Father Seriously Considering Knee Arthroscopy

rhonda.sam

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Hello,

My Father is early 70s, fairly decent health.

Always had mild arthritis in knees and controlled it with exercise and keeping weight down.

In early 2016 he started getting pain in left knee, said it was torn meniscus and iced it twice a day.

It has been more than a year he has done this.

My Father is scared of surgery and when he heard of knee injections (rooster-comb), he wanted me to research for him (my Father had head injury nearly 20 years ago so learning new things like email, internet is difficult, hence I help).

It seems knee injections only buy a person time for surgery. However if it is safe to use knee injections for rest of life, my Father is more than happy with that.

Otherwise if he must have Arthroscopy surgery, please tell what to expect.

How to prepare for the surgery and how to recover from it? The recovery is what is most daunting from that I am reading about other type of surgeries.

Thank you.
 
@rhonda.sam Welcome to BoneSmart! You are correct - injections are only temporary relief at best. For some they don't work at all.

Why is the surgeon recommending arthroscopy and not replacement? At your father's age he needs this fixed. Arthroscopy can be a more painful and complicated recovery versus TKR.

If you go to our Knee Replacement Recovery area and look for the threads with the purple TKR in front of them, you can read our member's recovery stories.

I am sure other members on the knee side will be along soon to comment as well.
 
Hello @rhonda.sam
I'm glad you are helping your dad.

Has your father had X-Rays of his knee, to establish what is causing his pain? Did he see a surgeon when he thinks he tore his meniscus and is he seeing an orthopaedic surgeon now? Before you and he make any decision, he should consult a surgeon who is skilled in doing knee replacements.

An arthroscopy is a less severe operation than a knee replacement. However, if your father has osteoarthritis, an arthroscopy is unlikely to fix his problem long-term. It could even make it worse, by accelerating the loss of his knee cartilage. If he has osteoarthritis, his knee will continue to deteriorate.

A knee replacement is a major operation, but it could fix his knee once and for all. The first two weeks are hard and he will need help, but after that he will improve slowly.

I'm going to ask @Josephine , our Nurse Director, to give you further advice.
 
Hello @Jaycey

We haven't seen any surgeon yet. My dad is scared of surgery and is looking for something minimally invasive that will get him home soon.

Plus there is a bigger problem.

My dad is unable to comfortably make bowel movement like most healthy people.

Long story short in 1965 (in his early 20s) he had surgery for Piles (not in USA, but overseas), it created scar tissue that built up over the years and narrowed the anal opening. In 2006 he got surgery in USA to correct this, but the Surgeon made it worse. Not only is the anal opening more narrow, but it is not even elastic. Surgery to correct this is even more complicated and may make the things worse.

My dad barely eats anything other than fruits, veggies, fibers, liquids. Plus he takes all sorts of stool softeners on a daily basis and still has to apply pressure before making a bowel movement, which is thin liquid.

Under these circumstances how is it possible for my dad to have total knee replacement? How will he make bowel movement while recovering in the hospital?
 
Hello @Celle

We haven't seen any surgeon yet, but I didn't realize that arthroscopy could possibly make it worse.

Really looking forward to advice, especially recovery guidance.

Hope I can get Dad an appointment soon!
 
Well, I can give you some recovery guidance.
I had two arthroscopies before my knee replacements. each time, my knee was bandaged straight for about a week and I needed crutches to walk. I did have some pain, which was controlled by taking Tylenol regularly.
It's important to rest well for that first week.

It takes a full year for complete recovery, but your dad should feel better long before that. He will be able to do almost everything by 3 months, but not anything too active or demanding. By about 6 months, his knee will just give him an occasional reminder that it's still healing.

And here are the guidelines for recovery from a knee replacement. The underlined writing in blue provides links to informative articles:
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now; they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. Here is a week-by-week guide for Activity progression for TKRs


The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs
Elevation is the key

Ice to control pain and swelling
Heel slides and how to do them properly

Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
Thank you for this in-depth post!

A whole year to recover from Arthroscopy? Seems like more recovery time that TKR. So much to think about.
 
Under these circumstances how is it possible for my dad to have total knee replacement? How will he make bowel movement while recovering in the hospital?
Staff will know about his situation and deal with it. This will not impact his having surgery. Yes, it is an factor they must consider. But I really don't think it is a roadblock to TKR.

Let's see what Josephine says.
 
@rhonda.sam, I thought I had a perfectly healthy knee until I tore my meniscus in December. I went to my Orthopedic Surgeon immediately because the pain was so severe and he ordered an X-Ray and an MRI. Those tests revealed *moderate* arthritis and he felt I would be best served with some physical therapy. Well, ....not so much. In fact, the PT was excruciating and just made everything worse, so back I went to the surgeon. We then discussed arthroscopy and I was reluctant to go that route for a wide variety of reasons, so I stalled. I kept hoping my knee pain would somehow magically subside. It did not, so I gave in and had the arthroscopic procedure, primarily because my surgeon said it was really the best diagnostic tool in their tool box. He didn't promise me any miracle fix, just a better understanding of exactly what was going on in my knee, but he did trim the torn meniscus. It was a large tear.

