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TKR Frustrated with recent doctor visit

KenUSA36

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I need to upload my latest X-ray, but the good news is in about 20 months it hasn’t really changed. I’m not bone on bone, but my symptoms still stink. My knee hurts or aches frequently. I feel like some torn meniscus is in there causing me pain. I’m really sick of limping and this knee controlling my life.

Anyway I had a second visit with a senior joint surgeon at a teaching hospital. I saw him first about a year and a half ago. I really liked him at the time. He said don’t do anything like an osteotomy or more arthroscopic surgeries. They won’t help. He also gave me the impression that when I’ve had enough he would help me out. Great!

Well this visit was basically I know it sucks but deal with it.

He said nsaids are your best friend to help inflammation and pain. Despite saying they bother my stomach, he said talk to your primary care doctor on how to take them daily and not have stomach problems. I thought this was terrible advice.

He then said young people are programmed that if I get a replacement, I’ll feel better and wear it out faster. I’ll go back to wanting to be super active. Ok? Never heard this.

Next he said I’m so big that they can’t fit the proper size knee in me. I’m 6’3 300lbs. I could maybe beat myself down to 260 if I had to, but I’ve always been built bigger. Sure I’m fat, but I also have a lot of muscle from years of lifting.

So they don’t make a knee that will handle me? What?

Basically at this point I was done with any questions. This visit was a waste of my time. I am not asking for a knee yet. I want to try and make 40. I haven’t damaged bones yet, I still have decent muscle in my bad leg, and I’m mostly managing.

It was just like thanks for this visit doc. You’ve given me no information other than swallow nsaids. No plan for the future. No reassurance you’ll help me out.

Sorry for the rant. I’m done with him. I’m guessing the problem is he’s nearing retirement. Old school thinking plus lack of any drive to stay on new research and methods means he’s not my guy.
 

Rockgirl4

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I noticed when I was seeking my own "second opinions", 2 of them were very old school, refusing to even discuss a TKR. It was obvious they were only looking at my age (45), not the 7 other surgeries on that knee. One of those was a "life-saving" surgery to prolong the knee's life 7-10 more yrs (ACI) . It failed in 2 yrs, so I was back where I started.

By that point though, I was on a mission!!!:no-fin: It wasn't until Opinion #3 and #4 (both with a University research/teaching hospital) that I was told to stop putting band-aids on the knee and get on with a TKR. I was shocked at the willingness to take me on as a patient until he told me he does LOTS of TKRs in people aged 45-50. It was amazing how completely opposite those opinions were from the first 2.

I don't know what your options are, but my 3rd and 4th opinions were with surgeons recommended by a Rheumatologist. She told me I needed a reconstruction/revision specialist who had seen it all, especially given my surgical history, and this type of orthopedic specialist isn't JUST an orthopedist, but someone who has seen/fixed it all at all ages. Plus, MANY people in their 30s/40s with Rheumatoid Arthritis, Psoriatic Arthritis, or Lupus NEED knee replacements much sooner than most, and many TKRs are done in those patient....thus she made it clear she refers ALL of her patients to the 2 Drs she recommended to me, even though I wasn't a revision patient, nor did I have a solid diagnosis of an inflammatory arthritis yet. She promised me they would not look at my age----just the state of my knee. She agreed I DID need someone who had seen major surgical work performed in a knee, as my ACI surgery was brutal and created loads of scar tissue. So yeah----not just any orthopedist would do. :)

I guess I'm mostly encouraging you to keep seeking other opinions if you're able and to ask other medical professionals NOT associated with Orthopedics who might take younger patients. My famous sports surgeon only gave me names of surgeons who agreed with him that no one under 60 should get a TKR, so I've never been back. :bignono: I NEVER would have thought to get recommendations from a Rheumatologist, and now I feel like an idiot for not asking her 3 yrs ago.

I wish you the best in getting some answers, and I was told there ARE options for people of all shapes, sizes, weights, etc. I hope you can find someone that agrees. :)
 

Jamie

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Absolutely go out and get some additional opinions. You want to see surgeons who are used to working with younger patients. Rockgirl4's suggestion to seek out surgeons who also do revisions is a good one as well as they will be more likely to have no issues with any problem your knee might present. It makes no sense to be disabled during these good years of your life. You seriously don't want to be in pain and misery for another three years until you turn 40, do you?
 

Celle

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I'm also concerned that the surgeon told you to keep taking NSAIDs regularly, when you already have a history of stomach problems when taking them. NSAIDs increase the tendency to bleed and it is possible for them to cause serious gastric bleeding.

