Am I going to be crippled?

[leehljp]

I have had some arthritis off and on for years but nothing that some Ibuprofen, tylenol, or aspirin couldn't take care of. Then last month, for three days I had the worst pain I could imagine in my left knee, then it went away. I had "open" knee surgery (3 places) 30 years ago immediately after a sports injury. In Sept, I thought the ACL and other parts were coming unglued! But the pain went away and I continued my ways.

About 10 days ago, it came back with a vengeance. Due to several long standing appointments, I pushed my way through several 10 and 11 hour days and finally got an appointment with a doctor of good reputation for sports medicine here in the Nagoya area. Well, I went today and here was the results of the MRI:

• Left knee Osteo-arthritis
• Meniscus dislocated and degenerated;
• Bone marrow changed and became hard at the bone. calcification. (eburnation)
• Cartilage to the inside of the left knee looks like a saw blade. On the outside, OK.
• Knee cap - cartilage is worn out on one side - gone

Doctor's advice - Method of Correction - some kind of gel shots (lubricant) once a week for 6 weeks. Crutches for 7 to 10 days; pain killer for 7 days but it doesn't seem to help) knee brace after that. After 6 weeks - followup tests. Some weight loss recommended - 10 kilos at least.

After reading Wiki (yes, I know it is not always trustable) I got the feeling that I am doomed. The doctor would not give me full explanations and that is the way it is over here. So far, I have only checked out WIKI.

WIKI:

Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a group of diseases and mechanical abnormalities involving degradation of joints,[1] including articular cartilage and the subchondral bone next to it. Clinical manifestations of OA may include joint pain, tenderness, stiffness, creaking, locking of joints, and sometimes local inflammation.
In OA, a variety of potential forces—hereditary, developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage -- a strong protein matrix that lubricates and cushions the joints. As the body struggles to contain ongoing damage, immune and regrowth processes can accelerate damage.[2] When bone surfaces become less well protected by cartilage, subchondral bone may be exposed and damaged, with regrowth leading to a proliferation of ivory-like, dense, reactive bone in central areas of cartilage loss, a process called eburnation.[3] The patient increasingly experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, andligaments may become more lax.[4] OA is the most common form of arthritis,[4] and the leading cause of chronic disability in the United States.[5]

ANYONE have this? Is surgery an alternative for disability? I am very active and hate the thought of setting in a chair more than standing or walking!

Apologies if it sounds like I am looking for sympathy - I am not - but I am looking for answers that the doctor didn't want to elucidate on.

OH, There was some GOOD news: He said that my ligaments and tendons were in excellent shape, very tight and no looseness. Lotta good that does when the bones are going!

[cabinetman]

Welcome to the club Hank. My hands and fingers are pretty bad, and I should have been getting treatment for my shoulders. Some medications I can't take because of the ones I do take. So, It's like selective treatment.

I live with and work with the pain and limitations. Not much choice other than giving up.
.

[Uncle Cracker]

Hank, I know two people who have had knee replacement surgery (one on only one side, and the other on both sides). Both have told me they resisted until the pain and disability became more than they could bear, because it is such an invasive procedure, and required considerable rehabilitative therapy. But, they both have also told me that it gave them their normal lives back, and there are no regrets whatsoever. I also recall that the Atlanta Braves manager, Bobby Cox, had both knees done in the off-season a couple of years back, and was back in the dugout for spring training, so you have a time reference there. Something to consider if less invasive treatment proves ineffective... Hope things work out for you.

[charliex]

I can commiserate / empathize. I ache therefor I am. I'm 67, and some years ago I used to bike 30 miles after work just for enjoyment. Several week ago I went a little over 3 miles and it was all I could stand. When I arise in the morning if a joint don't ache I get concerned. I only have pain when I stand, sit or lay down. Now the good news. If I stay busy and keep my mind focused I don't notice the pain and the day goes pretty well. If I try to lift or move something heavy without planning my moves I get an instant reminder. When we moved from the twin cities I twisted wrong while moving a large/heavy tool cabinet and paid dearly for over a year. I'm most comfortable standing, (walking around in shop) sitting for long periods is agony. My father used to get cortisone shots and they would help for a while but you can only get so many a year. I don't know about surgery but I would come out like the "bionic man" more artificial than original equipment.
A friend of mine keeps telling me welcome to getting older. Hang in there.
Chas

[cgallery]

+1 what UC said.

I knew one guy that, right after the surgery, was in tears. He said the doctor had totally misrepresented what it would be like to undergo two knee replacements at the same time.

Fast forward two months and he had lost weight, his grand kids couldn't keep up with him, and he said he was sure glad the doctor mislead him, because he felt like a young man again. Other joint pains had subsided as he was able to use his knees as they were intended (no longer having to overextend his back, etc.).

I would consider your current doctors treatment, it doesn't sound too invasive. Maybe it will give you some relief and buy time so you can get the work done on your schedule, rather than your knee's.

[Ed62]

Hank,

My wife has arthritic knees. One knee was so bad that if she stood, you could actually hear the "POP" while standing in another room. She could only walk a very short distance, like maybe going from one room to another.

The doctor told her about what he called "WD-40 for the knees". It was a series of 3 injections, 1 per week. He told her not to expect the benefits to last more than 1 year. It has now been 5 or 6 years since she had the injections, and she is doing pretty well. She still has minor issues, but she can walk at least a mile or two without a major problem.

I'm not saying this is the "golden egg", but it might be worth consideration, if your knee is not beyond being a candidate for it. Her's was pretty bad. The doc told my wife she would probably need a knee replacement before long, but so far, so good. The medication is called "Synvisc". Check it out http://orthopedics.about.com/cs/treatment/a/synvisc.htm . Good luck.

