Patient reports

Dear Dr Beck,

Here comes my report:

I am male, born in 1964. I am 187 cm tall and weigh 88 kg.

Unfortunately, I suffer from a few diseases: I have had psoriasis for decades, which, as you know, can also affect my joints.

In August 2017, I suffered a brain haemorrhage with left-sided hemiparesis. In January 2019, I was diagnosed with advanced hemochromatosis, which also gave me diabetes and other joint problems.

Today I can walk reasonably well again (with a limp). The left leg and foot are still weak and less dexterous than before. The left arm and hand are still not usable.

My complaints in my right knee started years before my brain haemorrhage with infrequent but sudden sharp stabbing pains when walking. After a few careful movements, the pain was gone and only reappeared months later. At that time, I had not yet considered surgery.

After my brain haemorrhage, I had a poor gait pattern and due to the weakness of my left leg, the right leg was loaded more than normal. At first there were no problems with this. From summer 2019, discomfort in the knee slowly appeared, not just these stabbing sharp pains but longer lasting pain when putting weight on the knee. This continued to increase until I could hardly walk in autumn 2019 and went to see an orthopaedist. He sent me for an MRI. It showed arthrosis with grade IV cartilage damage and a defective meniscus on the inside.

The standard solution would have been a knee prosthesis. I was not enthusiastic about that and looked for alternatives. Through internet research I found Dr Beck and the possibility of a cartilage-inducing operation. After sending me the MRI pictures, Dr Beck suggested that I have this operation and also have a meniscus implant inserted. The surgery was scheduled for 06.02.2020.

The operation was normal, but revealed even more severe cartilage wear than expected. There was also discolouration in the tissue due to iron deposits caused by haemochromatosis.

The time after the operation proved to be difficult for me. Although I had bought a pair of underarm supports in advance, I could hardly walk with the supports due to my left arm paralysis and only moved in a wheelchair for the first 4 weeks. I was given a motion splint for my right leg. After 4 weeks, I was allowed to put partial weight on my right knee again and could walk a little with the help of only one right brace. This led to back pain due to the uneven load, so I continued to walk as little as possible. However, the exercise therapy on the ergometer was carried out as planned.

Slowly, the knee improved over months. After the announced 6-8 months, I was able to walk again without aids. The operation was definitely a success, because I could hardly take a step with the damaged meniscus. Unfortunately, a complete healing in the sense of a fully loadable knee did not happen.

Today, one year after the operation, I can do my daily walking workload practically pain-free (including climbing stairs to a normal extent). For a short time, I can also carry about 25 kg on my right without the knee complaining. But there is always the feeling that something is wrong with the knee, caused by very slight pains that come again and again and go away just as quickly. Afterwards, stronger strains on the knee become noticeable. I still ride the ergometer every day without strain. The movement of the knee proved to be very important for success. However, further training on the cross trainer and treadmill led to knee pain and I had to stop again.

I still limp when walking because of my left leg and always walk carefully. I can't run or jump anyway and wouldn't want to put the right knee through that either. This slight pain when walking is sometimes more frequent and then gone again, without me being able to say what it is.

For me, it is still not clear where this is leading. I find it amazing that over such a long time there is neither improvement nor deterioration. I don't have my appointment for the control MRI until 11.3.21.

I don't know if it's relevant, but I took tablets with glucosamine and chondroitin for the first 6 months after the operation. The point is debatable, but the cost was insignificant compared to the cost of the surgery. I read a lot and it sounded sensible to take such supplements if the body is to build up new cartilage. It could not do any harm.

Although my ferritin value is now in the normal range due to the treatment of haemochromatosis, typical joint inflammations in my fingers appeared. I have been taking Wobenzym for 2 months. The redness in the fingers went down considerably and I had the impression that there was also a slight improvement in the knee. I have never taken painkillers for the knee. I want to know when the knee complains.

I hope that my report helps you. Feel free to quote it in full or in excerpts.

Yours sincerely,

W. E.

Dear Ms Beck, Dr Beck,

I would like to thank you once again for making the appointment last week so smooth and uncomplicated. The accommodation and care at the Kunibertsklinik was excellent.

I survived the anaesthesia without any side effects and to my surprise the post-operative pain was also very limited, which was certainly also due to the good and continuous supply of intravenous painkillers.

Of course, I was particularly pleased with the debriefing with Dr. Beck and the fact that - as far as I understood it - the surgical goal regarding the sutured meniscus damage and the filling of the cartilage defect with the chondrofiller was achieved as planned. 

The return journey to Hamburg last Friday also went without complications. Thanks to the very generous space in the Model 3, I was able to keep my right leg fully stretched out in the rigid rail.

Back at home, I took the 12 steps to the flat with some confidence and then changed to the Össur orthosis prepared by Dr. Beck, which I have been wearing over my compression stockings ever since.

I was a bit surprised that it allows only a slight but clearly visible flexion - originally I assumed that the leg would be completely rigid at first. However, I assume that everything is correct, especially as I do not feel any pain apart from a slight pulling in the kneecap area.

At the moment, the knee area is still clearly swollen; I am trying to counteract this by elevating it and cooling it periodically. Otherwise, as discussed, complete avoidance of pressure (at most putting the foot/heel down while sitting) with walking aids, daily injection of heparin, 2-3 painkillers spread throughout the day and wearing the Össur Rebound during movement and at night.

Tomorrow I have my first appointment at 10:20 a.m. for KG at https://physio24.de/ and on Wednesday with my family doctor for a small blood count and wound check and, if necessary, stitches.

What irritates me is the fact that no one has contacted me about the IROM splint - as far as I know, it is better to start sooner than later and now 5 days have passed since the operation (including tomorrow, Monday) - should I ask again and if so, where?

That's the update from my side - if you have any hints, comments or additions, I would be happy to hear from you and remain for the time being with best regards!

C. L.