While the risk of this happening can be reduced by taking PPIs (Proton Pump Inhibitors, such as Omeprazole) it is still unwise to take NSAIDs if they have already caused stomach problems.

The others are right. Keep looking for a surgeon who will look at the state of your knee before he/she looks at your birth date. You're too young to feel old and disabled.
 

luvcats

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That is all around terrible advice.
My pain specialist is very much against long term NSAIDS. They can do a lot of damage.
I don't know about the needs of a knee in a 6'3 frame, but I can tell you I am 350lbs and both of my knee replacements have gone perfectly and even though I am still healing, my life is significantly better.

I hope you'll look for other opinions. Living on the edge with pain killers is not fun, and it shouldn't be necessary.
 

InkedMarie

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I wouldn’t go to that surgeon again. Second or third opinion. You are not too big for a knee replacement. I know of pro athletes your size who have had both hip & knee replacements. Good luck!
 
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KenUSA36

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Thanks for the feedback everyone. It still blows my mind his total solution was nsaids.

No talk about cortisone or lube shots, exercising and stretching, or losing weight. Hopefully he’ll retire soon. Every hospital system doesn’t like you trying to switch doctors in a group, and I really like this hospital system.

Thanks again. I will try to upload my latest xrays.
 
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KenUSA36

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Hopefully everyone can see that.

It’s frustrating because there’s still space there. I feel I shouldn’t be complaining this much, but pain wise the knee feels a lot worse than that looks. The extra painful area is on the right side of the pic or my left outside. I’m sure walking on torn meniscus is causing pain.
 

Jaycey

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Everyone has a different threshhold for pain. What might look like a fairly clean x-ray of an area can cause significant pain. Bottom line things will never get better with that knee. Best to find that surgeon who will work with you to regain your active life.
 

Roy Gardiner

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Next he said I’m so big that they can’t fit the proper size knee in me
Nonsense; you're a big guy, but not off the scale.
I’m 6’3 300lbs. I could maybe beat myself down to 260 if I had to,
Without wishing to sound too much like a smart alec, what were you at 18 and at 25?
but I’ve always been built bigger. Sure I’m fat, but I also have a lot of muscle from years of lifting.
So you know how to train, you probably know how to eat and drink properly too. Losing that fat would be good for you, of course.

But that's minor; the main thing is that you need to find another knee specialist who will not treat you so disrespectfully or (for want of a better word) lie to you. As has been said, plenty of people much over 300lbs have had TKRs.
 
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KenUSA36

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Nonsense; you're a big guy, but not off the scale.
Without wishing to sound too much like a smart alec, what were you at 18 and at 25? So you know how to train, you probably know how to eat and drink properly too. Losing that fat would be good for you, of course.

But that's minor; the main thing is that you need to find another knee specialist who will not treat you so disrespectfully or (for want of a better word) lie to you. As has been said, plenty of people much over 300lbs have had TKRs.
In my younger years, I had two big swings in weight where I was as up to 360+. Since 2012 I’ve stayed under 320 and am just a tad over 300 now.

You’re right I need to shed the weight. Losing 30-40 more may alleviate current symptoms slightly and put me in a much better position for future TKR and all around good health.

I agree with you and everyone else in here. Time to seek out a new surgeon.

I love this forum.
 
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KenUSA36

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PS probably doesn’t mean anything, but my ACL reconstruction tore again years ago. Bad knee has no ACL. It used to slip or give out on me, but in the last 2 years it hasn’t thanks to major commitment to leg strengthening.

Docs actually say leaving it without an ACL is better due to arthritis. Not sure if true, but I have no interest in another ACL at this point.
 

Roy Gardiner

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:):)
In my younger years, I had two big swings in weight where I was as up to 360+. Since 2012 I’ve stayed under 320 and am just a tad over 300 now.
Well that's shown me up right smartly, I expected your younger self to be much lighter :thud: to me right there...
 
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KenUSA36

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:):) Well that's shown me up right smartly, I expected your younger self to be much lighter :thud: to me right there...
Oh haha I didn’t realize you were going that way.

Nah I decided to let myself totally go as a teenager then decided I should probably get it together.
 

