It’s a long title, but it is a long diagnosis: psoriatic arthritis (which I’d never heard of before August last year) and Osteoarthritis in my knees and hips, as well as a living with the result of a botched LARS ligament procedure (which should have been simple) by an orthopedic surgeon after a ski accident. This is the story of my botched knee operation.
I tore my ACL (anterior cruciate ligament) when I fell skiing at High Noon in Thredbo. It didn’t hurt much at the time so I started to try to ski, and then it hurt. I tried to edge my way down the hill but after 45 minutes to get 100 metres down the hill I called my husband and said “I’ve had a fall and might need some help getting down”. He was by myside in 10 minutes and was helping me get down the hill, when the beautiful Susie from Ski Patrol came and got me the “bucket” to take me to the medical centre. They x-rayed me and told me I’d torn my ACL but it was easily fixed traditionally but took a year to recover or I could go to the “fantastic orthopedic surgeon, Dr Craig Waller. He does this amazing new procedure with a LARS ligament and you’ll be back up on the snow in time for the end of the season. The other surgeons will try to persuage you to have traditional reconstruction with a hamstring, but the LARS ligament is the one the athletes get done and they are back 100% in six weeks.” I believed them and booked the appointment at St Vincents Private Clinic, and was give a full sales pitch on the LARS procedure.
What is LARS ligment?
According to Lars.com.au:
“A LARS ligament is intended for the intra or extra-articular reconstruction of ruptured ligaments, designed to mimic the normal anatomic ligament fibers. The intra-articular longitudinal fibres resist fatigue and allow fibroblastic ingrowth, the extra-articular woven fibres provide strength and resistance to elongation.
A LARS ligament can be used in conjunction with the remnants of the ruptured ligament, or as reinforcement of an autologous reconstruction. In both cases, LARS ligaments allow the original ligament tissues to heal during the immediate post-operative period*, when an excess of traction would otherwise elongate the tissue.
A LARS ligament can be used for extra-articular reconstructions intendon repairs such as Achilles tendon, patella tendon, biceps tendon, rotator cuff etc… Other repairs can be envisaged as tumours surgery.”
*I was later told by Professor Leo Pinczewski this cannot happen with an ACL. It cannot repair itself.
So I was excited and booked in my surgery $3K later even with insurance (op 1), with which my parents-in-law helped. I remember the day I went in, I said “so guys, you must be busy this time of the year with skiing injuries” and the anaesthetist replied “yeah we are in double figures today”. It was a lighthearted exchange that I later realised was a red flag. I did feel uneasy but then I was unconscious.
When I came to, I was so sick. I was sick the whole way home, but then went to sleep. The next day I was so swollen. Over the next few weeks the swelling didn’t go down. On the 6th day I was sitting on my desk and my knee locked. It was agonising. I fell on the floor unable to straighten my knee. After I wiggled it around I was able to move again, but it felt wrong and kept locking up.
At the physiotherapist, which I was religious about, I worked so hard, and the knee kept swelling. I even went to another physiotherapist who diagnosed damage to the hoffa’s fat pad. I don’t even know what that is.
Over the next 6 months my knee kept locking and I kept going to my follow-up appointments with Dr Craig Waller who would drain the swellling which made the knee hurt more. He said the pain is normal and to keep up my rehab and “you’ll rehab out of it”. Finally I was on the phone and begged the receptionist to book in an urgent appointment as I couldn’t live with the pain and Dr Craig Waller finally ordered x-rays, after 6 months of agony. From the moment I saw the x-ray I felt vindicated. There was a whopping great titanium screw lodged behind my patella (knee cap). It was supposed to hold down the bottom part of the ACL LARS. Instead, the screw had pulled up out of the tunnel in the bone dislodging the ACL and causing my knee to lock. I remember watching the Dr Waller’s face go white. He’s made me do physiotherapy for 6 months with a screw behind my knee cap. I’d been through agonising pain because of his shoddy handiwork.
I booked in for surgery immediately and the screw removed the next day (op 2). Dr Waller claimed that he’d replace the screw and everything was back of on track. Little did I know the story of my knee was just getting started. I went home, not as sick this time as I told the doctors to pump me full of anti-nausea drugs. I was booking myself back into physio. The problem was my knee just wasn’t right. I remember in Christmas night going up to Manly Hospital for an x-ray because my knee was so painful, and there was only the top screw. Dr Waller had not replaced the screw in my tibia, so the ligment was loose. I called him after the break and he said, “Oh I used a disolving screw”. It just didn’t sit well with me. My knee was as swollen as ever and I cut back on physio due to the pain. I asked for my x-rays and Dr Waller said the hospital had them and the hospital said Dr Waller had them.
