WC had his second knee surgery on October 6. This report probably tells you more about it than you wanted to know, and be warned that it does get a little gruesome. But here’s what was done and why.
As WC previously reported, his orthopedic surgeon’s diagnosis was that the articular cartilage on the back of WC’s knee cap had failed, that some or all of it had worn away, creating a bone on bone (well, bone on stainless steel) friction. That led to the discomfort and swelling WC was experiencing. The treatment was to surgically replace the worn or missing articular cartridge with an artificial steel and plastic appliance.
The surgery was finally performed February 6. What the orthopedic surgeon found was pretty much what he had diagnosed in advance:
There was the damage to the lateral patellar facet of the femoral component. This was a potential candidate for the cause of his pain. The patella itself had full-thickness cartilage loss on several areas of the patella with overgrowth of the lateral patellar facet.
To translate that from acute medicalese to English, a brief anatomy lesson.
The right image, the posterior surface of the patella, shows two articular cartilages, the Medial Facet and the Lateral Facet. The surgeon found significant damage to lateral Facet, areas where it had been entirely worn away (“full thickness cartilage loss”).
To place an articifical articular surface, the surgeon removed (“resected”) the entire back of the patella, grinding and cutting away all of the cartilage and the bone that separates the two facets, creating a smooth surface. Onto that smooth surface he grafted a 36mm, circular metal plate. The instruction manual for all this available on line. It’s just as well WC didn’t find that manual before his earlier, total knee replacement.1 Here’s an image from that instruction manual, showing how the metal plate is attached to the back of the patella.
It’s not surprising that the tendons above and below WC’s patella are extremely sore right now. The specific fake cartilage now attached to the back of WC’s patella is a Patella Symmetric Size S36 10mm Metal-Backed Triathlon Model 5556-L-360. So now you know.
Recovery is uncomfortable but mostly tedious. After the wound is sufficiently healed, about 7 – 10 days, physical therapy will start. WC can hardly wait. PT is painful, but at least you get to do something. The early recovery protocol requires icing the knee most of the day. Ice machines are a big improvement over bags of ice, but chain you to the machine for hours at a time. WC is already bored out of his skull.
It’s months too early to tell if the knee problems are resolved. It would be very nice to be able to hike again.
WC will keep readers posted.
1 The installation of the Total Knee Replacement back in August 2022 turns out to be an issue of hammer and nails. Well, one nail anyway.
The “Keel Punch” is extracted – the handle at the lower right turns out to be a lever like a wine bottle cork remover – after the hole for the lower half of the fake knee was created, but still.
Wickersham's Conscience 
Congratulations on successful surgery. I hope the recovery goes smoothly.
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Just think! Our grandparents didn’t have the option of undergoing these procedures. Only the option of being confined to a rocking chair on the porch, or in the living room if the weather was bad.
As another veteran of multiple joint replacements, I wish WC rapid and complete recovery (although “rapid” and “complete” in this context are relative terms).
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another recipient of TKR here (both knees). It is absolutely stunning how the medical procedures have advanced yet remained barbaric, hammer, grinders and nails, OhMy! Like WC I was glad to be ignorant of the procedure going in. I have memories of groggily waking up with someone pounding on my leg and the last thing I heard was “he’s awake”.
Technology sufficiently advanced is indistinguishable from magic. May your recovery be magical.
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