Doctors, opinions please--knee

[madmmac]

Doctors(or others who have slept in a Holiday Inn Express--recently),

My right knee had been really bothering me for a couple of months now. Went to my personal DR and had and exam and x-ray. X-ray showed a 40% collapsing towards the lateral side of the knee. He could not see in the x-rays but speculated a meniscus tear and sent me in for an MRI.

MRI was done and results were given to an Orthopedic Surgeon(OS). OS stated that I had a 2 to 2+ tear to the lateral meniscus and a 1+ to 2 tear to the medial meniscus.

But the OS seemed to be more concerned with the amount of traumatic arthritis that was present laterally. The lateral side is where the pain is persistent. Raising from seated, stairs and twisting are painful. Bending or squatting of the knee right now is impossible. I have been taking Celebrex for the last week which seems to have helped the pain quite a bit.

I'll get it repaired/cleaned up in another month or so when the rains/winter sets in and I don't have so much outdoor stuff to do.

The OS also mentioned injections for better movement and pain reduction but they only sounded like temporary solutions.

My biggest concern is that the OS said I probably would have to have a knee replacement within 5 years due to the pain. I want to put this off as long as possible but still be as active and pain free as possible.

I have been taking chondroitin and glucosamine supplements for years.

I'm open to both regular or alternative medicine as opposed to surgery for prolonging my original equipment as long as possible. I'm 53, 6'1 about 200lbs---yes, I could lose some.

Thanks for any input,

[RPKESQ]

Why the desire to put off surgery or knee replacement?

#1 You will heal and recover faster now than in a year or two or ten.

#2 Although knee replacements have a great success rate, if something goes wrong and requires addintional surgery or another replacement, see #1.

[Rikao4]

+1,
the tear's can most likely be fix by scope,
if not ..and the knee HAS to be done anyway..
?, why get put under 2X...
and he's right..
the older we get ..the harder we heal..

Rika

[gatotom]

I assume you have good health insurance, a good knee cleanout sounds like a good first step. Ask you Doc about synvisc or supartz, its a series of hyaluronic acid injections that thickens the fluid between your cartilage, trust me on this one, if this stuff works for your knee, annual injections will make your knee feel new again.

As far as knee replacements, imho, knee replacements in the future will be just injections to stimulate growth cells, they are already doing it, just isn't covered by insurance yet, have too many titanium knees to use up first.

As far as myself, I am one of those stupid Chiropractors that stayed at a Holiday inn express but most importantly have snow skied over 5000 days. To say the least my knees are shot, 4 surgeries later I still have my original knees, not much left in there but I now take Hyaluronic acid capsules and still function pretty good, can still ride my bike hard, backpack into the mountains, thou going downhill is a killer.

I would try the synvisc injections.

[aigel]

Never get the mechanic that is specialized in engine rebuilds and makes their living off of engine rebuilds tell you when to do an engine rebuild. You have to go to a sport medicine expert. Someone that is not interested in a knife over other methods.

I have had excellent success with physical therapy, strengh exercises and keeping my muscles and tendons strong.

You can loose 40 pounds, go through a physical therapy program, strenthen the muscles and flexibility and likely you will see quite some improvement.

Putting in a new knee is not a trivial surgery. I would argue that if you can delay it 10 years, the procedures, materials and even drugs will be better and your chance for success are probably twice as good.

George

[pavulon]

Also consider that one-side of a knee may be "replaced" (termed uni-compartmental surgery) if that is a good option for your situation.

I'd have the arthroscopy to clean up the meniscus as much as possible and minimize further damage, evaluate the importance of activites which may be hurting your knee(s) and lose weight (different than trying to lose weight).

Good luck!

[9dreizig]

Mad, some more info would be good..
How old are you? What do you do for exersize ??
I have had a hip (11 years ago) and a knee replacement (2 years ago),, I still bike 100 miles a week in the summer and ski 40+ days a year..Also still regularily do squats in the gym with sets of 250 lbs..
Don't think that the "clean out" will help much if they are telling you you're bone on bone. Basically you're toast just a matter of time.
No disrespect Pavulon but a partial knee replacement doesn't have the sucess with really active patients,, might as well get the whole thing done..
Find a good surgeon who will let you do the things in life you enjoy.. Make sure he does 100+ replacements a year.. Recovery sucks but well worth it in the long run..

[sammyg2]

I've had a scope done on one knee and almost had it done on the other knee last year. A doctor friend talked me out of it.
In a nutshell, he said they could go in and clean up the meniscus, but that usually results in bigger problems down the road, bone on bone, total replacement.

He said with cortisone injections and proper therapy it would probably heal itself and I wouldn't need the surgery.
4 shots and a 15 months later the knee doesn't bother me at all unless I bump it on something, then it hurts like heck for a few minutes.

[madmmac]

Thanks for all the replies and info.

