When I had my knees replaced as a teenager (almost 30 years ago) due to my juvenile rheumatoid arthritis, my surgeon worked hard to ensure I kept my kneecaps. Every other part of the joint was shiny and new, but my kneecap remained the same.
Artificial vs. original kneecaps
Ever since my knee replacements, I have wondered if it would have been better to have my kneecaps replaced. Almost 10 years ago, I had a revision (new knee replacement) of my left knee, and my new surgeon preserved my kneecap again. It came out a bit subluxed (pushed a bit to the side) because of the problems with my soft tissues and atrophy from decades of rheumatoid arthritis and immobilization. Thankfully, the joint revision worked OK.
However, this kneecap is weak and sensitive. It gets easily injured, doesn’t want to stay in place, and sometimes causes me pain. One of the great things about joint replacements is the lack of pain, but my kneecap stuck around to become a literal pain in the knee.
My problems started as a child
It’s a long story, but when I developed symptoms of juvenile rheumatoid arthritis around age 2, my left knee was the first alarm. It swelled up and gave me severe pain. I walked with a limp and was afraid of using it due to the pain and difficulty it caused.
Fast forward to my teenage years, and it was time for new knees (but especially my left one) because of the pain and disability the joints gave me. It was difficult to walk, but even when I wasn’t using my knee, I was in constant and nearly debilitating pain.
The replacements helped, but I had complications during my recovery, like tons of scar tissue formation that reduced my range of motion. Looking back, I wonder if my overactive RA with ineffective treatment (at the time) caused these problems. My knee felt better with greatly reduced pain, but I ended up with little joint motion. Still, it was enough to improve my quality of life.
Yet, whenever I had problems with my knee, it felt like it stemmed from the kneecap. I’m sure the RA continued to attack it as it was real bone and tissue, not the metal of the replacement. The soft tissues around it continued to incur damage, pain, and weakness.
My kneecap strikes again!
When I started experiencing a knee infection 20 years after the replacement (that would ultimately lead to the knee revision), the symptoms began as pain under my kneecap. Could it be my left kneecap is out to get me? It sure feels that way!
It was a hard recovery, but I’ve done well after the revision with walking and keeping up my physical therapy. Yet, I’ve always had to take great care of my left kneecap.
The need to be extra cautious
Recently I injured it, causing it to feel weak, unstable, and click uncomfortably. My orthopedic surgeon examined and x-rayed it; thankfully, my kneecap wasn’t even more out of place. He thought I had injured the soft tissues with perhaps too much exercise and suggested I take a break for a few weeks to let it heal.
Of course, an injury like this always seems to happen when I feel I’m making good progress in my exercise. It’s a terrible feeling to want to keep it up but have to be purposefully resting, icing, and treating my knee for recovery. Thankfully, it does seem to be (slowly, way too slowly) getting better and returning to its normal state.
I keep pondering, would I be better off with an artificial kneecap instead of my old, decrepit, RA-damaged one? It’s tough to tell. I’m not looking for another surgery, so I don’t want to find the answer anytime soon. In the meantime, I’m going to baby this left kneecap for as long as absolutely possible.
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