Kneecap shifting 1 year post total knee

[Destinyjb]

Hi Dr. Gross,
I had a total knee replacement 1 year ago for severe arthritis. The pain is still there and I can't walk right, also my knee cap keeps going out and I fall or almost fall. My Ortho gave me a brace to wear and PT to go to, to streng. then muscles around the knee. It hasn't helped. My knee cap is still my own. Why wasn't that replaced with the total knee also? Is that a norm?
I am so upset and will be getting a second opinion. Any ideas why this is happening. I am 58 year old lady.

Thanx.
.

[Michael L Gross, MD]

Yes. I have done several.

[Destinyjb]

Can they do a lateral release even thopugh I had a total knee done?

Thanx.

Destiny

[Michael L Gross, MD]

Whether the patella is replaced or not, does not seem to effect the reults of Total knee replacement.  A recent study showed that the incidence of patella problems was equal in both groups of patients post surgery.  The group who had not had their patella replaced originally, did have a higher incidence of second surgery, but this may have been because there was something obvious left to do. Interestingly, the group who had second surgery did no better than those who did not.
Your problem is not a result of the patella surface, but of the patella alignment. Tour patella is malaligned an continues to pop out of its groove.
This can be corrected with PT, bracing, or an arthroscopic procedure called a lateral release.