It was an Outpatient procedure and I went home the same day feeling no pain until the local anesthetic wore off and the swelling began; ouch! The bad news? I had severe, bone-on-bone arthritis that did not show up in the prior tests; x-rays and MRI's do not show everything. I needed a full knee replacement, but....didn't want to hear it. I resolved to go home, digest this unwelcome news and see how my knee progressed. It didn't. It was dreadful, in fact, I'd say worse after the arthroscopy. So, after dawdling about for a month or so, hoping things would improve, I knew I had to bite the TKR bullet.

TKR is a very tough procedure. Initially, recovery had been a bear for me. The first two weeks were the most painful and exhausting I've ever experienced, and I've had manymajor surgical procedures in the past, including a hip replacement. But (this is a BIG BUT) I am now 5 weeks post-op and really beginning to feel glad I've gone through with this! Sure, I'm still tired and have some limitations, but that awful, grinding, soul crushing, bone-on-bone pain is gone! It's definitely a lengthy recovery, a full year to be back to *normal* but, that doesn't mean total disability for a full year. I've just begun to drive again as of yesterday and actually visited some shops this weekend, so life is beginning to include some much wanted normalcy. In the long run, I think it'll be the best gift I could've given myself.

Hope this helps you and your Dad to make a decision.
 
Hello @Pheebs52

Agree there are lots of things to consider, but when you say it's the best gift to yourself that really hits home.

Wishing you speedy recovery!
 
My dad is scared of surgery and is looking for something minimally invasive that will get him home soon.
So does everybody! But if I'd had a pound for every patient I'd comforted in the OR holding bay who said they were scared, I'd be a VERY rich woman now! It's possible for him to be given a mild sedative the morning of surgery so he's not so anxious. It's done all the time.
How will he make bowel movement while recovering in the hospital?
Well he'll probably only be in hospital one night, two at the most so it's unlikely to be a problem for the hospital. But the pain meds do have a tendency to cause constipation so it will be essential that he intensifies his excellent diet or even intensifies it a bit.
We haven't seen any surgeon yet, but I didn't realize that arthroscopy could possibly make it worse.
Well it depends how the surgeon approaches it. If it's just a diagnostic (look-see) scope then it won't be made worse. But some surgeons just cannot resist doing a little 'smoothing out' of the rough, arthritic joint surfaces which simply put, just causes the same kind of damage that the arthritis would if left to its own devices!

I'm also intrigued that your father self-diagnosed the torn cartilage! It's really not that simple - you need xrays at least, or even better, an MRI scan. So ultimately, he has no option but to go see a surgeon to get his situation properly diagnosed. Until he does that, there is absolutely no point in talking about options and side effects and so on.

One more thing, the year long recovery referred to is the long term recovery, that moment when he will wake up and around midday, suddenly realise his knee was not the first thing he thought about that morning! Mid term recovery will be about 4-6 months when he is doing much of what he used to before his knees went bad. Short term recovery is when he finds himself not needing to take pain killers as frequently as he did at the start - about 6-8 weeks.
 
A whole year to recover from Arthroscopy? Seems like more recovery time that TKR. So much to think about.
I'm sorry I didn't explain that more carefully. Recovery from an arthroscopy is quite quick. It's a knee replacement that takes a full year for recovery.

While he will need to rest a lot, your father won't be bed-ridden after either a knee replacement or an arthroscopy. He will probably stay in bed on the day of surgery, but the next day he will be mobilised and up to the bathroom. While he may initially need a little help getting out of bed and back in again, he'll be shown how to walk, using a walking frame or crutches..
 
I thought I had torn my meniscus because the pain came on so quickly and so strong. I even knew I had arthritis in my knees, but still the power of this pain was surprising. I had a TKR 3 months later. Directly after the pain came on I had a cortisone shot in my knee, however the effects only lasted a few hours, so I knew a TKR was the next step.
My dad (never had surgery of any kind before) had a TKR at 70 and another when he was 82. The second time when he was 82, my dad went to the surgeon and said, "just give me a replacement", he knew it would give him his life back. Of all the people I personally know who had TKRs, his was the easiest recovery by far. He had a spinal for the surgery and was sitting up, eating in his bed after surgery.
 
@rhonda.sam In early March, I had my RK scoped and a torn meniscus trimmed. The pain was minimal. There was some slight residual pain, like it was just ever so slightly letting you know something was done, for about 6 weeks if I was too active. To me, any swelling was not noticeable. I used 3 pain pills, total. I have walked 4-8 miles several times. My "bad LK" was not happy with the 6 and 8 mile walks and was achy until the next morning. Ice helped. Last Friday, I spent 2 hours, 13,000 steps using a weed mower on a vacant lot and Saturday did 6 miles. On Saturday the 8th I'm going to walk a 5k. My RK recovery is very similar to the LK scope done 5 years ago, minimal discomfort.

In November, the LK gets a total. I'm concerned about that recovery but will muddle through.

