Tips, advice, things to ask Dr etc for potential TKR (Arizona)?

[RanchMan_17]

Hello,

I'm in the US - 34 male. I tore my ACL and meniscus about 12 years ago (surgery April 2012). My knee cartilage is dwindling and the arthritis pain is becoming more and more frequent/increased pain. Up until a few weeks ago, it rarely hurt - just from overuse sometimes. I have an appt with my knee Dr in a couple of weeks and looking for advice.

From what I've gathered there's a few injection options to buy me some more time as well as physical therapy. Any advice or something specific I should be asking my Dr about? I'm terrified that I'll likely need this at such a young age.

I'm seeing Dr. John Brown with the Core Institute - they did my ACL surgery and from everything I've looked up they seem to be a great surgeon but open to any other suggestions. Ideally find the best surgeon possible with my insurance.

 

[Axx72]

Hi @RanchMan_17 I kind of went down the same path as you. Lots of questions running through your brain and trying to organize them is not easy.

If you still have much of your meniscus left I would suggest looking into stem cell therapy but it is a pretty new technology and I have yet to talk to anyone who has firsthand experience. Your surgeon/therapists should be able to tell you whether you are a candidate for meniscal stem cell therapy.

Meniscus repair: up-to-date advances in stem cell-based therapy - Stem Cell Research & Therapy

The meniscus is a semilunar fibrocartilage between the tibia and femur that is essential for the structural and functional integrity of the keen joint. In addition to pain and knee joint dysfunction, meniscus injuries can also lead to degenerative changes of the knee joint such as...

stemcellres.biomedcentral.com

When it comes to TKRs, many of us on bonesmart have been through the process and are still continuing on in our own recovery journeys. Sharing in each other's experiences is can be very heartwarming through all the positives and negatives. We draw courage and strength from the wealth of information.

I have added a few Bonesmart links below on the TKR process.

Knees - TKR

Scientific articles on Total Knee Replacement (TKR) (No Posting)

bonesmart.org

Nutritional Snippets

research articles on nutrition and diet

bonesmart.org

Keep asking questions, there is almost certainly someone here who has an answer for you. I hope some of this info is usefull and gives you some insight about your choices moving forward

 

[benne68]

Welcome to BoneSmart, @RanchMan_17.

If you don't have advanced osteoarthritis in the knee, you may be a candidate for alternative therapies. I tried injections with hyaluronic acid prior to my TKR, but got limited relief because I was already bone-on-bone.

This article may help you understand where you are in terms of knee deterioration:

How do I know if I need knee replacement surgery?

Most knee replacement patients are between the ages of 60 and 80 years old but in some cases, younger patients with knee problems such as traumatic knee injuries may also require a total knee replacement. Read more about it here.

bonesmart.org

If you do determine that you need a replacement, be sure to go with someone who specializes in replacement surgery -- not a general orthopedic surgeon. Here's more about that:

How to Choose a Knee Replacement Surgeon, Surgeons, Questions

You’ve suffered through pain and discomfort related to your knee degeneration and have finally decided to consult with an orthopedic surgeon. Choosing the right orthopedic surgeon is very important to a successful surgery and recovery. Learn more.

bonesmart.org

 

[mendogal]

Hi!

I blew out my R ACL and medial meniscus in a martial arts accident and had surgery in 2001 with follow up scoping in 2003. In that two year period I also had cartilage loss - when parts of the meniscus are gone there's uneven wear and tear with each step we take.

I did live with it for twenty years - it wasn't constant pain, but I did give up martial arts after 2016, at which point my ability to walk non stop was limited to a mile, and my tolerance for standing, pivoting, and turning were impaired by pain.

If you have bone on bone, there's no current treatment other than joint replacement. It's a matter of choosing when to do it.

In addition to injectables - stem cell if appropriate, various combos of steroid, anti inflammatory, and local anesthetic meds - if you have good insurance coverage for durable medical equipment a custom offloader brace may buy you time. Worth asking if it's appropriate given the shape of your knee compartments.

 

[Nlh61]

You seem to be in Arizona as am I. I am having my left knee done May 20 by Dr. Brandon Gough. He is a pioneer in robotic surgery. He’s in Scottsdale so that can be a long drive unless you’re in the area. It‘s about a 40 minute drive for me and he is worth it. He did my first knee using robotics 7 years ago and I had an excellent outcome. He will give you all the options. Alternative therapies would not be to my benefit but may be for others.

 

[lrj]

I had a torn meniscus at 30. Now at 37, I've had partial replacements of both knees. I had to fight to get it done. 7 doctors around home told me to wait till I'm 60. I tried various NSAIDs, Tylenol, topical lidocaine, cortisone shots, 3 rounds of PT, ice, heat, decreased activities, acupuncture, and had to use a cane after mowing a flat 1/4 acre yard. The doctors pointed out I had arthritis on the back of my kneecaps and that they sat towards the outside of my knee. I took that info and looked up alignment specialist. Traveled 6 hours and was referred to another doctor (#9), still 6 hours away. I had bone on bone patella femoral arthritis, 5.5° valgus (knocked knee) deformation, and a leg length discrepancy of 7/8 inch. Along with PKR, I had an osteotomy (which realigns the leg) to hopefully delay full knee replacement by 20ish years.
First, try the conservative measures. Knee replacements are for cartilage damage and when nothing else helps. X-ray is the first determination, but MRI can show more. If you do have bad arthritis, it could be a sign of underlying problems. For me, I had alignment problems.
I would make sure to ask what could be causing your knees to turn bad at a young age. Try what they recommend. If it's not helping and they say to just keep doing the same thing, look for a new doctor. If they are dismissive because of your age, look for a new doctor. Somehow, only doctor #9 asked to see me walk.
As someone else who had problems while young, I would say it's more important to be prepared to explain to the doctor what is going on. Write it up before hand. Described your pain (location and how it feels), what helps, what doesn't, what you have tried, how it affects your daily life and/or work, pain level at best/worst (mine was at best, I'm always aware of my knees, at worst, I'm ready to take a kitchen knife to remove my own knee caps), what any other doctor has said, how long it's been a problem.
I hope you are not needing replacements yet, but if you do, your age may make it difficult to get. But even if you need replacement, they will likely make you go through some conservative measures first before insurance will cover it at your age.
Once you get more info, I'd be happy give you more guidance. I wish I could have had someone help me figure out what was going on instead of having to learn more about knees than any non-orthopedist should know and research specialist hours away all by myself.

 

[RanchMan_17]

Thanks for your replies, all. I saw my Dr yesterday and now have a plan of attack. I haven't lost too much cartilage since last year (xray) thankfully. Getting an MRI and PT next. After MRI, I will begin some injection treatment (TBD).

 

[mendogal]

Thank you for updating us. Please let us know about the MRI results and your injection treatment decision.