Whats next after diagnoses?

[jimisbell]

I have just had x-rays of both knees done....because I was experiencing horrible pain in my left knee after playing around with a WII bowling game. Last time I do that!!!!

The dr (same dr that replaced my wifes right knee with perfect results) came in and said, "I am amazed". When I asked why, he said he was amazed that I walked in because both knees needed replacement. By that time, 2 weeks after the pain had started, I was no longer having any pain so he could not believe I was without pain.

He said I have to have both knees replaced, BUT not until the pain is such that it is affecting my lifestyle. That is the correct answer in my opinion....maybe.

BUT....I have four questions that might bear on when I have it done.

1) I am 74 years old and very active including solo sailing of a 36 foot sailboat, where I need my agility and weight bearing capability. With the new health care act I am concerned that someone somewhere will say, "He is too old and/or doesnt need that fancy prosthetic, let him suffer till he dies in 10 years at 84 (I expect to reach AT LEAST 120) or give him the simple one that is cheap."

So I think at some point I need to start having pain...whether I do or not...to make sure I don't get past that dead line and miss my chance???

2) For my active life style I want the best there is...with the least invasive surgery...right?

3) If I am having no pain...or minimal pain that seems to respond perfectly to three Glucosomine tabs a day, as needed.....maybe I should wait as long as possible so that the science will be further advanced when I finally need it.....if I wont be refused for my age.....I seem to be between a rock and a hard place on this, ROCK=Medicares age limit, HARD PLACE = state of the art???

4) Should I begin documenting my lifestyle so that I have evidence in case they want me to go cheap rather than good? Would it help to be documented?

Any comments?

 

[Jamie]

Hi, jimisbell....welcome to BoneSmart! I'm glad you decided to join our forum.

Boy, you are in an interesting place with what seems to be bone-on-bone knees and no pain. That definitely gives you the luxury of waiting to have your knees replaced if you want to. And, frankly....as long as your lifestyle is not impacted, if it was me, I would wait.

I do think you misunderstand the various implants that are out there. They are all basically the same in spite of what you might read in advertising. It's not like there are cadillac models and cut-rate cheaper models. So don't worry about that and I see no reason at all to try and document your lifestyle. A verbal description of your activities and goals following surgery will be all that's needed when it's time.

The difference in surgery is related to the skill of your surgeon. You do want someone who does a LOT of knee replacements each year - like 400-500 if at all possible. There are some threads in the LIBRARY (link is in the red tool bar at the top of every page) that will give you some good basic information.

There are surgeons who practice what is termed "minimally invasive surgery." In some cases this technique may give you a slightly shorter recovery period.

People these days have joint replacements at almost any age. With your activity level, I can't imagine that anyone will try to restrict you because of your age....even 10 years from now! Don't panic about our healthcare program. You know how politicians are.....we are a long way from any type of health care rationing.

But....do consider that if there are things you WANT to do in life that you cannot because of pain from your knees (like Wii bowling), you might want to consider getting the replacments now so you can enjoy those things. It's really a personal choice at this point since you do not have regular pain.

 

[Josephine]

True minimally invasive surgery doesn't actually exist for total knee replacements - the implants are too big! But the majority of surgeons practice a 'reduced incision' type of MIS where the cut is about 6" long as opposed to the 10-12" it was a few years back. It's pretty much standard practice now as they all know it makes for an easier recovery overall. The rest of what I would advise, Jamie has already mentioned.

But there is an urban myth that older patients who are less active can receive the cheaper implants. Well, for my money, some of those 'cheaper' (i.e. older) implants are the most tried and trusted ones and there are people still walking around and doing all sorts of sporting activities with them who have had them for 30-40 years! So considering they received them in 1970-80, and considering the advances in metallurgy, biomechanical engineering, implant manufacture and surgical techniques in that time, I think you could be very happy with one of them! Newer pretty much always means more expensive but doesn't always mean better performing.

To support this, there was a knee brought out a few years back which was supposed to be more suited to females but a significant study has shown that this knee actually performs less well than the regular type knees!

