ongoing rt knee issues

[pims69]

am 42 active male, injured my r knee while working(funeral director). have had cortizone shots, steroids, pain management, physical rehab, failed micro and debridement. they want to do HTO with cartilage implant 8-12 wks later. sounds like major procedure. not sure why work comp would just do tkr instead of all this? the waiting is ddriving me nuts, now have hip and back issues from using a cane for 6 months. i dont know if I can return to work or what to expect. any info from anyone, never got response from other forums

thanks all

 

[Josephine]

Re: on-going rt knee issues.

Oh I can promise you lots of feedback on this one! Welcome to the family of BoneSmart!

I've never been a fan of HTO. Seen far too many end up having to have a TKR anyway a few years later, even a few months if they were unlucky. It's painful and the rehab is protracted. Are you saying you are being forced to have this? That's not right.

 

[Dewy]

Re: on-going rt knee issues.

Both a HTO and cartilage implant is being proposed? Why both?

I believe that HTOs are done less often these days - there are more options now. They used to be performed as a way of delaying knee replacement in younger active patients, but I have read that when a TKR eventually is performed following HTO, it can be less successful in terms of higher risk of revision - I will try to find the reference.

 

[Dewy]

Re: on-going rt knee issues.

Here is a useful summary of HTO

http://www.coa-aco.org/coa-bulletin/issue-81/themes-high-tibial-osteotomy.html

Based on this, there are advantages of doing a HTO in selected patients - perhaps you are an ideal candidate for HTO? Based on the reference, "Ideal candidates are relatively young, active individuals with mild to moderate osteoarthritis isolated to the medial compartment of a varus knee." Is that you?

The surgeon should explain to you why he is proposing a HTO over other alternatives such as TKR, UKR or even conservative options such as unloader bracing.

If you are not comfortable with the explanation, get a second opinion - it is your knee!

 

[Josephine]

Re: on-going rt knee issues.

Conservative alternatives to TKR are gaining popularity amongst surgeons, Dewy. Apparently because of the decreasing age of the patients. However, I predict (and you can quote me on this!) that it won't be a very long lasting option! :wink1:

 

[Tykey]

Re: on-going rt knee issues.

Is stem cell repair an alternative "conservative" option?

I think it worth exploring

 

[Josephine]

Re: on-going rt knee issues.

It will be when it's reached a usable state.

 

[Tykey]

Re: on-going rt knee issues.

I saw an op on TV last night when they repaired a cartilidge with it. They said that it was now available on the NHS. Maybe not too long to wait for full knees. I think it's already available in the US, judging by some adverts on t'internet.

 

[Josephine]

Re: on-going rt knee issues.

Yes, we've had some of the surgeons speak at the conferences I have attended of late.
But even they say the results are somewhat patchy.

 

[thevoice]

Re: on-going rt knee issues.

it sounds like MACI/ACI thats being used on the NHS.

I had the MACI operation (to repair a defect on the MFC) - cartilage sample grown in lab and then put into defect in the knee - apperently its fully healed however my knee is awful because for whatever reason they missed all the allignment issues and now the back of my knee cap is worn away because the groove is an odd shape.

I think these treatments are good for the right people but if like me you have multiple underlying problems then it will only be a success if the rest of the isues are corrected.

 

[Dewy]

Re: on-going rt knee issues.

Pims69,

Going back to your original question - I suspect the reason a combination of cartilage repair and HTO is being proposed is that you just have defects in your articular cartilage rather than widespread areas of total loss of cartilage.

This would imply that cartilage repair (a more conservative treatment) is an option for you. The purpose of HTO is to take some of the pressure off the repaired part of the knee.

For more explanation see: http://www.kneeguru.co.uk/KNEEnotes/node/742

However I still can't understand why the surgeon didn't explain the rationale and the pros and cons of this treatment versus alternatives to you

 

[Josephine]

Another Sir Lancelot Spratt, perhaps? :th_heehee:

Voice - trouble is, there aren't many people who don't have other issues in their knees!

 

[kneesrus]

Here would be my take on your situation. You are 42 years old. In many areas of the US, the OS really don't want to do a TKR on someone that young. They fear that it could lead to a complete knee fusion in the future. So, I feel they are directing their attention to your cartledge, see if that can be altered before OA sets in on the ends of the bones. Even though, the procedure you propose, is many times denied my Work Comp because it is so experimental.
Both your OS and WC are looking 15 to 20 years down the road for you. There is still fear that by having a TKR at your age, you could be very disabled at 65 years old. In your case, a TKR is the more radical approach, and the OS would like to try a more conservative track.
Hope this helps.
Good luck
David

 

[PhoenixS]

I wish I hadn't waited until I was 50 to get my new knee. Since age 40 I was having progressively worsening pain in my right knee. I was bone on bone (documented) for 5 years. During this time, my leg muscles atrophied, I curbed most of my activites that I loved, my knee was swollen all the time.
All this took its toll. I had my knee done, and am still dealing with all the tissue junk from chronic inflammation, including scarred muscles.
I do think that the implants that are being used today do last longer, but for me, I'm planning on taking care of my knee so it lasts.
I also agree with Knees, in that there are many OS's who still worry about the age thing.
Best,
Sandy

 

[pims69]

thanks to all with info on knee issues. this forum is great. anyways, i have now been referred to orthopedic for back issues associated with knee.....my gait is effected and have been on cane for 6 months. work comp is so slow. suppose to have the hto/implant in the next week or so(16th)this probably will be delayed as the norm. montana has the worst process ever. am now planning on filing for ssdi due to time frame for approval. hto was recommended to releive pressure, actually have two compartments affected. they are delaying tkr, and the state has basically denied everything to this point. pain meds dont work. any suggestions there?

thanks all

 

[Jamie]

Hi, pims69....Welcome to BoneSmart! Boy, it sounds like you are running smack dab into a bureaucratic nightmare!!!

Is it possible for you to obtain a second opinion from another orthopedic surgoen completely independent of the practice where you are being seen now? I am concerned that you may be going through two procedures and then (because you already have involvement in two compartments), you may need the full TKR shortly afterwards.

We do have folks here on BoneSmart who are in their 40s (and some younger) that have TKRs, so it is done. If you don't fully understand and agree with what you're being told about the procedures that are proposed...you need to be very assertive and insist that more information is provided. This is YOUR knee and YOUR life and you must be comfortable with whatever is done.

As for the pain, if the meds you are currently on aren't working, talk with your GP and see if he can help you try something else. There are LOTS of choices. If that fails, see if you can find a pain management clinic within a reasonable distance.

What pain meds are you taking and how frequently??