After months of multiple xrays and a bone scan the doctor determined there is a lack of blood flow to the patella and it is dying / calcifiing in addition to having shifted. It may heal it self, continue to die or worse case crumble. If it is the later then it will need to be replaced. Thankfully there is no infection. Doctor says my wife may have to live with the minor pain, 3 on a scale of 10. Hoping someone else may have similar occurrence and see what they were given as next steps.
Thanks for your feedback!