For what it's worth, I once scrubbed for a patient who had a knee replacement when she was 95 years old! She did extremely well, too!

 

[brs0660]

Welcome to BoneSmart. Consider yourself fortunate to not have a lot of pain with your bone on bone. The decision to have them replaced is definitely in your ballpark. But if your quality of life is not suffering...wait (personal opinion). I suspect with your lifestyle that your muscle tone around your knee has been your saving grace.

As far as the new medical reform (yuk-personal opinion), my OS does have some concern about how it will affect his practice. Will his patients lose freedom of choice? Will there be a standard procedure...what implants to use etc.
However, at the same time, I (personal opinion) think that there will be some major reforms in health care reform before the final platforms go into effect.

Anyway..you crack me up...I like your attitude.

 

[jimisbell]

I do think you misunderstand the various implants that are out there. They are all basically the same in spite of what you might read in advertising. It's not like there are cadillac models and cut-rate cheaper models.

No, I didn't misunderstand anything. My wife had the last 4" of both bones cut off and a stainless steel "new" end implanted. But I see that there are many that don't cut 4" off the end of your leg bones. Some just put a cap on the end. I cant help but believe that just resurfacing must be a lot less painful than chopping up your skeleton!! I had a broken bone when I was 12 and the thing still aches every now and then 62 years later. Completely cutting off the end wont be any better.

I can see that there must be a big difference between what she had and the bicompartmental implant when it comes to trauma.

But maybe I am wrong.....she doesnt think so.

Also, this site states that some are longer lived and some give better motion. I dont want just to be able to walk and last 15 years. I have another 45 years of activity and I want to use it.

 

[Josephine]

Yes, we are in the process of updating all that info as it's 'not entirely correct'! As I said in my previous post, there are an awful lot of people walking around today with knees that were put in 30-40 years ago. Given all the improvements (as previously stated) I have every expectation that knees put in today will be lasting anything up to 50 years. Barring accidents, I think any knee you have put in will last your lifetime! I am fully expecting my knee to last me out!

But when did your wife have her knee done? It sounds like it was a while ago. They only use the 'recapping' type now unless they need something more extensive due to bone destruction from tumours or similar.

However, I can tell you that it's just as painful!

 

[jimisbell]

She had hers done 4 years ago and was told it would last 10 to 15 years. To paraphrase the old chili commercial, "Well, thats not long enough.!"

I looked at the model in the doctors office and was horrified that they removed that much bone. Hers was not diseased in any way, just no miniscus left. She will have the other one done in a few months and I have been trying to get her to find another surgeon with more modern techniques, but she, rightly says, "its still working and its working well and the recovery was not too bad." She can clamber about the boat as well as any sailor a third her age. I cant argue with her logic.

 

[Jamie]

I misunderstood the procedure your wife had done, jimisbell....sorry. And only 4 years ago? I agree with you that it would be better to search out someone who didn't remove so much bone. IF needed down the road, a revision would be a lot easier with more bone to work with.

 

[jimisbell]

Right now the research I am doing is for both of us, though I imagine she will be using the results sooner than I. She recently had a bout of pain with her left knee, the "still designed by God" one. She was told four years ago that it would eventually have to be replaced and it looks like it will be sooner than either of mine.

I suggested to her that since it was her right knee and my left knee that maybe we could tie them both together with belts and a splint, like a three legged race, and then we would be good until my right knee went out and a lot cheaper.

 

[Jamie]

Now THAT'S a plan!!!

 

[skigirl]

There is some evidence that after autopsies, many people have bone on bone knees and have NO pain. My pain was tolerable for almost 10 years, but then it became too big a part of my life. I had my left knee replaced with minimally invasive surgery--the doc took off about 2 cms of bone---less than 1/8 " with a four inch incision.

My recovery was fairly easy---I would not let anyone take off four inches of bone.--are you sure is is not 4 centameters. We Americans are metrically challanged!!