I'd like to walk half marathons again. We'll see about next summer.

That being said, if you father has any hint of needing a total in-order to maintain a level of activity he desires, I think I'd go for it.

Edit to add: My surgeon said he liked operating on me because I did well after he was done. He has done my partially torn biceps tendon also.
 
Hello @Josephine

So does everybody! But if I'd had a pound for every patient I'd comforted in the OR holding bay who said they were scared, I'd be a VERY rich woman now! It's possible for him to be given a mild sedative the morning of surgery so he's not so anxious. It's done all the time.

He's anxious because several past surgeries made things worse. As for taking sedative, my Dad avoids meds when possible. Doesn't even like Tyenol :)

Well he'll probably only be in hospital one night, two at the most so it's unlikely to be a problem for the hospital. But the pain meds do have a tendency to cause constipation so it will be essential that he intensifies his excellent diet or even intensifies it a bit.

Oh my! That's something to prepare for.

Well it depends how the surgeon approaches it. If it's just a diagnostic (look-see) scope then it won't be made worse. But some surgeons just cannot resist doing a little 'smoothing out' of the rough, arthritic joint surfaces which simply put, just causes the same kind of damage that the arthritis would if left to its own devices!

I'm also intrigued that your father self-diagnosed the torn cartilage! It's really not that simple - you need xrays at least, or even better, an MRI scan. So ultimately, he has no option but to go see a surgeon to get his situation properly diagnosed. Until he does that, there is absolutely no point in talking about options and side effects and so on.

Currently searching for surgeon

One more thing, the year long recovery referred to is the long term recovery, that moment when he will wake up and around midday, suddenly realise his knee was not the first thing he thought about that morning! Mid term recovery will be about 4-6 months when he is doing much of what he used to before his knees went bad. Short term recovery is when he finds himself not needing to take pain killers as frequently as he did at the start - about 6-8 weeks.

That clarifies many things.
 
I'm sorry I didn't explain that more carefully. Recovery from an arthroscopy is quite quick. It's a knee replacement that takes a full year for recovery.

While he will need to rest a lot, your father won't be bed-ridden after either a knee replacement or an arthroscopy. He will probably stay in bed on the day of surgery, but the next day he will be mobilised and up to the bathroom. While he may initially need a little help getting out of bed and back in again, he'll be shown how to walk, using a walking frame or crutches..

That's somewhat of a relief. Because that's the first thing my Dad was concerned. We'll certainly help him!
 
I thought I had torn my meniscus because the pain came on so quickly and so strong. I even knew I had arthritis in my knees, but still the power of this pain was surprising. I had a TKR 3 months later. Directly after the pain came on I had a cortisone shot in my knee, however the effects only lasted a few hours, so I knew a TKR was the next step.

Ouch, my goodness!

Cortisone is the same as rooster-comb shot? Or something else

My dad (never had surgery of any kind before) had a TKR at 70 and another when he was 82. The second time when he was 82, my dad went to the surgeon and said, "just give me a replacement", he knew it would give him his life back. Of all the people I personally know who had TKRs, his was the easiest recovery by far. He had a spinal for the surgery and was sitting up, eating in his bed after surgery.

It's great your Dad has an easy recovery.

Why did he need spinal though? Is it because of TKR or something else?
 
@rhonda.sam In early March, I had my RK scoped and a torn meniscus trimmed. The pain was minimal. There was some slight residual pain, like it was just ever so slightly letting you know something was done, for about 6 weeks if I was too active. To me, any swelling was not noticeable. I used 3 pain pills, total. I have walked 4-8 miles several times. My "bad LK" was not happy with the 6 and 8 mile walks and was achy until the next morning. Ice helped. Last Friday, I spent 2 hours, 13,000 steps using a weed mower on a vacant lot and Saturday did 6 miles. On Saturday the 8th I'm going to walk a 5k. My RK recovery is very similar to the LK scope done 5 years ago, minimal discomfort.

In November, the LK gets a total. I'm concerned about that recovery but will muddle through.

I'd like to walk half marathons again. We'll see about next summer.

That being said, if you father has any hint of needing a total in-order to maintain a level of activity he desires, I think I'd go for it.

Edit to add: My surgeon said he liked operating on me because I did well after he was done. He has done my partially torn biceps tendon.

Hello @Arttie

You are quite active!

It seems TKR is like getting a new set of knees.

My dad would certainly like to have increased level of activity.
 
"Cortisone is the same as rooster-comb shot? Or something else"

No, they are different. Cortisone is a steroid which has anti-inflammatory properties. I have had them in my knees for several years. Their effectiveness seems to last shorter times after several injections. There can be undesired side effects with continued when injected into the knee joint. For me the procedure was painless.

The rooster comb is "The injection contains a gel-like mixture made from a substance called hyaluronan (pronounced hy-al-u-ROE-nan) that comes from chicken combs. Hyaluronan is a natural substance found in the body and is present in very high amounts in joints." There again , from what I understand, the injections may or may not help and may be less effective with time. My surgeon did not offer them to me.
 

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