knee replacement after reconstruction

  I am 53  male - at age 19 a had a severe knee injury that resulted in tears to three ligaments, including my ACL . At the time they wanted to fuse the joint but a young doctor at the time ( now head of the department ) said he would like to try and repair the tears and he could repair  all but the ACL . At age 36 I was constantly falling and had the knee giving out- 3 doctors reported that their was no satisfactory solution and the knee was unstable but also arthritic ( DJD ) . I went to a doctor who did a ACL reconstruction to try and help for a while- at the time he said it may give me 5 -10 years but not sure- Will now it is 17 years later and the doc says I need a knee replacement. ( fell down cellar steps 4 times in 5 weeks ) The knee also swells up very bad when on it for over an hour .

Questions?
Will the reconstruction surgery have any effect on the knee replacement surgey???
Almost forgot- my kneecap is right against the bone ( no gap on x-ray ) will the replacement fix this???
Lastly- I am actually feeling slight pain and pulling around the bone plug that I have not felt the previous 17 years--Doc says the ACL still seems tight.

Thanks

[JainMD]

Hi,
Your reconstruction surgery, which was done 17 years back, would not have any effect on knee replacement surgery.
I think the surgeon would try to fix all the problems once he has opened up the joint space in a sequential manner.
I think the doctor is right in thinking about the pathology of ACL if you still feel pulling with pain around bone plug.
Keep me informed if you have any queries.
Bye.

[frwbeach]

  Trying to put off the surgery but Synthis didn't help ( actually made it worse ) Is this rare??  I guess I'll have to just afraid to go through all the surgery once again  ( I have had pain all my life in knee since age 19- can deal with that - its progressed to sharpe pain and giving out that has me concerned ) Doc says giving out is because of pain more so than ligament .

Just curious-- How do they fix knee cap ???????

X-rays from age 19 showed an old knee cap fracture and x-rays through the years shows a progression of the gap between the knee cap and joint getting closer . My new doc says he is concerned about the knee cap and dislocations but has never mentioned a fix.

I am going to bring it up on the next appointment--Anything you feel I should inquire about???

Thanks

[JainMD]

Hi,
What is your name?
I can understand that you have gone through so much of pain and would not want another surgery. But I think the treatment plan left is surgery.
I didn’t get about which injection you are talking about, is it Synthis or Synvisc?
What I would like to know is whether it is subluxation or dislocation?
Patellar dislocation usually refers to lateral displacement of the patella out of its normal alignment in the trochlear groove of the femur.
The patella is held stable by ligamentous forces, muscular forces, and bony anatomy.
Disruption of any of these 3 components can lead to recurrent patellar instability.
Imaging study with X-ray should be done before attempting any procedure.
Several procedures have been attempted for treatment of patellar dislocation.
Patients with acute dislocations and disruption of the medial Patello-femoral ligament have been treated with acute repair.
Lateral release for patellar instability has poor results.
Patients with excessive Q angles (>150°) and recurrent dislocation may benefit from distal realignment via the Elmslie-Trillat or Fulkerson procedure.
Keep me informed if you have any queries.
Bye.