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Trying to decide what to do

Discussion in 'Knee Replacement Pre-Op Area' started by Vansan, Jan 7, 2019.

  1. Vansan

    Vansan junior member
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    Hi. I am 54 and was pretty active up until July 7t. I did a lot of biking zumba and power walking. In July i came down with a bad bout of sciatica. Took me till Sept to start to come back. Started walking and knees have been swollen ever since. Had 3 cortisone’s and do PT every week. Have 3 different ortho doc opinions

    MRI shows almost bone on bone, 3mm of cartilage on patella.
    1st doc said TKR
    2nd doc days PT and Rooster Shots.
    3rd doc says to try arthroscopy first then maybe a partial?

    Help.
    They say I have moderate degenerative OA. The only things I have been doing is 10 minutes of stationary bike and 30 minutes of walking a few times a week. Lots of crunching knees and swelling is bad in right knee


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  2. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Vansan my first recommendation is to stop all that PT. It does nothing for a bone on bone knee and actually increases the swelling.

    Are you icing your knees? Ice and elevation may ease some of the pain. But unfortunately there is nothing out there that eases pre-op pain.

    If your MRI shows bone on bone why not go for TKR. All the other suggestions are just time and money wasters. Get that TKR and get back to the active life you love.
     
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  3. Vansan

    Vansan junior member
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    Hi Jaycey.

    Thanks for advice. I was doing PT to keep some strength in my legs. Yes I ice a lot. Not much elevation. 3mm I guess is almost bone on bone. I never had any surgery. Nervous about TKR.


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  4. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    Plenty of our members felt the same pre-op including me. No one likes to face surgery. But when the pain begins to narrow your activity it's time to move forward.

    Have a read around this board. Plenty of recovery stories in the Knee Recovery area. Ask any questions you might have or feel free to discuss your concerns. We were all in that space at one time and fully understand.
     
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  5. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    Have you done this quiz? https://bonesmart.org/forum/threads/score-chart-how-bad-is-my-arthritic-hip-knee.19871/
    The mri seems to show you're ready, but often it helps to do this quiz to see how much your knee is really affecting your life.
    My rheumatologist told me that Synvisc and the like ("rooster shots" ) tend not to work well when the knee is bone on bone.

    What you do also may depend on what your insurance requires. Sometime they want PT etc. before they'll allow tkr.
     
  6. Jajakio

    Jajakio graduate

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    I did the rooster shots (synvisc) and got very little relief. Steroids worked for me the first couple of times but eventually did no good at all either. However, i have a client who gets the synvisc shots once a year and says they`ve worked fine for him for the last 5 years. So i guess its a tossup on that. Some insurances wont pay for them and they are not cheap. It might be worth a try and it's not going to prevent you from going for the TRK if it doesnt work.

    I think I'd be wary of a PKR if the issue is just general degenerative arthritis. Most likely it will eventually spread and you will need a TKR before long. It seems from reading recovery stories here that patients with injury damage limited to one section of the knee get longer benefit from PKR than those with normal arthritis. I was terrified of the idea of TKR in the beginning and I still see it as having been my last resort when there was nothing else left to try. For me it worked wonderfully and i have my life back. It is a long recovery but somtimes it is the only thing that works. Im 18 months out and more active than i have been in 10 years. I hike, I bike, I seldom think about the new knee at all. Good luck.
     
  7. Bay89

    Bay89 new member

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    I'm 50...tried the pt first...then tried orthovisc but only had relief for a couple of months. Dr was trying other options because I'm young...I finally told him that because I'm young I want the tkr...I was bone on bone even had arthritis in the knee cap. I'm 9 weeks post op... the week of surgery I didnt have the quad strength to lift my leg into bed. I now bike 1.5 miles in 10 minutes, leg press 125 lbs, hamstring curl 50 lbs, can walk about 1 mile per day, do squats, take stairs. I've resumed all household chores, including laundry and dinner, go grocery shopping including went xmas shopping...discontinued pain meds at 2 weeks and take ibuprofen for swelling. Moderate swelling but doctor said it's normal. Started work from home 2 weeks post surgery, back in office 8 weeks post surgery. No pain, only symptoms are moderate swelling and some stiffness....I attribute my progress to the quad exercises that I did for a month prior to surgery...I continue to do exercises at home, ice and elevation and I'm finishing PT 2x per week...Extension is 0 degrees Flex is 120 degrees. Wish I would have done it sooner and if I need on the other knee, I wont wait.
     
  8. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Bay89 Welcome to BoneSmart. Can I suggest that you start your own thread in the recovery forum. You will get more input from our members with your own thread. If you need me to do this for you just give a shout.
     
  9. Vansan

    Vansan junior member
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    Thank you Bay89. You give me inspiration

    Sounds like you are making good progress

    Its so hard to decide because I have never had major surgery and I know docs are recommending visco shots to try to delay the surgery because of my age.

    How painful is when you wake up from surgery



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    Last edited by a moderator: Jan 10, 2019
  10. Bay89

    Bay89 new member

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    Jaycee I was just responding to Vansan to give some input because of options...I went through all the options being considered and we are comparable in age...so basically I was responding to the post with my experience.

    Vansan...regarding your question on pain after waking up...I really didnt have much immediately because of pain meds...I was in recovery at 1130 and walking by 300. What I would recommend is that you remind the nursing staff for pain meds every 4 hours in case they dont get to you right away. My worst pain was the night of surgery, they didnt issue pain meds and 7 hours went by and they tried to move me from chair to bed....it was excruciating...but I learned my lesson...dont let the pain meds lapse so long that it takes a while to get the pain back under control...
     