Ed

[gsmittle]

I don't have knee issues (yet), but I did have some major surgery on my back for osteoarthritis. In my case L4 had slipped off of L5 (spondylolisthesis) and the disk was totally gone, so I had bone rubbing on bone. Plus L1-L5 had major bone spurs poking into my spinal chord. Needless to say, I was in major pain, and every so often my legs would go numb (great fun when you're trying to walk or stand and teach).

My doc tried several different things before surgery, including physical therapy, a brace, major painkillers, and epidurals. Nothing worked for more than a couple of hours. Recovery from the surgery took an entire summer and a lot of therapy, but now five years later I'm pain-free and I have a great excuse when I don't want to carry anything heavy.

Sounds to me like the doc is on the right track (realize that I'm not a doctor, nor do I play one on TV) trying the least invasive treatment first.

In any case, best of luck to you and keep us posted!

g.

[germdoc]

I would follow your doctor's advice there. Synvisc is a reasonable treatment option, vs. injectable steroids. If you are becoming disabled I would consider knee replacement, but I wouldn't take it lightly. Remember, what's removed cannot be put back in! There is a 1-2% incidence of infection no matter how rigorous the hospital is about hygiene, and this is a devastating complication--think 3-6 mos. of complete disability, unable to walk on leg. Having said this, I would choose it if there is no alternative.

I have read that the MRI you had in Japan only costs $85-200, vs. ~$1200-1500 here in US. Interestingly, MRI is used 3 times as often in Japan. I'd be interested to know your health care experience there in Japan.

[natausch]

Osteo-arthritis is a slow progressing condition. The end result may very well be that you need a Total Knee Replacement, but for the time remember that your doctor is looking after your best interests. Since he doesn't have patient history for this condition he is taking a very normal route.

If it is a major concern ask for a referral to an Orthopedic Surgeon. They'll be the one to determine if TK or Arthro is an option. If its minimally invasive Arthro the recovery time is lower, but still significant. Remember that a Physician has a "toolkit" designed to diagnose, MRI, CT Scan, monitors and their hands. An Orthopod has a kit that looks more like a mechanic/tradesman's including hammer, drill, clamp, glue, screws, chisels and saws are the bulk of what they'll be using on your body. Having observed dozens and dozens of Orthopedic surgeries (used to work for a medical device/software company) they're pretty brutal.

Complicating the surgery is the fact that each device producer's artificial knees perform differently. They all conform to the same standards (primarily based on FDA for worldwide except for some differences in Europe) but depending on the generation of technology there are noticable differences. The bad news is that your surgeon chooses the brand, based on studies and ultimately the cost per unit versus reimbursement.

Remember that a TK will never result in the same performance level as your actual knee, even in a damaged condition. While the pain would be gone you'll never have the same reliability, which is why it's often seen as a last resort.

Perfect examples in my life are that my wife had an ACL repair from a partial tear in college and to this day has significant sensitivity and occasional pain since the surgical repair can never be as good as the original. I on the other hand had a partial tear that was not treated through surgery but through brace, steroids and crutches. (This was back in the 90's) Even though my recovery was longer my knee is as strong as it was before the injury.

[SARGE..g-47]

I haven't experienced it yet but... I blew one knee out sky-diving and one snow skiing and have some pain I have not had diagnosed. My wife does have arthritus in one knee but no surgery yet. I would talk to a couple of doctors to see if their diagnosis and solutions concur.. then just weigh the options and do what you feel is best with surgery as the last resort.

Good luck in how you proceed...

[Kristofor]

My grandfather had both knees, and later both hips replaced. In both cases he was down to relying heavily on a cane or walker and moving very slowly before the surgery, and afterwards was able to walk pain-free and unassisted at a pretty good clip.

He went for almost 20 years on the knees and ~7 on the hips before he passed away last year, but he remarked many times about wishing he hadn't waited so long to have the knees done (he and his doctor had tried many other treatments for several years ahead prior to replacement).

[billwmeyer]

I was sitting here with both knees aching when I read your post. I blew out a knee if high school football, and have never had anything done to it. Back then -1967 - it was invasive surgery. It was a trick knee for years that would just go out on me and I would be on the floor or close to falling. It hasn't done that in years. With many years favoring one knee, the other one hurts too. I am sure I will need the replacement someday, but for now, like the hearing aid post, I am stalling. Good luck with yours!
Bill

[Uncle Cracker]

Hank, LOML says to tell you that her knees are fine, but she does have one huge pain in her @ss... I'm not quite sure what she meant by that...

[jackellis]

I try to avoid both surgery and medications except as a last resort (I'm also not a doctor) but this seems like something that physical therapy alone won't fix.

If I was the one having a problem, I think I would try the least invasive solution first and the most invasive solution (replacement) last. I would also not waste too much time hoping one treatment will work before moving on to the next alternative. I don't know how old you are but if you do not get the problem fixed, you could be living with it (if you want to think of putting up with constant, extreme discomfort as "living") for at least two or three decades.

I would also not wait until you're in your 70s to get this fixed. I've seen two elderly people go in for surgery at an advanced age and leave the recovery room with all kinds of inexplicable, subtle changes in personality.

[DonHo]

For the last couple of weeks I've been seeing an ad on TV for a new procedure where they can fuse some type of new material on to the knee joint when the cartilage is gone. If the pain gets bad enough I'd look into it. I gone thru the senvic (sp.) lubricant shots, they didn't help me but I know several people they have helped. I ended up with knee replacement and it did solve the problem ( I was bone on bone) but if a less drastic fix was available I'd try that.
Good luck,
DonHo