I had my second knee done in April 2010. I can see that I have more disability with both knees---that is another reason why I would never do the two together. My doc will not do two knees at one time as he feels the results are not as good as single legs. I have really had to overcome balance issues and strengthening---the second leg was more disabling that just having one knee replaced.

I think if I were not having pain, I would go on my merry way and worry about my knees when and if they begin to hurt you. I have total faith in our health care system and think the only major change is that the poor folks who have not been able to afford health care will now be in the system too. I am glad for them and welcome them into the same system that I have enjoyed for many years---I am very lucky because of my husband's work. kelly

 

[Tykey]

I often mention stem cell treatment, and the likelyhood that this will become a real alternative in the future.

As you are having no pain, I'd just stay as you are in the expectation that these new techniques will be freely available when you really need something to be done.

 

[Josephine]

Do you have copies of any xrays of this knee, Jim? I just cannot envision any knee that requires 4cms let alone 4" being removed.

We used to use knees like this back in the 80s but they dropped out of favour years ago

Stanmore knee

Shire fixed hinge knee

As for the prediction of 10-15 years, do remember that this is his opinion and in no way a certainty. It really sounds like she was done by a very old, out-of-date surgeon as that is what we thought back in the 80s and even into the 90s, that they would only last 10 years or so. How wrong could we be!

In any event, I think you are quite right to be looking for a really good, modern thinking surgeon and if you get such a chap, I can pretty well promise you that, barring any accidents, any knee either of you have will almost certainly outlast you! :thmb:

 

[jimisbell]

I will have to dig out the paperwork to see which knee she got, but that upper picture looks a lot like the model in his office....bear in mind, the model in his office may NOT be what she got. But it is that model that I am basing my opinion on.

If I remember right I also saw an x ray of it after installation and it looked similar to the model. There is definately enough metal in it to trigger the metal detectors in the airports while some of her friends say theirs do not. Of course she may enjoy the strip search, I havent heard her complain....:wahey:
And it has worked perfectly for 4 years and she has no complaint with it. BUT, I thought they cut out a lot of skeleton that didnt need to be traumatized just to fix a "contact" problem. And again, I am not a medical professional but my wife is, she was a surgical nurse back in the 60s and remembers the horrors of a knee surgery then when, she says, they threw the leg up over the shoulder while they worked. It sounds grotesque!!

She was told NOT to jog on it and I was told not to jog on my knees as they are gone and it will damage them. I hope by the time I get a replacement they will be "jogging" knees as I use that to control my weight and not being able to jog has really hurt my figure

 

[Josephine]

Which model - there are two different knees there, the Shier and the Stanmore.

Jim, have you read in the Library? The link is in my signature at the bottom of this post. There is an article in the knee section about a survey that was done proving that sporting activities do not harm modern knee replacements! So bye bye to that myth! Besides which, if I might suggest, if your surgeon used a Stanmore knee as recently as 4 years ago, I would NOT want him near me! That knee was consigned to the archives at least 15 years ago!

If he used a Shier, then I would think it a case for compensation! That knee hasn't been used since about 1975!

 

[jimisbell]

The "upper" picture that I referanced is the "Stanmore" knee if it is labeled correctly.

That is good information that I can jog. Thanks.

 

[Josephine]

Did you read the article?

I cannot believe that a surgeon, in the 21st Century, would use a Stanmore knee! It just beggars belief! I worked at Stanmore hospital, more properly known as the Royal National Orthopaedic Hospital, London, and I know they would be horrified too.

 

[jimisbell]

No, I couldnt find it. What is the title of it?

Was I in the right place where it starts with an article on Myth Busting: ??? Thats where it went when I clicked on the library link.

Like I said, I am JUST going on the model they showed us in the office. If it is not correct, then all bets are off.

 

[Josephine]

You were half way there! That is in the general section. If you'd looked at the top, there is a special section for hips and another for knees. It is in there. But here's a link to it Knee Replacements Not Harmed by Most Sports

 

[jimisbell]

I got it and forwarded it to my wife.

That is really good news.

My wife is still looking for the paperwork on her knee. She thinks she had a card that she was supposed to carry in her wallet, but she cant find it.