Hip OA effect on knee Chondramalacia

[Canadian-Ice]

Hi Folks,

I posted on this a while back but now I have a diagnosis.

My left knee stared feeling hot and painful about 6 months after I was diagnosed with OA in my left hip.

Over 2 years later, the knee has been diagnosed by MRI and surgeon as having Chondramalacia/Patelleo femoral syndrome.

I had it controlled with leg curls and single leg squats but could not use a bike so Dr. Galea told me to have Synvisc injections. Unfortunately he forgot to tell me until after the injections started that I would have to refrain from any of my strength program for 6-8 weeks.

That was 6 months ago. My knee is worse than ever and I can't go up and down stairs, sit in a chair, or do any strength training without making the problem worse. My knee hurts 95% of the time no matter what I do.

Eventually this condition can lead to knee replacement if not checked early.

I've tried physiotherapy. Currently seeing a Muscle Activation Therapist but helping only slightly after 4 weeks.

Does anyone have any advice or experience to share? I know this is a resurfacing site but what can anyone share?

[chuckm]

Canadian-ice, go see another orthopedic surgeon. The part where you say your knee began to feel hot and painful is peculiar. I've had five surgeries on the same knee including a microfracture procedure to the patellofemoral area due to grade four osteoarthritis. My other knee below my new BHR has mild chondromalacia. Never have my knees been hot or even warm.
Chuckm

[moe]

Canadian-Ice my situation is not exactly like yours but I'll relay my experience. Last winter my knee started to get stiff and I didn't listen to it and kept cycling and eventually I ended up where you are now. Constant pain, swelling, couldn't bend my knee whatsoever and was basically walking around like a pirate with a peg leg. I also had an MRI and was diagnosed with quad petalla tendonitis with some chondromalacia. I refused the synvisc because of side effects and evidence that they don't work and make things worse. My research shows that the more proper term is tendonosis.

What worked for me was complete rest, no bending or cycling or any activity that hurt. After a month of that I resumed very mild activity being careful to avoid any pain producing movement. I also greatly increased supplements, especially Vit D and Magnesium. Eccentric exercise has also proven effective. Ice did not help me much but warm epsom salt (magnesium sulfate) compresses did. All this was over a period of 8 months.

Edit, I also started Glucosamine Chondroitin MSM supplements. Also use an rub called Blu-Emu, and Epsom Salt lotion by Morton.


At this point I am much better, at 95% and back to full activity. I never thought I would get to his point.

Hope this helps, moe

[Canadian-Ice]

Thank you both,

I do have a pretty firm diagnosis by several OS's and MRI that this is chondramalacia/PFS. It is not super painful, but just enough to keep me from doing anything safely.

I try to limit daily activities that aggravate it, but find that is nearly impossible. Slide down stairs, sit up with hand assistance, etc. But I'll give an extra effort.

I am trying super slow 30 second rep squats prescribed by a muscle therapist. We'll see if super diligence with that will work.

Hope something does.

[hernanu]

My daughter had this when she was twelve and doing lots of dance, soccer, basketball. In her case it was also called "growing pains".

The pain grew until she couldn't keep doing her activities and affected her daily. The treatment was to stop all other activity and go to a physical therapist who worked three to four times per week with her to strengthen her muscles.

The proposed cause was a muscular imbalance that was causing the sliding of the kneecap to be pushed to one side by muscles that were much stronger than the other side. Since the kneecap floats over a groove, the deviation to one side was causing inflammation and pain.

After about two months (or maybe three) of dedicated PT work, she was in good shape and didn't have a recurrence. She did keep her exercises up, since her muscles on the outside of her legs were much more challenged than the inside muscles.

She still dances at 21 for her college dance troupe and has not had any issues since. So in that case, and maybe in yours, concerted PT by a therapist that knows the problem and can work it may help greatly.

[whyme]

Hi Canadian-Ice,
I've had Chondromalacia / Patello Femoral Syndrome, not sure if that's the norm but in my case it's about the knee cap moving too much laterally when bending the knee (because the groove is too shallow), therefore rubbing against the bone cartilage and producing inflammation and pain.

For me it started in my teens, and it went on and off for quite a few years, and examined by quite a few doctors / physios as well. Nothing seemed to fix it.
As Hernanu explains, an adequate exercise program to stabilize the knee (both in terms of strength and resolve the muscular inbalance) will help to "fix" the knee more in place.

It's crucial to stop first the activities that exacerbate or produce the symptoms, then gain that strength and muscular balance gradually. For me one of the keys was that the leg strengthening exercises (mainly leg curls and leg extensions with weights) must be done with LOW angles.
The reason is, if you bend the knee more than 30-45 degrees under strain, the knee cap will be displaced and you're rubbing at the same time you gain strength, and it won't work.

I did leg curls at no more than 90 degrees, and leg extensions at 30-45 degrees. Eventually, once you gain lots of strength, you can do squats or leg press, but up to 45 degrees or so.

I couldn't run for years for this reason. Eventually, I have done 2 marathons (until the hip stopped me!).

Good luck, let us know how it goes...

[Canadian-Ice]

Thanks, that really is encouraging to know that recovery is possible even after a long time.a

Its very hard to rest adequately when so many things can aggravate it. Im at a hotel in downtown Montreal this weekend and went across the street to the YMCA to workout and do hip PT and super slow squats. But you know what? Turns out to be full of stairs. Kept it to a minimum, but ouch!

Seems like the land mines are everywhere.

Especially when people around aren't exactly understanding of an athletic looking guy protecting his knee like an invalid.

Since PT has worked so well, maybe it would be worth giving that a try. I'll try to fund the best.

Thanks guys. Your suggestions and stories help.

[hernanu]

Maybe let your PT know about the issue and they can add some exercises to help.