  11. Jamie

    Jamie ADMINISTRATOR Administrator

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    @Vansan....here are some threads for you to read that may help you in your decision about when it's time to have your knee replaced. I would recommend that you steer clear of a partial knee replacement, though. It sounds as though you have arthritis in more than one compartment of your knee and that normally means you need a full TKR.

    New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

    If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

    Score Chart: How bad is my arthritic knee?
    Choosing a surgeon and a prosthesis
    BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
    Longevity of implants and revisions: How long will my new joint last?


    If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

    Recovery Aids: A comprehensive list for hospital and home
    Recliner Chairs: Things you need to know if buying one for your recovery
    Pre-Op Interviews: What's involved?


    Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

    And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

    Stories of amazing knee recoveries

    Please do be aware that no one can predict how your recovery will go. We are all different and our recoveries are unique to our individual situation. There are many factors that can impact how someone recovers from TKR surgery. That said, it will always be a good plan to go into surgery with your leg muscles as strong as possible PROVIDING whatever exercises you do pre-op do not cause any pain or swelling. The one thing you want to avoid is an irritated knee as you're heading for your TKR! It's also a good idea to build upper body strength to help you with post op movements where you'll depend on your arm strength to get you up and down and walking with an aid for the first few weeks.

    Please try not to worry about post-op pain. This is something you should discuss with your surgeon to learn what his particular protocol is (they are all different). You might want to read our pain management articles too....they are linked at the PAIN MANAGEMENT tab at the top of the page.

    Don't hesitate to ask any questions that come to mind. We're here to help you!
     
  12. Vansan

    Vansan junior member
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    @Jamie. Thanks Jamie.


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  13. maryo52

    maryo52 FORUM ADVISOR Forum Advisor

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    I bought myself a few years by getting the occasional cortisone shot, and also doing straight leg lifts with an ankle weight. I found that strong quads resulted in significant pain relief. Maybe try to modify your routines. I will tell you that I have yet to meet someone who had arthroscopy of their knees who felt improvement, and I think research has verified that in most cases of OA, arthroscopy has little benefit. I never went for the rooster shots.
     
  14. SusieShoes

    SusieShoes FORUM ADVISOR Forum Advisor

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    I had spinal anesthesia (along with a nice sleep-inducing tranquilizer) and woke up from surgery in no pain at all. The pain kicked in later after anesthesia wore off, but my pain was never horrible. The advice to take your pain meds every four hours, even if you're not having much pain, is spot on. The goal to not let pain get going. It may not be completely absent, and won't be, but you can be comfortable. Your surgeon and medical team want that for you, so talk with them ahead of time. Also, talk with them if the pain control they offer isn't working. They can find something that will work.

    I also relied on cortisone shots for several years, and Synvisc injections, too. They did buy me a few years, but... those were painful years! In retrospect, seeing how well my new knees turned out, I would have done myself a favor to have the surgery sooner. But I went for buying time, and the injections did help me do that.
     
  15. rosieNZ

    rosieNZ junior member

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    Me too! I waited (and suffered) for years before my LTKR and I knew I needed a RTKR at that time. Its taken me 2 years to get organised and get it done. Not because it was terrifying (it is challenging for the first 2 weeks especially if you don't take your pain meds regularly) but because life, holidays planned and nee family members meant I didn't put my own needs first. Be confident. If you need surgery then its only going to improve your life. Take care of you xxx.
     
  16. Vansan

    Vansan junior member
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    @SusieShoes.

    Thanks for your response.
    Sometimes I feel like I may be doing it to early
    Because I can walk a few miles yet and am not in severe pain




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  17. Vansan

    Vansan junior member
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    @rosieNZ

    Thanks for your input
    I have only been suffering with the swelling since Sept.
    but its good to hear that you felt you waited to long.



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  18. rosieNZ

    rosieNZ junior member

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    Xray will show the severity. But pain and how it affects your life is the most important aspect. Our question to ourselves is usually do I really need to do this. Maybe there's some guilt about expecting to do everything you want to. It's all about our quality of life. Its different for everyone. There is a questionnaire on this site that assesses against what you value most (and can no longer do without suffering pain).
    You may be like me. I changed what I did because I couldn't do it any longer due to pain. It happened slowly. For example, I bought shoes I could get on without bending, I stand on a towel instead of drying my toes, I can't lift my baby granddaughter now (because the extra weight hurts) so I do other things with her.
    The lifestyle questionnaire our hospital asks us to fill out said can you put shoes on, can you dry yourself, can you play with children etc. My answer was yes because I changed my life to cope and the assessor told me to go back and be real because she realised I was just trying hard to keep some sensible quality of life. Theres no need to be a hero or tough it out. I had to learn that.
    I had that surgery and all I can say is...how wonderful and thank goodness its available to sort knee no2!
     
  19. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @Vansan, although I went forward with a PKR, my situation is distinctly different from yours. Mine was the result of a decades old injury with no signs of OA elsewhere in my knee. It doesn’t appear that you are where you are due to an injury (unless there is something I missed). Because of that, I have to agree with Jamie and her recommendation. Normally I’m a strong advocate for PKR, but I think it mainly works best in specific situations, based on what I’ve read from others here and my own discussions with my OS.
     
  20. Vansan

    Vansan junior member
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    @NavyGunns.

    Thanks for your advice. I have no injury
    Its just OA. I am leaning towards a TKR.
    I have my pre op next week

    I can still walk a few miles and I am going to PT to strengthen my quads. I am pretty anxious about the operation.
    Never had any type of surgery or been in hospital before .



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