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This submission came via email from Marilyn Bates, a Mayo Clinic patient.
Bulbs crack the soil as sleet clears from Pittsburgh streets. Spring is almost here or so I think. Not so in Rochester, Minnesota, where my sister and I journey along I-90 to the Mayo Clinic. Here, plains are snow-swept and box elders border an occasional farm, the landscape stark and icy.
Procedures performed at the Clinic are often above and beyond those achieved at other medical establishments. Physicians there are not afraid to undo medical mistakes made by others. I am looking for a solution to my dilemma of coping with a missing left kneecap.
Previously, I suffered a broken kneecap (patella) in a fall in my driveway. The physician who initially mended my knee removed the patella entirely because it was fractured in five pieces. Regrettably, the inevitable happened. When walking down steps, my knee collapsed, my leg buckling, unable to bear weight. In the process, I damaged the tendon that held the knee together. I broke both elbows in falls over the next few months as the knee collapsed regularly. The only advice I could receive from local physicians was to use a walker and wear a rigid brace that required both hands to release it when bending into cars or sitting down. It was life-altering and made living autonomously impossible.
Simply stated, the kneecap is central to walking because it acts as a fulcrum when leg bones move from a fully straight leg to a bent knee. The powerful quadriceps muscle (thigh muscle) inserts into the upper surface of the kneecap. When contracted, it pulls on the patellar tendon to straighten or flex the knee joint.
Most people think a missing kneecap can be mended with knee-replacement surgery -– not so. Metal parts, used in knee replacement surgery, cannot be substituted for a kneecap which is a bone attached to living tissue. This complex extensor mechanism can be replaced but only with a “transplant” from a cadaver, called an allograft.
My appointment in the Orthopedics Department at Mayo was late in the day. We’d been keeping an eye on the weather for days, hearing of snow storms to the south in Wisconsin, watching the skies warily from the 14th Floor of the Gonda Building.
The Mayo culture is conservative. Everyone is professionally attired with neat haircuts -– no ostentatious jewelry, facial hair or earrings. Even the pharmacists in St. Marys Hospital wear suits and ties.
Like all Mayo personnel, the young resident who initially interviewed me wore an elegantly understated suit. He was extremely friendly as he recorded my medical history -– heart by-pass surgery, back surgery, a popiteal bypass in my left leg, breast cancer and most foreboding of all, 60 years of diabetes. Trying to minimize my anxiety as I showed him my leg, he remarked, “Nice lined slacks for the winter weather.“ I chuckled, “Only someone of your sartorial splendor would recognize the lining.” We all laughed.
“Dr. Pagnano will be in to see you shortly,” he said. “I know what he is going to say, but I’ll let him tell you.” My sister and I sat in silence, wondering what his remark meant. Was Dr. Pagnano going to give me the bad news -– that my medical history rendered me unfixable? Experiences in the past led me to see myself as a “broken person” who was better off “patched” with paraphernalia and assistive devices than subjected to additional assaults on the body. Inferentially, I was a risk to the surgeon’s reputation.
Dr. Pagnano entered the exam room with an entourage of physicians and his Physician’s Assistant, Pat Taylor. After asking a few questions and seeing me walk, he described an involved surgery called an extensor mechanism repair using an allograft, which is another name for a cadaver kneecap and tendon. During the operation, I would receive a new patella tendon, using a cadaver’s achilles tendon which would be connected to my shin bone. The tendon would be tunneled upward and implanted in my quadriceps muscle. The kneecap replacement was really like putting together a puzzle -– selecting a cadaver kneecap that was suitably sized to my anatomy and etching the piece to “click” in place under maximal pressure. Then the leg would be encased in a formidable toe-to-upper-thigh cast until it healed, 6 to 8 weeks later. After, a brace is worn for another six weeks as my knee acclimates to a 90 degree bend. And then he paused.
A long period of silence elapsed before I realized he was waiting for me to respond. I didn’t understand that he was actually offering this operation to me because it sounded so radical and no one in the Pittsburgh area ever suggested it.
Finally, I realized it was my turn to speak and asked in disbelief, “You mean you would actually do this for me?”
And he responded simply, “Yes.”
After the operation, enduring the cast was rigorous because I could do very little unassisted, but I kept telling myself all that mattered was that I had received a new knee and would one day walk. I kept saying, “You can do this.”