I decided to get a second opinion, this time from North Shore Orthopedics, and the new surgeon, Dr Sam Sorrenti, who was horrified, but not surprised by my MRI scans and x-rays. Apparently he has seen a lot of Dr Waller’s previous patients with the same or similar problems. Artificial anything is not like living tissue and so has a finite life. The LARS cannot replace a peice of living tissue such as an allograft or hamstring graft. The LARS had been damaged by the wayward screw and was acting as an exfoliant (like steel wool but plastic) in the joint and had worn down the cartilage in the media compartment, and some areas were Grade IV (bone on bone). The back of the knee cap was also a mess. Because the Dr Sorrenti felt sorry for me he did a “tidy up” procedure (op 3) as in intermediate procedure, so I could decide what to do. I could have the LARS removed, fill the enormous holes left behind with donor grafts and then have another ACL construction.
I waiting for a bit to see it the clean up would help. I was still in excruciating pain when I walked or exercised. I joined the Outpatient Clinic at Royal Northshore Clinic, and met with a dietician and physio who both were very helpful. Lose weight, wear a brace, use a stick. Anything to take weight of the joint. I failed in the weightloss area, because I was eating out of comfort to ease the pain but using a stick and wearing the brace helped.
Finally I made an appointmet with Professor Leo Pinczewski as Sam Sorrenti was now working in the area of stem cell therapy, and no Ididn’t go down that path. Professor Leo Pinczewski ordered new in-depth MRIs and basically told me he needed to take out the LARS ligament and fill the holes and them look again once done to see if I needed a reconstruction. $6000 later I was LARS ligament free and full of donor bone (op 4). He pointed out the Dr Waller’s angles and circumference of the holes weren’t right, and that he’d started drilling one hole in the wrong place, it was on the video of the procedure. Still it felt good to have the plastic out of my body and the grating in the joint stopped.
As suggested I went back to Professor Leo Pinczewski a few months later and after new MRI scans he told me that there was no point having an ACL reconstruction because the damage to my knee was now grade IV chondromalicia, in the medial compartment, so I was walking bone on bone. There was no process that would help it either because it was also grade III (now grade IV) on the other side. The only option was a knee replacement.
The Knee replacement Dilemma
When a number of doctors told me I needed a total knee replacement I thought “oh well at least that will mean I can be more mobile and pain free”. Except knee replacements, like any artificial prothesis, only has a 10 – 15 year life span and secondary replacments are not always “successful”. I was 45 when they first told me.
Booking in with the forth expert orthopedic surgeon, he said that he would book me in to be seen by a panel of experts, 12 of them at Hornsby Hospital, to assess the risks versus benefits of having a replacement “so young”. They all agree that it isn’t fair for me to be in pain or on pain medication until I am 60, the recommended age for replacements. But they were all worried that it would fail. The ultimate concensus was that the surgeon should do it, but next year once my health insurance waiting period is up. It is further complicated by the fact that I have Psoriatic Arthritis (which I will outline in another story) so my joints are degenerating father than a normal person anyway.
So now while I wait, I’m trying to lose weight, I’m trying to stay active. I take turmeric, fish oil, chondroitin and a bunch of other vitamins and herbs that may or may not do anything. I feel embarrassed walking with a stick. When I park my car I get routinely told off by well-meaning members of the public for parking in a disabled space (I don’t look disabled enough), despite having a sticker on my windscreen that allows me to. I have the conversation about why I have a stick, on a regular basis, so I decided to write it down in this story.
Lessons Learned?
Research the surgeon. I have since heard terrible things about Dr Craig Waller, and only glowing reviews about North Shore Orthopedics. Research the procedure. Be conservative. Go with the mainstream treatment. There are no short cuts to surgery. Do not get a LARS ligment. Ever.
Wait until you have a clear picture of the damage caused by a surgeon before discussing compensation. Dr Waller got out of it cheaply, and I had to sign away my future right to conpensation. I also had toaccept he wasn’t going to accept any blame for the procedure and the compensation was “out of concern” for me. I asked him why he didn’t order an x-ray earlier, to which he replied “you weren’t acting like a woman in enough pain to have a dislodged screw”. I literally wanted to reach across the table slap him and his smugness.
Anyway, I will get my new knee and hopefully the pain in my knee will be rbetter and I can get back to a more normal life. I know I’m not in a wheelchair or significantly disabled as much as some, but being in pain every day and not being able to walk far without pain isn’t fun and I wanted to write a cautionary tale for future ACL reconstruction patients when weighing up their options. Stay active, watch your weight, don’t comfort eat. If it doesn’t feel right, get a second opinion. Trust your instincts. Don’t rush into any surgery.
