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Patellar fracture during knee replacement surgery
I'm 8 ish months post total knee replacement. I suffered an inter operative comminuted patella fracture with half of my kneecap removed. I had 5 months of home health visits for PT and OT. I have been in chronic pain since day 1. I did, and still do, my best effort at strength, ROM and balance. What now? I'm only 40 flex on a good day.
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Hello @krikett, Welcome to Connect. I know it must be difficult dealing with kneecap fracture with your knee replacement surgery. Here are a couple of articles that discuss the kneecap fracture and different treatment options that may be helpful.
-- Kneecap Fractures (Patella Fractures): https://www.hopkinsmedicine.org/health/conditions-and-diseases/kneecap-fractures.
-- Patellar Fractures After Total Knee Replacement: https://www.ajronline.org/doi/pdf/10.2214/ajr.185.3.01850655.
What next is a good question to ask your surgeon or care team. Have you discussed any treatment options with your doctor or surgeon?
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2 ReactionsI feel my surgeon was less than thorough in regards to my known risk factors prior to and during my surgery. I am 62 female with limited flexion <90 in both knees, osteoporosis and chronic pain medication management. The comminuted fracture occurred during my surgery. The repair required me to be in a long rigid brace with weight bearing as tolerated and minimal flexion for 8 weeks. The delay in active ROM and strength building physical activity severely comprised the function and performance and I am disappointed beyond measure. Only x-rays were used. No other images were taken. I firmly believe the surgeon lacked any due diligence beforehand. I'm not a candidate for MUA. I had a lumbar sympathetic nerve block that didn't help.
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3 ReactionsDoes an MRI help to dignose this if you know? I am many years post op but have had pain in both replaced knees for years. So not want to attempt another replacement at 80. My Dr. will agree to an MRI . Does anyone think it will be helpful? I realize it won't show an optimum image.
How did your patella get fractured and why do you only have half of it left?
I think a CT scan would be more useful than an MRI.
Surgeon applied too much force during surgery trying to get more flexion. The fracture was comminuted and displaced. Only 50% was viable.
Hi @krikett, welcome. I'm sorry and can only imagine your frustration from the set back and delay in your TKR rehabilitation. My husband had TKR revision surgery 2 months ago because his bone was abnormally growing and loosening his original implant. Towards the end of surgery, his patellar tendon began to peal away from the bone and had to be sewn back into the bone. As a result his rehab plan had a whole new look similar to yours... 8 weeks in the full leg brace with only graduated minimal flexion and weight bearing as tolerated. Rehab on hold basically. His doctor explained the importance of delicately striking a balance between allowing one repaired area to heal while not allowing the knee itself to stiffen up too much. That sounds similar to your endeavors.
I know your frustrated with your doctor, but how did he explain the patella fracturing during your surgery? It seems that resurfacing or shaving down the knee cap is a questionable procedure depending on mitigating circumstances like bone on bone and arthritis. You mention half of your knee cap is gone. Did it happen while the doctor was resurfacing the patella? Some situations may be unavoidable during surgery and while it's difficult to hear, not much can be done about it afterwards except move forward as best you can with a positive determination to be the best you can be given the circumstances.
After 5 months, are you continuing with PT and OT to get you farther along than 40 flex? What in home exercises are you independently doing to keep what range you do have? Please know that I am rooting for you and your forward progress. Keep hope alive, my friend! Will you keep me posted on how you're doing?
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2 ReactionsI think a bone scan might have been helpful. I have osteoporosis and I don't think an x ray is enough. I don't think an MRI would have shown the degree of bone loss.
He put holes in the patella but didn't get to the resurfacing stage. I only had 90 degrees of flexion postop. The scarring set in quickly. I'm working on strengthening and balance. Stairs are tough. Sleeping is getting better. I speak with a pain psychologist and am working on accepting my condition. Pain is an issue I didn't expect to be faced with this far from my surgery but since I can't predict the future I will try to be the best me I can be regardless! How's your husband's mobility?
I only have half of my kneecap because the fracture was in so many places that it wasn't salvageable completely. My patellar tendon also avulsed and was reconnected with the remaining viable pieces and all bits were stitched together and that's it. No Dr wants this to happen and it's extremely rare, but it's my new normal.
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