Advice/Help needed on TKR

[Max]

Hi,

**I have had arthritis in my right knee since about the age of 21 (I am 29 now) which involves a massive amount of fluid on the joint.
**This initially shifted with cortisone injections and for a while Methotrexate (I have also had an arthroscopy and a Synovectomy) Both these methods started having less and less affect and for the past year to 18 months I have had fluid constantly on my joint.
**As a result the cartilage has basically completely gone and I have the bone on bone situation going on which is getting more and more unbearable as is the ugly limp I have aquired due to my inability to bend or flex my joint properly.

That is my background and I have had TKR mentioned to me by my consultant (even though I and he recognise I am quite young for this to be considered) but would like to get some first hand answers to a couple of questions as my consultant does a good job of skirting round the issues!

* Is constant and plentiful swelling/fluid on the joint a common trait for you giuys and if so have you found any ways of controlling/dealing with it? (as an idea my right knee is about 3 inches more in circumference than my normal left knee)

* If I was to have a TKR would this mean the swelling of the joint would go and not return? This is one of the main reasons for not being able to fully move the joint as if I bend past a certain point it feels like the joint is going to explode!

*The muscles in my upper thigh and my calf have noticeable got smaller obviously due to the incomplete movement of the knee joint meaning they dont get used. Would a TKR mean I would be able to move my knee joint to the degree that I would be able to rebuild these?

Hopefully I havent bored you all to death with this I am just so relived to have found a site where it seems like I can get normal everyday responses from people in a similar situation. Thanks for any advice/knowledge you can give me!

Max

 

[Max Wallace]

Welcome Max I am also Max

I injured both of my knees during and shortly after high school over the years I had 3 surgeries on the right one and 2 on the left one. I experienced the typy of swelling only on the right knee the left knee always appeared normal. Both knees gave me constant pain and through the years the range of motion decreased dramatically on both. At 35 I was told that they were both bone on bone and that I needed BI-TKR but I needed to wait as long as possible. My range of motion bottomed out at around 100 passive on both knees I had a limp but not one that was very noticable and I did not have to use a cane or any aid to walk. I was able to put off surgery 11 years, I am now 5 months post op and my passive ROM is 110-115 the PT can stretch to 130.

The swelling will go away.

Your muscles can regenerate.

you can walk again without a limp.

At 5 months post op I now walk with no limp or pain, I still have slight pain on stairs. I have no swelling on either knee. I coach a T ball team, Golf, Bowl, Cycle, Hunt etc. This surgery can give you your life back, all of the things I just mentioned were not possible pre-surgery.

Max in Memphis

 

[Jamie]

Hi (new) Max!!! So glad you found us here at BoneSmart!! Our forum nurse, Josephine, will check in with you in a while and offer her expert opinion. But in the meantime I can tell you we have had a number of forum members who are in their 20's and who benefited from their knee replacements. If you think about it, why in the world would you want to waste these good years in your life when you could replace the joints and move on? The key to success will be finding an excellent surgeon with a good track record who does MANY, MANY knee replacements. Then you put yourself in their competent hands and go for it. Here is a link to a guide that will help you with some questions to ask as you interview one or more surgeons:

https://bonesmart.org/hip/how-to-choose-a-hip-or-knee-replacement-surgeon-and-prosthesis/

Good luck to you and feel free to post any time you want with questions or concerns....or just to say hi!

 

[Josephine]

* Is constant and plentiful swelling/fluid on the joint a common trait for you giuys and if so have you found any ways of controlling/dealing with it?

It is an indication of acute inflammation and degeneration in the joint. There's no successfuly way of dealing with it other than a TKR. All the other things you mentioned - injections and synovectomy - are just attempts to put off the inevitable but, as you have found, they don't work!

* If I was to have a TKR would this mean the swelling of the joint would go and not return?

It will go and not return unless you developed a new problem althogether.

*The muscles in my upper thigh and my calf have noticeable got smaller obviously due to the incomplete movement of the knee joint meaning they dont get used. Would a TKR mean I would be able to move my knee joint to the degree that I would be able to rebuild these?

You will have free movement of your knee once it's replaced. The intention is to get normal flexion and extension to around 120/-5 degrees. You should be able to build up your msucles again, no problem!

Hopefully I havent bored you all to death with this I am just so relived to have found a site where it seems like I can get normal everyday responses from people in a similar situation. Thanks for any advice/knowledge you can give me!

Max

Delighted! Glad you found us!

Other than all that, follow Jamies advice and make sure you get a really good surgeon and a young-ish one! You want him to be around for years to look after you!

As a matter of interest, joints can last around 20+ years, some a great deal longer given the right circumstances. So you could be looking at at least 2 revisions in your life. Just so you know but I hope that doesn't put you off.

 

[Max]

Thanks so much for your response so far guys, and your very kind welcomes!

As you can imagine, finding a site like this after so many years of struggling on my own with my family who dont have all the answers is a bit of a godsend!

