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Believe it or not, I've actually become extremely limited because of kneecap arthritis of all things. I've tried exercises and various braces and splints. Nothing seems to help. Is there anything else that can be done?

Your condition is called isolated patellofemoral arthritis. This means the arthritic changes are confined to the patellofemoral joint rather than throughout the entire knee. The patellofemoral joint is located where the patella (kneecap) fits into a groove at the bottom of the femur (thigh bone).

In the normal knee, the patella moves up and down over the femur. The groove guides the movement and keeps the patella along the right track. The back of the patella is covered by smooth articular cartilage to protect the joint and make movement easier.

Arthritis can cause pits, holes, and tears in this cartilage. The patient with severe patellofemoral joint arthritis has pain and swelling that limits function resulting in disability. Early treatment with antiinflammatory drugs, exercise, and activity modification does help. If you've tried these without success, you may be a good candidate for surgery.

Several different operations can be done to treat degenerative patellofemoral joint disease. Sometimes the back of the patella is shaved and smoothed off. If this doesn't work or the damage is too much, then the patella can be removed.

The patella can also be removed and replaced with a patellar replacement. This type of implant is favored by surgeons for young, active patients. It also works well for older adults who may need a total knee replacement later.

Your next step is to make a follow-up appointment with an orthopedic surgeon. Take a record of what you've done so far and the time frame. This will help you and the doctor decide what course of treatment is best.

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