Mine was a good tenure at Mayo, which included a wonderful woman at Samaritan Bethany residence, where I rehabbed. Her name was, “Comfort.” She helped me during the long nights when sleep was impossible. Terms that I use when telling others of Dr. Pagnano are that he was brilliant and fearless because he knew he could “fix me,” and wasn’t afraid to proceed. He made me feel that I deserved to have a better life, unlike others who viewed me only in terms of my physical risks. Compassion was the true healer in my experience at Mayo -– one person’s reaching out to lift a little of the suffering of another.
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Another wonderful Mayo story!!!! I wonder how a NATIONAL HEALTH CARE PLAN will affect all that Mayo has done and what will Mayo be able to do in the future to continue to bring this care to the world. I am concerned and all should be !!!!!!!
Why was this surgery so unusual? Are cadevars not usually used in joint replacement? Or was it the other health issues that made this so unique?
No, cadavers are not used in joint replacement. They are usually artificial parts made of metal and plastic. (I am a Surgery nurse) I have 2 bad patellas that the cartilage is worn away and was told that just a knee cap replacement does not do well. I thought I would check the internet and see if there was a possibility of a cadaver replacement. I was not told of that option. I will now talk to my Dr about it and I am sure it is only done at select hospitals as Mayo. goodf luck to you , i am interested in your progress
Hi Mary – I’m interested to know what the Dr’s suggested as options for you, with two bad patella’s. My Mom is also trying to find info. on her options, she has one patella that has worn away to about a half the size of her ‘normal’ patella. She has arthritis in both knees. The Dr. we saw seemed to think there may not be enough bone to ‘resurface’ and add some patella prosthesis. He also was not too enthusiastic sounding about patella replacement. Just wondering what your other options are? Thanks.
Mayo Clinic is obviously proud to have been pointed out as an example of providing health care with better outcomes at lower cost, one for our nation to learn from.
On Mayo Clinic’s website:
“Obama cites Mayo Clinic in advance of White House Conversation on Health Care
“In an exclusive interview with Diane Sawyer on ABC’s Good Morning America President Obama continued to point to Mayo Clinic as an example of health care that delivers better outcomes at lower cost. The interview precedes a town hall meeting on health care reform being held at the White House on June 24, 2009. Responding to a question about whether Americans will need to make do with fewer tests and procedures in the future, President Obama commented, “I think what’s important is to say to the American People that you should get the best possible care to make you well. And that the measure of the quality of care is not quantity, but whether or not it is making you better. Now, what we’ve seen is that there’s some communities and some health systems that do this very well. Mayo Clinic, a classic example. In Rochester, Minnesota. People go there. They– spend about 20-30 percent less than some other parts of the country, and yet have better outcomes.”
I HAVE ALMOST ALL OF THE SAME PROBLEMS EXCLUDING DIABETES AND INCLUDING A STAPH INFECTION THAT REQUIRED THE REMOVAL OF MY AFFECTED SHATTERED PATELLA. THE INFECTION IS GONE BUT AFTER 8 SURGERIES THE TISSUE LEFT CANNOT SUCCESSFULLY BE CLOSED OVER THE ARTIFICIAL KNEE, AT LEAST NOT BY DR.H. FINN IN CHICAGO.IL. HE DID NOT FEEL A CADAVER KNEECAP WOULD WORK…I AM EXTATIC TO HEAR THERE IS A DOCTOR THAT CAN ACHIEVE THIS.
I normally bounce all over the ‘net because I have the tendancy to read too much (which isn’t always a good thing because the majority of sites just copy from each other) but I have to say that yours contains some great substance! Thanks for stopping the trend of just being another copycat site!
I read what Ms Bates had to say about her knee and it gives me hope. I have been fighting with a knee problem for 3 years. I have seen 10 doctors and they are clueless what is wrong with my knee. My last doctor mentioned that I need to come to Mayo. I am so looking forward to finally finding out what is wrong with me and to get this fixed.
After a number of revisions to my original knee replacement, an ifection in that same knee, an explantation for 3 months (requiring total immobilization and no weight bearing for the 3 months) and a re-implant with a hinged knee, I fell when my knee buckled and broke my kneecap several months later.. I now have an active Baker’s cyst behind my knee and require it be drained quite frequently. My pain is not only constant, but often excruciating — in my knee and thigh. I have oxycontin and oxycodone, but they do little or nothing. I cannot use NSAIDS due to ulcer issues. Elevation of my leg doesn’t do much other than keep the cyst from draining into my calf and sometimes slightly relieves my pain. My orthopedist is frustrated — doesn’t want to “go in there” again. I feel pretty much useless and dependent on others to a ridiculous point. I still haven’t givien up hope that somewhere, somehow there’s an answer. In the meantime, my derrier seems to be expanding at an exponentioal rate as I spend more time on it.
