Is this a good idea?

[ConcernedDaughter]

First, forgive me if this is not the right place to be.

My mother was recently told that she had a meniscus tear in her left knee and needed to have arthroscopic surgery to have it repaired. After researching it a tiny bit, I suggested she get a second opinion.

The second doc said that yes, she did have a tear. But he went on to say that both her knees were bad (he x-rayed both, 1st doc only looked at the one she was complaining about) and that she really needs knee cap replacement surgery on both knees!

My questions:
1. I am finding it difficult to find any references to knee cap replacement surgery on the internet. Is it, in fact, different than knee replacement surgery?

2. What kind of recovery time is she looking at for the repair or the replacement? The docs seem to be a bit overly optimistic and are telling her that it is no problem that she lives alone.

3. If she is looking at knee replacement surgery and not just knee cap replacement, do it really make a difference what brand of replacement she gets?

4. I've seen a good bit of talk here about losing weight prior to surgery. How important is that?

5. Is this sort of thing hereditary?

Her stats:
70 yrs old
5 feet 2 inches tall
weighs between 180 and 200 lbs
Pre-diabetic (has been for years if you ask me, but has only recently begun taking medication for it)
High Blood Pressure
Has neuropathy in both feet that makes it very difficult for her to walk sometimes.
Hypothyroidism (controlled with medication)
And I believe she is still on hormone replacement therapy.
Oh, and she suffers from depression and sometimes takes medication for that.

She lives in the Houston, Texas area of the US.

Any advice is greatly appreciated!
Thanks!

 

[Josephine]

Well now, this is the kind of report that is really helpful!

First though, I'll run through what your surgeons are actually telling you - or rather your mother.

I would ignore the first opinion. I would suggest it highly likely he was not an experienced knee surgeon.

The existence of a meniscal tear in a person of her age and general stats is indicative of wear and tear (otherwise known as osteo-arthritis) in the joint. BUT I have never known a knee cap (patella) to be replaced - or more properly resurfaced - in isolation. O/A on the knee cap does not occur in isolation but in concert with wear in the whole joint. Thus it's of little value to resurface the patella when the bone it sits upon (the femur) is also in poor condition. Therefore the whole joint needs to be attended to.


1. You won't find any specific reference to it because it is part of the procedure of total knee replacement (TKR)

2. The recovery is not uncomplicated after a TKR if she lives alone as she will be very incapacitated for the first few weeks - read around the other posts in here to see many other peoples' experiences which will tell you far more than I can in a single post.

3. Interestingly, i find this the most difficult question to address as here in the UK we don't get a choice! It's the surgeon who chooses the prosthesis and the patient's personal doctor who chooses the surgeon and that is dictated by which is your local hospital! But I know in the US that you have to choose and I am therefore at a loss for comment.

So far as I am aware, from the patient's point of view, one prosthesis is much like another in that the rehabilitation and function is much the same. But given your mother's age and existing problems, I wouldn't think it would be that crucial. However, when the patient is young and active then it can make quite a bit of difference especially when considering the expected life span of the prosthesis.

4. The question of obesity is a complex one. The primary concerns are two-fold.
a) from the anaesthetic point of view and
b) from the patient's ability to be mobile

A person who is overweight has more risk of complications such as respiratory problems including chest infections and circulatory problems including blood clots (embolism). Especially considering your mother's other conditions (BP and diabetes) which also increase the risk of in the embolisms, these are not issues to be taken lightly. However, having given you the bad news, I would assure you that modern anaesthetists are very skilled and more than capable of dealing with all these situations. They will closely monitor the patient and take action at the slightest sign of problems.

But the obese patient may also find it difficult to get around and to do the straight leg raises and other physiotherapy that are crucial in the rehabilitation regimen.

Conclusion is that it is always best to have a low a weight as possible but, unfortunately, obesity and arthritic knees/hips have a tendency to go hand in hand!

5. Heredity - no. Runs in families - yes. BUT it is also simply an age/life style/obesity related thing and so I wouldn't put too much emphasis on that.

Do ask me again if there is anything I have not covered or have been too technical on! Sorry it's such a long post!