Wife too young for replacements?

[JeRM82]

Hello, I'm new here. I just found this site and I was hoping to find some answers. My wife is 25 years old, and she has had knee pain since she was a kid, even while still in primary school. She has been told that she hasbeen told by a couple of doctors that she has something called "Chondromalacia". She has had three knee surgeries altogether (one knee twice). Our last doctor told her that the only thing left after the surgeries and the physical therapy didn't help her much was knee replacement. The doctor told her that no one would do that sort of surgery on her because she was too young and would return to an active lifestyle. That didn't sit very well with my wife and I because she hasn't had an "active" lifestyle since she was in grade school(K-5th), and even then there was some pain. I understand that research has shown that if it is caught "early" that rehab with physical therepy, and knee injections can keep it from getting worse. It's been probrably 7-10 years since she started all of this and the pain is just getting worse.
My questions:
*Has anyone had to deal with this from doctors?
*Did you have to just find a good specialist yourself?
*Have you known anyone this young to have problems like this?
*Has anyone had a problem like this and something other than "replacements" helped thier situation?
*Can you really be "too young" for knee replacements?
*Anyone had to do this with military (NAVY) doctors, or TRI-CARE?
*Is there a link to a site that I can find out information on GOOD Military doctors. No offense to them, I have just hear too many horror stories from inexperience.
*Has anyone had military doctors do thier procedure with success?

Thank you for reading this. I am in the Navy and I can't just stand to the side and let this issue be baindaided with pain killers from doctors anymore. I want to help my wife, I just need some advice from some people who might have gone through this before. Any information is helpful, and appreciated.

Jamie

 

[bushstreetkid]

I would get a second opinon. It is all about quality of life for your wife.

 

[pt109]

I would also get another opinion. It is all about quality of life and they can now do so much with replacements. I just had hip replacement surgery and there were 5 other people having revisions to their original replacements of 10 years ago. Why wait? Youare only young once! Be firm and go for more opinions.

 

[dids]

Hips are different to knees. No self-respecting surgeon would contemplate doing knee replacement on a patient under 50 years (or so) because the history of the knees is not long enough unlike hips which have been going now for nearly 50 years. The modern knee replacements aren't much more than 20 years old and so the predicted life span is not known past that time. No-one has data of their reliability beyond 20 years. Thus it would be very ill-advised to put such an implant ina person so young as a mechanical failure of knee prostheses can be very problematic. What I am saying is that it's all fine and well to be looking at the situation now but if she got problems 15-25 years down the line they could be extremely difficult to resolve and she would think the surgeon had been somewhat reckless in acceding to her wishes. Plus knee revisions are a whole different ball game to hip revisions for numerous reasons and cannot be compared in any way.

But - chondromalacia is a degenerative condition of the cartilage and I can tell you that there is a new development in techniques to get the cartilage to regrow with very good effect. Or is this the treatment she's already had?

If you want to pm/email me I can give you more detail as I'm not sure how much such information I'm allowed to give on this forum since I can't find the forum rules.

 

[Joanie]

I've just been for a second opinion following my GPs suggestion and he is willing to give me two new knees stating that it is the quality of life that is important and age should not be an issue. He stated that he'd NEVER let age be a reason not to perform surgery. Whereas the surgeon that I originally attended said that new knees would be a necessity in my lifetime but he wouldn't offer it until I was older. Just goes to show that there are different schools of thought within the medical profession. I am not as young as your wife-I am 46 but have had degeneration since the age of 25. Hope this helps

 

[dids]

A surgeon might well say that to a 46 year old. I think the opinion might differ for someone in their twenties.

 

[Joanie]

dids,
why is a knee revision so much more complex or difficult thaN a hip repacement?

 

[pt109]

Any revision surgery is more complex than the initial replacement surgery. The knee joint is the largest joint in the body, so it makes sense that it would also be the most complex in terms of revision. But, it is not impossible surgery and the techniques get better and better. Make sure you are comfortable with your surgeon and make sure this is his/her specialty and that he/she does this surgery many, many times successfully.

 

[Josephine]

dids,
why is a knee revision so much more complex or difficult thaN a hip repacement?

Joanie - I once was dids but now I'm on staff here!

Sooo - what pt had to say was perfectly correct. The other points are that the knee is not only the largest joint in the body it's also the most complex. Also, by ratio of muscle and other soft tissue to the size of the bone and therefore the prosthesis, it's more complicated.

Hope I'm not going to bore or confuse you now, but a rough guesstimate of that ratio would be in a hip, the prosthesis to soft tissue and bone mass is maybe around 5%. In the knee it's more like 40%. So you can see the prosthesis is much more intrusive in a knee than in a hip and there is more bone and space in a hip to work with than in a knee.

Also, it's not that the revision is more complicated, the primary replacement is more complicated as well. One of the reasons it took the early surgeons so long to devise the implant in the first place. When the hip was first done way back in the fifties, it was said that the knee couldn't be done because of this complexity. The only treatment then was to excise the joint and make the thigh and shin bone fuse together as one. A procedure known as arthrodesis. Only drawback was you could on have one knee done as it was not considered wise to arthrodese both knees! I worked with the surgeon who first did knee replacements and, indeed, scrubbed for him when he did the very first one! Though hailed as a great man for his early work in hip replacements (several years before Professor Sir John Charnley) his peers laughed him out of town for even considering the possibility of attempting knees!

How things have changed in 50 odd years!

 

[smithj8]

Re: Wife too young for replacements? -- Tricare

JeRM82,
I have similar problems to your wife, including quite a bit of chondromalacia. I'm 31 and have had 8 knee surgeries. 6 of those surgeries were under TriCare (I'm in the AF). The last 4 were over a span of 10 months and were all in a military hospital. There are two main surgeries that can help w/advanced chondromalacia (grade 3 or 4) that aren't knee replacements. One is OATS (osteochondral autograft transfer system), or "mosaicplasty". It is for smaller instances of chondromalacia and is similar to a hair transplant, they move good cartilage to the bad spot. The other is ACI (Autologous chondrocyte implantation). It is used for bigger spots, but is very expensive. They take samples of good cartilage, send it to a lab in Cambridge, MA and then re-inplant it. I had this done in 3 locations on my left knee and 1 on my right. Results are really good in certain locations (on the femoral condyles), and not so good in others (the trochlea and knee cap). This was done by an Air Force surgeon at Wilford Hall Medical Center, but there are very few military doctors who can perform this surgery.

A non-surgical option is an injection of thick oil-like fluid called SynVisc. It's only good for about 6 months, but can provide great results, and can be done in 3 short Dr. visits, no surgery. If you want to talk about this more, feel free to email me at lazydj98 at yahoo dot com.

-Josh

 

[Josephine]

I looked into Mosaicplasty for another member and found that (in the UK, at least) they will not consider it for degenerative conditions such as osteo-arthritis. But it's always worth making enquiries. Please let us know how you get on, it's good to have additional data to add to our archive.