I had a total knee replacement in January and am still not able to bend my leg. I have been told that my body builds scar tissue and this is what is preventing me from using my knee properly. I have had 4 manipulations and my leg has been cast 5 times I even had orthoscopic sergy in August to remove the scar tissue. My leg is at 90% on the bend and 10 in being streight. Is there any hope for me as I havebeen in constant pain since Jan 25th…Please Help
I had a total knee on October 9, 2009. I have also been unable to bend my knee or walk on it without severe pain. I had the M.E.L.I.S.A. blood test and found out that I am allergic to the allumin in the device. I have been trying to get an appointment with the orthopedic clinic but they turned me down, I think I answered some of the yes,, no questions wrong. I am too young to be crippled. Any suggestions on how I can get someone from the clinic too see me? Frantic in Kansas City, Karen Cullison
What is the risk of getting an infection in a hip – or knee-replacement operation? Is it one out of 100 operations? more?less?
gah, nothing on your site is loading fast for me. I click something and it just waits for around 20 seconds, then my anti virus thing pops up and says there’s a threat and asks if I want to continue. Anyone else getting this or do I just have a crappy antivirus?
Dear Ms. Bates,
I am in very similar shoes and am wondering two things… 1. How old are you? and 2. How are you doing now?
I also suffered a very severe patella fracture and have gone through 4 knee surgeries over the last 6 years. I now have a patella femoral knee replacement that has started to fail. I work as an Orhtopaedic nurse for a very large group of surgeons in Jacksonville Florida. I have showed your story to my surgeon/boss and he is very interested in your story, and especially the two questions stated above. I would love to have a chance to “pick” your brain, as I am also looking to have my life restored. I hope this post finds you well, and I look forward to your response. Sincerely…Tammy
I crushed my right shoulder about 4 years ago washing windows. Now I have had it put back together which didn’t work, then I went to the Shoulder Clinic in Boise, Id and it was suppose to be the best in the northwest. They put a partial replacment in and attatched the rotator cuff. Well when I went for one of my last appts. it had come loose and they basically told me-Goodby and gave me a t shirt. Now I can’t lift my arm above my shoulder and it is killing me all the time. There is tons of pain. My daughter has been to the mayo in AZ and sings its praises. My two daughters asked in AZ about me and they said I should go to Rochester , that it had the best doctors. Do you think you could help me? I am desperate now.
April, to schedule an appointment at our Rochester, Minn. campus, please call 507-284-2511.
I am scheduled to have double knee replacement on Nov.8 2011 by a Dr Kirk Kindfatter at Orthepedic Center of the Rockies in Ft. Colins ,Co. I’m not sure if this is the best for me. When I had my appointment with the Dr., I had to wait over 2 hours to see him after driving for 125 miles. He looked at my x-rays and said both knees were bad. He showed me the replacement parts and asked me if I had any questions. I could’nt think at that time. He examied my legs, twisting and turning them and then left the room. I am 71 year old women and in basic good health, short of walking up stairs, draging my feet at times and falling. I have a bakers cyst behind both knees. I have been told by my local Dr. that the cysts are not bad. Right now my knees only ache, not really hurting like they had been. It seems like the hurt comes and goes. The worst part, st times, is not sleeping well as I have very restless legs. Everyone is telling me that I should’nt have both knees done at the same time, but the Dr. said I should because Medicare likes when it is done at the same time. Dr. said I would be in the Hospital 3 days and that I would be in a rehab place for 10 to 14 days. My problem is should I have a second opinion or just go with this Dr. in Fort Collins? I am supposed to have a pre-op appointment Oct. 20, 2011. Where can I get my questioned answered? Most people that have had knee replacement tell me it will improve my life, but do one then the other. Please respond. Thanks I really do need some guideance. Thank you.
We have received your question and are looking into an answer.
I know it has been a year since you posted this question, but i am 49 and have been told i need 2 knee replacements but they will not do both of them at the same time because the risk of too much blood loss is likely. please do not let them do two knees at once. thank you and good luck!!!
IS IT BETTER TO HAVE A KNEE REPLACEMENT OR A MINIMAILY INVASIVE.I AM 87 YRS OLD.??????