I am booked in for an arthroscopy on 11th May and the consultant reckons this will then decide my suitability for a TKR. Is that normal process?

One other question regarding swelling/fluid. No-one really knows why my knee started swelling in the first place as it cant be placed to one specific injury like a lot of you guys can pinpoint, it has just been called zero negative arthritis (a term I reckon they use when they dont actually know what else to call it!!)
My main concern is that with the TKR you have said the swelling will not come back. which was very welcome news!!! I am just keen to know how would this happen/work seeing as no-one knows why it appeared in the first place and from what I can gather the TKR adds knew bits to your knee joint but effectively doesnt take anything away?

Thanks for you help in advance from all the way over the pond!!

Max Mk II

 

[Josephine]

I'm not over the pond, Max! I'm a Brit too.

Well now, why does the fluid appear in the first place ... well, you're right on one thing - no-one does know! There are a lot of guesses and suppositions but nothing concrete. All we know is that excess synovial fluid is a response to an inflammatory process but that's more often the case in things like rheumatoid arthritis which you haven't got anyway. Hmm - that was a lot of help!

What we do know is that when a TKR is done, the inflammatory tissue (i.e. diseased bone) that is probably stimulating the excess fluid will be removed so that it should stop.

Which brings me to your question about not removing anything from the knee. That's not entirely true (to put it mildly!). Here is a couple of graphics showing what's removed and what's inserted.

 

[Max]

Thanks for that Jospehine, I didnt know all that was involved in a TKR!!!

I have pretty much decided I'm going to have a TKR, depending on what comes out of my arthroscopy and if the consultant will do it. Like Jmaie and Max Wallace (thanks guys) have said, I'm keen to make the most of life now rather than clinging on until I'm older just for the sake of it.

What will the consultant be looking for from my arthroscopy on the 11th and how will that effect his decision on my suitability for a TKR?

Also, being from UK Jospehine, how difficult is it to change your consultant in terms of choosing the right surgeon to do the operation? Im guessing this is harder than it might in the States with our NHS?

Thanks!!

 

[Josephine]

Not now, Max. This year the government changed the rules and we can choose to go where ever we want to. No restrictions.

And as for your choice of TKR, do you mean as opposed to a partial? Because that's not your choice. It's dictated by the condition of your knee which is one of the reasons the surgeon is doing the diagnostic arthroscopy. A lot of surgeons choose to do this although this assessment can be made from the xrays.

To have a partial knee preplacement, the damage needs to be clearly confined to one side of the knee only with no damage at all under the patella. If there is any damage anywhere else, or any hint of it, it will progress and 3-4 years down the line, the pain would reoccur, necessitating revision to a total knee. So if your surgeon offers you a partial, just make sure he can give you some assurances about the state of things and how long it might be before the arthritis progresses and requires further intervention.

 

[Simon]

This might not be your problem but I thought I would throw it out there. My knees towards the end where also always swollen even on high dose aspirin but the right one really starting swelling after a fall in which I torn the meniscus. Now, like you I didn't think that was possible as for years the knees were bone on bone and I didn't think I had anything left to tear. The OS did drain the knee once (about 25 cc of fluid) but within in a month the swelling was back worse than before and the more I pushed it the worse it got.

Simon

 

[Max]

Hi Simon,

Thanks for your response and sorry to hear of your problems.

Have you had a TKR and the swelling is still a problem or still deciding whether to have one? Did anyone ever pinpoint why there was swelling in the first place?

Max

 

[Texas]

Hi Max Welcome. I am 41 Had 5 prior scopes that you are getting ready to have. Had a TKR 2 1/2 wks ago. Yes its rough the first few days but it gets better and even this short amt of time I see a diffence and now I do see the light at the end of the tunnel, no more scopes. Good Luck on your operation hope you keep us updated after surgery. and what ever else you choose to do ..Yes you need your life back. I also really only see a lil swelling in mine and I am as lil as 2 wks out. Good
luck and have a speedy recovery.....Kim

 

[Josephine]

Max, it's not really possible to 'pinpoint' why there is swelling. You have a knee which is arthritic and inflamed. THAT's why there is swelling!

 

[Catzcradle]

Max, I'm so glad you shared your question. It lead to this fascinating thread! I've had similar swelling, and bone on bone in both knees for years, and have decided to go ahead with knee replacement. Surgery is scheduled May 11. It took me a lllloooonnng time to get around to doing this. I'm sure I've needed it for years. This forum is helping me get ready for the process, and I hope it is for you too! Keep us posted!
Josephine - Thank you so much for the details and drawings!

 

[Josephine]

You're more than welcome, my dear!

 

[Nana55]

I agree that things do start to get better after the surgery, sooner for some than others but with so much damage, what choice do we have other than give up walking? Welcome to the forum, Jo and Jaime are great moderators and everyone on here is so helpful. I just love the site.