Should I cancel or postpone TKR?

[lnich]

Hello, everyone:

This is my first post to this forum, but I've been lurking for several months and found it to be a great source of information. I'm a 68 year old female who has always been very active--played tennis daily for decades. Two years ago I had surgery for a torn meniscus, and the OS said that once he got inside the knee, he knew I was a candidate for knee replacement, grade 3and 4 chondromalacia throughout the knee. I had a horrible time recovering from that surgery, lots of pain and limping for many months. I didn't consider TKR at the time, because I also had a torn rotator cuff and had shoulder surgery about 2 months after the meniscectomy (yeah, all that tennis caught up with me). The shoulder required many months of PT, and about 6 months later the shoulder was much improved but the knee was still sore. The OS tried to persuade me to consider TKR then, but I just couldn't face the thought of more surgery and PT so we decided to try synvisc.

Well, the synvisc worked better than I had hoped, and I've had 2 additional synvisc 3-shot series over the last 1.5 years, each series about 6 months apart. I've been able to walk on level ground easily for several miles, no pain sleeping, and I even took up old-ladies doubles tennis again. The most recent synvisc series was about 2 months ago, but a couple weeks after the shots, I felt bad pain in that knee during a mild doubles match. I hadn't been doing anything strenuous to cause the pain.

The pain continued for a week and I was limping pretty badly, so I figured that the time had now come to reconsider TKR. In mid October, I saw a new OS, one that specializes in MIS-TKR. He took new x-rays and confirmed I was bone-on-bone, but he wasn't sure what caused the sudden tennis-match pain. We scheduled TKR for Dec. 17. In the meantime, we had a Mexico vacation scheduled for early November and houseguests until early December, so I was going to take it very easy on the knee and hope to manage without too much pain until the surgery.

Well, after taking it easy for another week, the knee was much improved. The Mexico vacation went great, and I walked for miles without pain on the beach and into town. The knee now feels as good as it ever had since starting the synvisc. I'm now starting to wonder if I should go through with the TKR. I could live with the knee the way it is now, but maybe I'd be postponing the inevitable. What could have caused the tennis-match pain, why did it go away after a couple of weeks, and will it happen again? Should I cancel or postpone the TKR until I can't take the pain, or should I get it over with and get on with my life?

Sorry to bore with this long ramble, but I'd appreciate any advice.

Thanks,

Lois

 

[ship4]

Lois,
Welcome to the daylight of the group! I was like you with my left leg. I made the mistake of putting it off and unconsciously over used my right leg and had more problems with that one than the first! My advice is to get it done when you only need to have one done rather than 2...... JMO
Best,
Crystal

 

[exjock]

I would agree. Get it done now. Xrays do not lie. It is only going to get worse.

 

[Linda2]

Another thing to consider is your range of motion. It seems that people who have good range of motion are more likely to regain good range of motion. (assuming, of course, that they do the work). That was the decider for me. I wanted the knee to bend again, and it does. My surgery was at the end of July, and my knee now bends to 140 dgrees and straightens to 0. I also figured, as my folks would have said, that I couldn't get it done any younger. And exjock is correct, it won't heal itself.

 

[JudyS]

Lois,
I am a hippy. I had my replacement on June 6th. Now my knees have bothered me on and off for years. I have spent life as an obsessive runner. After my right knee giving out on me a few times, I had my surgeon check it out. Grade 4 chondromalacia in the kneecap. The MRI showed no other problems. I had cortizone, did little, if anything. I had the 5 series of hyalgan, did nothing until about a few days after the series ended. It has definately helped a little. My left knee has been bothering me a lot now. I am scheduled for a right knee scope on Dec 17th. My doc will possibly do a lateral release and microfracture. Long recovery.
I am like you with the indecisevness (sp?)
As running is no longer an option with the new hip, I have converted to a mountain trail hiker. That is when the knees really kick in and hurt.

Sorry i am going on and on. Just wanted to share my decision making dilemna with you.,

I would suggest an apt with your surgeon to discuss your issues. I did that before any surgery I have had. I considered doing it this time as well. I had one of those apts before my hip arthroscopy as well as my hip replacement. Of course I went through with both of them. My surgeon both times presented everything so my decision to proceed was very clear in my mind.

Good Luck
Judy

 

[JudyS]

Lois
I forgot a big welcome to bonesmart!!!
Judy

 

[Rowdy66]

Lois, welcome to the forum, the folks here have been a blessing and Jo, well, she is just great.