Hello – Can you please let me know how to go about making an appointment with Dr. Pagnano? What is the process; are we able send in reports, x-rays, etc. if we live afar (NE Pennsylvania) and have an initial phone appointment prior to traveling to Minnesota?
I suffered a shattered patella in an automobile accident when I was 19, now 43. Patella was pinned together in 3 pieces and now disintegrating. “Patella” (scar tissue) grew together very long and thin and a TKR or patellofemoral replacement both pose the threat of re-shattering patella from the components.
Thank you in advance, Wendy
Your questions have been referred to Dr. Pagnano’s office.
Is there an orthopedic surgeon at the Jacksonville Mayo Clinc that can fix my knee , since I am allergic to metal, including titanium? My Dr. here in Ft. Myers says there is nothing he can do because the knee replacement surgery would be too risky because of my metal allergy. My pain is worsening and my mobility is bad. This is controlling my life and I wonder what will happen to me. I am only 62. Can this type of surgery be done using cadaver parts? Help….
Ms. Lepola, please contact our Orthopedic Surgery Department, at Mayo Clinic in Jacksonville Florida. Contact information can be found at:
http://www.mayoclinic.org/knee-replacement/jaxtreatment.html
Over a year ago my mom had a knee replacement ever since she hasn’t been able to walk because a nerve was damage during the surgery. Her knee is always swollen and test have been done and the metal part is ok. THIS WAS NOT AT MAYO CLINIC! Is there anything at Mayo Clinic that can be done to replace this damage? Before surgery she was not assited by a walker or any of these devices, now she is. Please help!
We have referred your question for a reply.
My mom has had a series of issues with her knees. She has had several knee replacements in the past years and never had a normal recuperation. Both of her knees have been replaced multiple times. In November she was hospitalized with staff infection in her left leg. Her artificial joint was removed along with a large portion of her thigh bone that was infected. She had a hickman catheter for anit-biotics. The infection moved to her right leg. That artifical joint was removed as well. The infection wasn’t as bad in the right, so a replacement knee was put in immediately. Then the infection moved back to the left lef, which is still without a knee. She has been in patient (either in the hosptial or a rehab facility) since the day before Thanksiving and goes from one complication to another. There is lots of other history on this, but is this something that could be addressed at Mayo? We are at the end of our rope. Thank you.
We are you checking on this for you.
Bueno ante todo un coordial saludo mi nombre es Pablo López G. soy de Perú bueno motivo por el cual les escribo es por que tengo a mia madre (54 años) muy adolorida le detectaron artrosis en la rodilla y osteopenia en la columna la verdad me preocupa mucho su salud ya que la veo muy deprimida por los dolores que tien y quisiera saber que tipo de tratamiento podria hacer ella para mejorar a ella le inyectaron hace un poco más de 1 año un liquido llamado Maxiostenil el cual dicen que es un lubricador con el cual disminuyo un poco el dolor pero no se calmo la verdad me gustaria saber si ella lo que necesita alguna operación (artoplastia,artoscopia,ect) o que tipo de tratamiento pero uqe sea segura ya que me preocupa mucho que no salga bien y que tengamos que tengamos que afrontar mas gasto la verdad somos de condicion humilde y no tendriamos como costear otros gastos por eso me veo en la necesidad de ahorrar dinero y juntar para la operacion para que ella pueda tener una vida normal y si ustedes saben de algún especialista en ARTROSIS en mi país( PERÚ ) me lo recomendaran porfavor le agradeceria infinitamente bueno me despido esperando su respuesta gracias y que DIOS los bendiga .
atte.Pablo López G.
Buenas tardes, Pablo, y gracias por sus comentarios. Lo siento que su madre esta sufriendo de este problema con su rodilla. Desafortunadamente, no le podemos ofrecer una recomendacion por este medio de comunicacion. Generalmente, un ortopedista tendria que revisar radiografias de las rodillas y hacer un examen fisico para poder proveer un diagnostico. Muchas veces, ciertas especialidades medicas, como Ortopedia, tienen asociaciónes nacionales que mantienen listas de cirujanos. Gracias por su pregunta y esperamos que su madre encuentra la mejor atención médica.
Very interesting info !Perfect just what I was searching for!
Ms. Bates,
I had a knee replacement and immediately afterwards I fell on it and shattered my patella. The surgeon said that he could not repair it because there was no longer anything to attach it to. I walk with a walker and brace as you did. So, I am just wondering if the type of surgery you had could be effectively performed in my situation.
Nancy