Hello everyone! I need your advise and help please! I am going to give an update. I know it's long, but if you can get to the end, I would really appreciate it
After pain that never went away in the right knee, (see signature for procedure), I underwent a radio frequency ablation in July of 2018. It actually did help a little and I felt like, "OK, maybe this is going to be alright now!" and I continued PT and went back to work. (This was my 3rd attempt at going back to work).
Fast forward to Christmas/New Years 2019. My left knee was hurting more and more from wear and tear and walking solely on that leg for so long. My insurance company is denying me my Monovisc injection in the left knee; apparently they changed their policy on that. They just won't cover hyaluronic acid injections anymore even though I have already had 5 of them and they did work for me for approx 3 months...problem was, they only covered them every 6 months, so I had to hobble around for the last 3 months waiting for the time to be up so I could get another one.
Anyway, my left knee has sharp pain in it when weight bearing and it throbs every night and there's nothing I can do about it. (??) On my right knee - the one that had the PFR and OATS - I can't walk without a limp and the more the left one hurts, the more I walk poorly on the right. Sometimes the right one feels unstable and I will have a sharp pain in that one. I am out of work now (again!!
) and back on crutches. Basically, the crutches are for stabilization and to make sure I don't fall when I get a sharp pain.
I forgot to mention, during all of this... I moved.... I now live in Charleston SC!
So, I made an appointment with my doctor in NYC end of February 2019; 2 weeks ago. because I don't really know anyone down here yet and I had new MRIs of both knees. Unfortunately, she didn't have time to look at them because the radiologist hadn't written the report on them yet before I saw her. And she was leaving the next day for a month long vacation. She did briefly look at the left one, scrolled through the images quickly.
She said I have grade 3 under the knee cap; she couldn't explain why I had sharp pain on the medial side. I told her I felt like something ''broke off" one day and I have had sharp pain ever since. I was at work and 2 of my coworkers actually had to carry me back into my office!! Anyway... she told me that she would do another PFR on the left but not until the right one "recovered more fully". OK... it has been 2
years since my surgery and it's still painful; how much more recovery does it need?
She told me to "fire" my PT and get into more aggressive PT for gait retraining. I have been in PT for 3 years. I told her I was walking this way because of pain in both knees. She never looked at the right MRI to even know what was going on in there.
So her recommendations were to "keep getting the hyaluronic acid injections on the left" Umm I just told her my insurance wont' cover them anymore... I actually am in the middle of an appeal to see if I can get coverage but they said it may take 90 days for an answer. And she mentioned PRP, also something that costs thousands of dollars and isn't proven to work. She also said I should see a pain specialist. I had been doing that for the entire last year of my life; he is the one who did the radio frequency ablation! She seemed to have forgotten that I have already been down that road.
So I left the appointment in tears, literally feeling hopeless because she didn't offer any solutions. She barely listened to me. I think she was already in vacation mode.
Anyway I had the radiology dept send me the reports in the mail and I finally got them yesterday. I will give you a little snip -it.
Left knee MRI: "Cartilage over the patella has grade 3 loss with near exposure to bone..." "Patellofemoral dysplasia grade 3 with fat pad impingement"
Nothing else too interesting. No indication of why I'm having such sharp pain on the medial aspect of the patella, because the arthritis seems to be more on the lateral side.
I want to say this though: in both of my previous MRIs, the first one I had done prior to the scoping and the second one that led to my surgery, the surgeons said that when they got inside my knee, it was "way worse" than what they saw on MRI. The first time, my xrays and MRI looked totally normal and the Dr did the scope and found grade 3-4 arthritis under patella and a large cartilage defect in the lateral compartment (that later got fixed). And NONE of that was seen on the MRI. SO.. I am
quite sure that there is more going on in the left one that they are not seeing, but either way, at a minimum, I have grade 3 arthritis under the knee cap that is causing pain and immobility.
Right knee MRI: The implant itself and the OATS graft look good; no signs of loosening, infection, etc. "Meniscal degeneration noted, with free edge blunting and fraying, but no defined tear" "Chondral thinning over the medial femoral condyle with new focal area of exposed bone over the inner aspect" "cystic change along posterior of the graft, that has increased in size" "new area of high-grade chondral thinning lateral to the meniscal horn over the posterior of the lateral plateau, yielding small focus of exposed bone"
So there is is! Clearly, the arthritis is spreading on the right. No amount of PT is going to fix that.
I am trying to get in to another surgeon here in SC who apparently does revisions.
I am at the end of my rope and I feel like I'm just going around in circles.
My question: Is it unreasonable at this point to go in to my new surgeon's office and basically ask for a bilateral TKR? I am
done with my knees ruining and dictating my entire life and I feel I have exhausted all my resources. I wake up every morning and think about my knees. I go to bed at night, thinking about my knees. Every step I take, everywhere I go, I think about my knees.
The thing is, the left knee - according to the MRI - doesn't really warrant a FULL knee replacement because the arthritis is only under the patella. But I tried the PFR in the right knee and within 2 years, it spread to the other compartments. I mean, I am assuming that having chondral thinning with areas of exposed bone means bone on bone arthritis?? None of those findings were on the last MRI I had done, 1½ yrs ago.
I don't want to keep having surgery after surgery and trying this and that and being out of work and suffering, and walking on crutches blah blah. I guess I need your opinions. Am I 'giving up" too soon in wanting to be off this roller coaster and just asking for bilateral TKR? Does it seem reasonable to ask for a TKR on the left side even if the arthritis is only under the patella at this point?
Thoughts/advice/please and thank you!
Sorry so long and thanks for reading xoxo