Patella Bone Spurs

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Topic Title: Patella Bone Spurs
Created On: 02/01/2005 06:13 PM

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 02/01/2005 06:13 PM

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I have identical bone spurs at the top of each patella. The spurs curve upward and then in like a fish hook. While they have been there for years with no or mild symptoms, over the last 10 months severe inflammation has begun and continues to worsen. I could not sit on a chair or stand up from a chair without using both my arms to push on something strong enough to take my weight (210 at 6/1"). I could not descend stairs without using both hands on the handrail to take as much of my weight as possible on my arms. Skiing and rock climbing were out of the question. I could still hike on relatively flat ground with an ice axe used as a cane, but I could not handle steep uphills or downhills, Detailed X-rays and exams have confirmed no other knee problems. My cartilage is apparently in excellent shape for an active 55 year old male. I've been taking glucosamine/condroitin for seven years, and have had no knee injuries or surgeries. The conclusions have been that the bone spurs are digging into the quadriceps tendon and causing inflammation. Two months of physical therapy including twice a week topical dexamethasone with TENS electricity over the pain site completely eliminated the problem. But within two weeks of stopping the dex (due to maximum dosage reached), the pain returned as bad as ever. I've tried two doctor-recommended anti-inflammatory creams which have had no effect whatsoever. I've tried twice/weekly acupuncture with promising initial results that unfortunately waned after about six weeks. I am now functioning only so long as I take the maximum dose of Ibuprofen (12 OTC/day), but the pain is beginning to strengthen again. A few weeks ago the ibuprofens helped enough that I could sit down using only one arm. Now I'm back to both arms needed, and descending stairs is once again a four limb activity. Two surgeons have confirmed that potential corrective surgery consists of making a small lengthwise incision in the quadriceps tendon to allow access to remove the bone spur. I'm to expect 7-10 days on crutches and 6 weeks of no stress on the quadriceps beyond normal walking. One surgeon thinks surgery for this problem is a waste of his time. He believes that stronger/more medication is the appropriate solution, and if that doesn't work I should simply live with activity limitations due to age. The other surgeon thinks surgery is a completely appropriate treatment, and is ready to do one knee at a time whenever I say the word. Unless something miraculous comes along that's as effective as the dexamathasone was, I believe surgery is in my near-term future. Other relevant knee history includes occasional problems with the "downhill hiking problem" in the right knee, where weak or unbalanced leg muscles allowed the knee cap to track out of center in its groove. This problem began at age 40 but has almost completely resolved with appropriate leg exercise. It still occurs occasionally on cold days, but I've learned to always hike with a neoprene sleeve on that knee. So long as the temperature is above 40 and I am waring the sleeve, this pain does not return. Since the inflammation limiting my activities is in the quadriceps tendons, I have some concern about making incisions right where the tendons hurt. Is it likely or possible that scar tissue from the surgery could cause any pain or limitations in the future? Is there any best guess as to the likelihood of the spurs re-forming at some point? Are there any other risks to this surgery that might make it wise to avoid it and live with limitations?
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