Rockgirl4

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@KenUSA36 Others can speak to this more clearly, but many here have reported x-rays that didn't show complete bone-on-bone arthritis. There's usually much more to the story, and you need a surgeon willing to see the big picture, especially with your history of ACL problems/failure. I don't know how often this happens, but we read it here often where people went under the knife and learned their knee was MUCH worse than an x-ray made it appear.:yikes:

I have my own interesting x-ray story! My "4th opinion Dr" ended up doing my TKR. :) At my initial appointment to feel him out, his radiology staff took x-rays of my knee in 4-5 positions I'd never been placed in before. Then they took x-rays in the "usual" 2-3 positions I'd experienced with every other surgeon. Keep in mind I'd had 10 knee surgeries prior to this, spanning 2 huge metropolitan areas, with a total of 5 different surgeons over 20 yrs.....yet THIS surgeon wanted to see things from many, many different angles.:scratch: This thoroughness won me over, especially when he started discussing it all with me and pointing out why I was so miserable!!!!!

The overall take-a-way is my x-rays with this TKR surgeon looked very different than the ones from my former sports surgeon's office that were only a month old. This set clearly showed my lateral femoral condyle had collapsed onto my lateral tibia. The overlap/overhang was obvious. I was amazed my famous sports surgeon didn't see this the month before. However, he didn't exactly seem eager to go over the new x-rays, (which I now know was a huge red flag), plus there was no effort put into digging deeper into the cause of my worsening pain.

I also wanted to add I still have "some" space in my left knee (the non-TKR knee). I'm currently in a decent spot with it, but my TKR surgeon said it likely only has 1-2 yrs left, considering my history of rapid cartilage degeneration on that side and early on with the other knee. I was advised not to wait too long like I did with the right knee. Granted, the left has only had 3 surgeries (compared to 8 on the right), but the last was a Microfracture procedure to "repair" a cartilage defect the size of a half dollar on my lateral tibia. It appeared out of nowhere one day during a workout, making it impossible for me to get up a flight of stairs. Yet, X-rays of that knee in 2018 looked "fine," though I could barelywalk on it.:headbang:Surgery was my only option, as even an MRI with contrast didn't show the severity of the hole and size of the loose pieces banging into everything else, creating MORE damage.

He said this just proves x-rays DO NOT show everything!!! His words were don't let anyone talk me into more life-saving arthroscopies and difficult rehabs on a knee this far gone. Get on with the TKR so I can go back to LIVING!!!!

Sorry for the novel, but I thought some of that might help you out.
 
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kneeper

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A torn meniscus is very painful. I had lots of pain and instability.
Did they do an mri or anything to diagnose it? It won't show up on an xray, as far as I know. They did an mri to diagnose mine. Or are they hung up on the fact that you're heavy? :(

I agree with you about being cautious with NSAIDs. Sure your GP can prescribe something for your stomach to protect if from the NSAIDs but :scratch: . NSAIDs are fine--until they're not-- says someone who developed an ulcer from too many NSAIDs.
 
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KenUSA36

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A torn meniscus is very painful. I had lots of pain and instability.
Did they do an mri or anything to diagnose it? It won't show up on an xray, as far as I know. They did an mri to diagnose mine. Or are they hung up on the fact that you're heavy? :(

I agree with you about being cautious with NSAIDs. Sure your GP can prescribe something for your stomach to protect if from the NSAIDs but :scratch: . NSAIDs are fine--until they're not-- says someone who developed an ulcer from too many NSAIDs.
I had an MRI done about 1.5 years ago. It showed various small tears like degenerative tears in the lateral compartment.

Yeah NSAIDS can go pound sand. I use them occasionally, but I am absolutely not dosing daily on them. I already take omeprazole for acid reflux anyway. I find that things like exercising, stretching, and low carb diet makes my knee feel better anyway without the side effects of heart burn or other fun stomach problems.

At this point, my goal is to get to 260lbs and do my best to keep the knee quiet for a few years. Once the X-ray shows a full collapse, I'm sure I'll find a doc to do it. I was just hoping to find a winner now so I wouldn't have to waste time searching, but that didn't work out. Maybe I'll get lucky and the next 2-3 years will see more widespread robotic assist, better approaches, better hardware, or something.

Although I have to laugh reading articles from 5 years ago where "biological solution to regrowing meniscus will come any day now!!!" Still waiting...
 

donnag1108

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I'm technically obese and 50, which I was told by two other surgeons, the second of which was so cold and indifferent he left me in tears were both reasons they would not help me. Surgeon 3, who is AMAZING, never even hesitated after seeing me and my images. 10 months later it has been a God send. You keep going and sooner or later it will happen if it's right for you!
 

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