Meniscus, OA, Osteotomy, Transplant?

In my very untrained medical opinion, the unloader brace is not a very good long term solution. I have been using one since October 2018 and it does not give me much relief and it is cumbersome to wear to say the least. It you have a bone on bone condition, it will only get worse over time.

I would recommend getting several "second" OS opinions and do some research on your known. I'm sure you will get some additional advice from this here on BS that at much more knowledgeable than I.... all the best!

 

Hi
I am a 67 year old female. I put off my TKR for as long as possible due to all the reasons you state. My xray indicated bone on bone several years ago but it wasnt THAT painful so I lived with it.
Suddenly last August when on holiday my knee buckled and a large effusion (swelling) developed. Its been very painful since and my TKR is scheduled for this month. I have been taking analgesia ever since and am close to not being able to walk due to pain, knee locking and instability/falling. Using a brace helped me to get by but wasn't a long term option. I still had constant pain, couldn't walk far, started falling due to instability and struggled to work due to pain, lack of sleep etc. Who knew it could be like this!
So this is what I think :
1. Get second opinions. It helps to weigh up the options and make a decision.
2. Look at the impact on your life. For me, when looking back, I realise how my knee has impacted my life. Its been stupid to allow this to happen.

Quality of life is what it comes down to when considering a surgery like a TKR. There is no easy answer. Even with a knee replacement your life will be impacted.

If it was me, I would sit with a blank sheet of paper and make some columns, write my potential limitations and potential gains for each option.

You only have 1 life and today is just as important as the future.
Make the best decision you can and embrace it. If you postpone surgery it can be revisited.
If you have surgery and your new knee wears out, C'est la vie. There are options.
If pain is intolerable, your life is being changed to live within restrictions. A replacement knee is not as good as a perfect natural knee but its not as painful.
Good luck with your decision. Remember a conservative decision now does not preclude making a differant decision later.
Rosie

 

From my own experiences, I wish people had convinced me sooner to have a right TKR. I was 43 and believed in "Hail Mary"-types of surgery to buy me time. In the end, it only bought me more problems and pain. My final straw was the catching you described. That will only get worse. I had it happen on stairs once and actually got stuck, where I couldn't go up or down for 10 minutes until I could get something "in there" to shift/move.

As for shots, I was told get shots (hyaluronic acid, AKA Synvisc or Euflexxa) don't usually work if you're already completely bone on bone. That was also my experience in both knees. I also bought the sport's surgeon line of being too young for a TKR at age 43. He even tried it this year, and I'm 46. I politely told him I need my life back.

Lastly, there is such a thing as waiting too long. I'm now there. I waited too long, my bad knees have created other problems, and life circumstances in December forced me to postpone my right TKR until May. Now I'm counting the days. I only wish I knew THEN what I do now. Best of luck to you.

 

My history:
1997 (I was 16): Medial meniscus tear, partial meniscectomy
Very active for twenty or so years running, cycling team in grad school, a few full and half marathons.
2014: Medial meniscus tear while running, partial meniscectomy
2016: Medial meniscus allograft
2016: Re-anchoring of medial meniscus allograft
2018: High tibial osteotomy
(All surgeries on same knee.)

To address your questions:

1. I would see as many reputable doctors as possible. Yes, my understanding is that an allograft or a synthetic replacement is usually only an option for younger patients who have the majority of the surrounding tissues in excellent condition. Of course, “younger” and “excellent” should be left up to your orthos.
2. I had an osteotomy four months ago and I’m still not at a point where I can say I’m better off than just prior to the osteotomy. My doctor is very optimistic and it feels like most of my pain/soreness/discomfort is coming from where the tibia was cut and drilled into, so that’s comforting and gives me hope that this is pain that will subside and due to the cutting/drilling. However, my other doctor also felt optimistic after my allograft and the allograft didn’t wind up really help with my limited mobility or pain. My question to you, as someone whose had a bunch of knee surgeries, is is there some kind of improvement since your event a few months ago in the gym? Does the unloader brace help with mobility and/or pain? If it does, then that might indicate that the HTO MIGHT help. Might.

Here to help, so feel free to reach out.

 

I had a meniscus repair 4 years ago and my knee is so much worse I'm bone on bone. Been thru multiple treatments that didn't help. Now getting a TKR on March 7. It's hard but I would talk to them about a replacement. The alternative treatments don't last long

 

I've had a few of these issues myself. Here's the gist: I tore my meniscus, had the knee scoped, and my valgus knee ended up with even more valgus, which creates more stress for the knee to bend inward, which in turns stresses the meniscus and ligaments. An osteotomy was suggested to me, but after I looked it up, I didn't think much of the idea, and since then I've seen research saying that an osteotomy complicates a subsequent knee replacement.
It's possible a partial knee replacement might serve you. I explored that too but my arthritis was in all three compartments of the knee.

Having been to way too many orthopedists over the years, I will say that the very best thing one can do is find a knee doctor who does tons of knee replacements. I had a mediocre knee replacement that was a nightmare to recover from, and a superb revision just recently that has been a breeze to recover from. The acute recovery seems to be about 2 weeks, and people return to work in a few weeks depending on their line of work. But the tissues don't become completely heal until about a year.

And about that brace, I'm with you. I find unloader braces to be difficult and uncomfortable. I used an Ossur Oasys rigid brace I bought off the internet for 6 years, and it did a decent job of reducing the stress on my knee and was fairly comfortable. I even snorkeled with it on. I love not wearing a brace any longer.

 

Ditto. I've gotten the exact same lecture.

After my MRI (2016 or so) showed a massive tear in the medial meniscus, I said to the OS, isn't there a world class radiologist who can look at that MRI and tell me whether or not I would benefit from Meniscectomy. My x-rays were up on the screen at the time, showing no space left between the bone (medial side).

He said, "no". He said I'd have to try it to find out, and I wasn't about to do that.