pain when starting to move from a sedentary position, but gradually improves over time. Pain going upstairs is also a common symptom that she experienced.
A Second Opinion
Sharon’s examination at TJN Orthopaedics showed that she had grinding at the knee cap when extending her knee, but still maintained a good range of motion. Her knee stability was strong, meaning the ligaments were intact. The knee was structurally sound, but had a worn-down surface under the kneecap, causing tenderness. Dr. Tchejeyan suspected that a total knee replacement might not be the only answer.
The next step was to take x rays, which are incredibly important for looking at knee arthritis. Four x-ray views are needed – two that are weight-bearing, and two others that show the lateral side view and sunrise view underneath the kneecap.
With these x-rays, Dr. Tchejeyan was looking for how much space existed between the femur and tibia, thereby identifying how much cartilage remained. Her weight-bearing views appeared normal but on sunrise x-ray, there was bone-on-bone arthritis and no cartilage.
Many surgeons would perform total knee replacement for this condition. However, with intact ligaments and healthy cartilage between the femur and tibia, that wasn’t absolutely necessary. In fact, the disadvantage to TKR is that ligaments and some normal cartilage are replaced unnecessarily, thereby increasing the chance of future physical limitations. With partial knee resurfacing, Sharon could fearlessly engage in more functional high-impact activities post-surgery.
In the best interest of the patient, Dr. Tchejeyan offered less surgery, specifically a partial knee resurfacing. Sharon agreed, and they moved forward with the robotic Mako Patella-Femoral Replacement.
Postoperative x rays show an implant on the emoral trochlea and backside of the patella. In all knee resurfacing surgeries, only the damaged surface of the knee resurfaced and the implants are bonded with cement to the person’s bone. So, in Sharon’s surgery, like others undergoing partial knee resurfacing, only ⅓ of the knee has the surface implant, the rest is the patient’s natural knee, including ligaments and tendons.
Above images were taken during Sharon’s surgery.
Post-Surgery Visit
Two weeks post-surgery, Sharon walked into the office without any assistance. She showed range of motion from 0-110 degrees, and was feeling great! Having the same issue in her other knee, Sharon has decided to have surgery on it with Dr. Tchejeyan in about three months, when she completely recovers from this surgery. After that, Sharon will resume her daily activities – happy and pain-free!
Board certified orthopaedic surgeon, Dr. Tchejeyan, is perhaps better known by his reputation as “The LA Knee Guy”. That’s because he specializes in helping patients achieve optimal knee health – whether that means knee replacement, knee resurfacing, or no surgery at all. He has an honest interest in your health.
At TJN Orthopaedics, our trained staff stands by ready and waiting to answer your questions and help in any way possible. Give us a call today!
(805) 495-3687
250 Lombard Street, 1st Floor
Thousand Oaks, CA 91360