I don't think anyone can decide for you when it is time for you to have this surgery. You know that it is going to have to be done and since you have had shoulder surgery you probably have some idea what it takes to recoup from this. One thing is sure, you are going to need several weeks to recover from this surgery and it is hard work. I had both knees done at the same time and wouldn't have done it any other way. For me the thought of two surgeries was just one too many, if you get what I mean. We are about the same age, I am an active 67 yo female. I don't play tennis, but I do chase six very active dogs around everyday and a much younger husband. I would not advise that you wait as long as I did to have the surgery though. By the time I had mine I couldn't walk without help, I had a fractured tibia that I didn't know about and by putting the surgery off for so long I created quite a mess for my OS to clean up. A surgery that was supposed to take 4 hours max ended up taking 6. But I still recovered very quickly. I was very fortunate in that I regained my ROM very quickly and could extend my leg and straigthen it out from week one. If you have been lurking for some time you have to realize there is no indicator as to how long it is going to take an individual to recover from this surgery, some recover quickly like I did and some hit snags and take months and/or end up having to go in for surgery to clean out the adhesions. The best advice I got was to be very careful in choosing the surgeon, go back and you will find a post by Jo that tells you specifically what you need to look for. I did a lot of research choosing my surgeon and he ended up being wonderful. If you are in a part of the country near other members of the forum you might even get some help here in being certain you have the right surgeon. Whatever you decide I wish you the very best of luck. Hope you continue to post and keep us updated. This is a wonderful forum, full of advice that is given by people who have been where you are going and are really concerned about your outcome. Again, welcome and good luck. Rowdy

 

[Josephine]

Well, this is MY personal experience. I started having pain in November 05. I got to see the surgeon in January and he said I was a candidate for a TKR. I put it off because of stuff I had booked and eventually got around to having the diagnostic scoping in July 06. This confirmed his diagnosis and I was duly put on the waiting list.

Well, time went on and I kept having episodes as you describe, often ending up back on crutches for anything from a day to a week. But in between times I was right as rain!

Then I figured this - when you get O/A in any joint, the wearing away creates debris in your joint. Most of it is tiny stuff but so long as it stays where it usually is, in the outer reaches of the joint sac, then all is well. It's when the odd bit gets between the weight bearing surfaces of the bones that you get that 'owie' moment. I describe it as being just like having a sharp stone in your shoe. You take some steps it's okay but then you take a couple more and it's ouch, ouch, ouch! Utimately I found mine would move out of the way again and it would all settle down.

Now so long as this is all that happens, I am of the opinion that I am going to wait for more significant symptoms. If I ever get to the point where I have (almost) continuous pain such as aches even when I am sitting down or wakes me up in the night, then I will reassess the situation. But so long as these episodes are only occasional and do settle down, I'm staying out of OR!

Now you have said you had one episode but now you're fine. I would not take that as an indicator to rush out and get my knee done. After all, you can't beat your own knee! and once it's done, it's done.

Having said all that (and you thought you'd written a long post!) it is entirely possible to leave it too long but that would mean having lost all the things in your life that make it enjoyable; 'sooner rather than later' rather depends upon the stateof now. If you can still play tennis and walk about, do pretty much what you want to, what's the rush. If you can't, and you're spending too much of your day only thinking about what you cannot do and the pain you have, then that is already too late in my book because quickly after that comes the weakening of muscles, contraction of ligaments and bone deformity. But only you can decide this for yourself, of course.

Welcome to BoneSmart!

 

[Sandy R]

Welcome to the forum, Lois. My history is very similar to yours... I'm 69 yrs. old and 2 1/2 yrs. ago, had an arthoscopic surgery that didn't help. I did 3 sets of Synvisc, the first was great, the second was so-so, the third didn't help at all. In-between, I had injections of cortisone. Some days were really good, others were filled with pain. I've always been an active person, so on the painful days, I would change my gait slightly to compensate for the pain or put off what I needed to do until I felt better. I went on like that for a long time. Then, last Dec. my husband had one of two TKR's. His second was this past May. He's 75 yrs. old and doing well but recovering his energy level has been slow. I decided that having this surgery at 69 had to be better than waiting until I was 75.

I had a RTKR this past Sept. with the same MIS surgeon my husband used. I feel MIS surgery is the way of the future, less cutting, less recovery time, smaller scar. I'm 7 weeks post-op now and I'm driving, going upstairs normally, my ROM is great. On the downside, there's still aching when I do too much but my OS said in another month or so, that should be gone. I can't wait for that!

By the way, changing my gait to compensate for the pain... once I started out-patient PT, I not only had therapy because of the surgery, I had additional therapy to learn how to walk properly again!

Good luck in whatever choice you make... Sandy