I'm 53 years old, about 200 lbs. I don't ever see myself being 160 lbs as suggested. I weighed more than that in high school while playing 3 sports. Played at a solid 180 in college. I'll say I'm a medium frame and shoot for the 170-175 lb range which seems reasonable.

Exercise has been kind of tough the last few years. I tore my plantar fascia while coaching basketball. Running backwards all night reffing our scrimmage. Felt a bit of pain that night and iced my foot, the next morning I could not put my foot on the floor without excruciating pain. Walking boot for a couple of months, therapy, orthotics, cortisone injections with little or no relief. Finally after a year+ I had a plantar fascia release surgery. Quite a bit better but then I got a neuroma in the ball of my foot and the outside of my big toe has been numb since then. It feels like a rock in my shoe under my big toe at all times, not very comfortable.

I think the sore foot hastened the knee problem...they are both on the right side and I am sure I have not been walking correctly.

I still coach baseball and basketball. I play tennis when it is nice and racquetball when the rains come. I do overnight hikes into the mountains and also mountain/street bike. I play golf and usually try to walk, depending on the day.

All the limitations prior were due to my foot pain and now I get to throw my dang knee into the mix as well.

I am a minimalist when it comes to surgery, but when it comes to prevention or therapy/delay I'm all for it.

The SynviscOne option looks very promising. I'm leaning to trying this option even before the clean/repair since some have mentioned that cleaning/repairing can lead to more problems.

Again, Thanks,

[teenerted1]

get the bionic knees done now. the younger you are the easier the rehab and recovery will be.

my mom had two very arthritic knees...she took care of one and them with a replament and that side is much better. she still needs to the do the second. been 2-3yrs now and the family is still wondering why she hasnt done the second. she is 75 now and the rehab might have taken a lot out of her. but she might be looking to do the 2nd one soon.

she had back problems this year due to being off center for so long. all the PT for that got her in better shape and she lost some weight so she might finaly be off a cane for the first time in 10+yrs, if she finally gets the second one soon. the last year before she did the one knee she was using two canes just to get around the house.

i have a customer that got both done at the same time and he was up and around and almost back to nomal in a month he was about your age.

[aigel]

College weight often includes more muscle mass, something you tend to lose when you get older, unless you keep up weight lifting and upper body strength exercises. But even if you drop just 20 pounds it will be a big difference on the joints. You'll feel it on your hikes too - hiking with a 40 pound overnight pack will suddenly feel like going in with a day pack!

George

[SteveinTO]

I'd put off the replacement as long as possible. Those things wear out.

[porsche4life]

My mom blew her meniscus. She went to a guy that was an Olympic DR and the best knee guy in the state. I think she was down for about 2 months total. If I could get from VHS to PC I would post up the vid they took while doing the laproscopic.

[porsche4life]

YouTube - TORN MENISCUS



Oh on my mom they just took the damage out.

[sammyg2]

Originally Posted by porsche4life

YouTube - TORN MENISCUS



Oh on my mom they just took the damage out.

Which tends to lead to bone on bone damage and total knee replacement later in life. Not always but it increases the likelihood.
My left knee has been scoped. The torn meniscus that they cut out does not grow back. Over time the meniscus get squished more and more, thinner and thinner.

I know two guys who have had total knee replacements. Both of them had meniscus surgery earlier in life. Not saying thats always the case but the two are related.

[madmmac]

Been reading up on knee options, this looks promising, The Regenexx â„¢ Procedure stem cell therapy. People are reporting pretty good success rates. It's not covered by insurance at this time.

Ran out of Celebrex 2 days ago, holy crap that stuff relieves all kinds of my aches and pains.

Must call Doc for refill!!

[red-beard]

You will be surpised how good the knee will feel after being scoped. I was PO'd for not having it done sooner.

As far as will it "weaken" the knee. It depends on what is wrong and how they fix it. Mine just had a bunch of fibers in the knee, no serious tears. Also, if they "fix" the tears, they can heal and be stronger.

Don't we have an OS on the board? Calling Dr. Tobra....

[madmmac]

Saw a second OS yesterday. He came highly recommended by a few people I know and others in the field.

His diagnosis is that he did not think scoping would do much good. He said that if he did do it, he would also drill some holes in the bone to try and stimulate some growth.

He wants me to try a brace to off load the lateral side of the knee as that is where most of the pain/swelling and arthritis is present. I'm going to give it a shot.

He also concluded that I was too young for a knee replacement(I agreed) and that there was a lot of arthritis in there. I will need it replaced at some point in the future....maybe a partial, lateral compartment.

Opinions???

My take.....If you are having pain in your knee or knees, get it checked out right away. My pain tolerance and still being able to do everything up to this point has put me in this situation which probably could have been avoided.

[Tobra]

You are too young, and it does not sound as though your problems would warrant a total knee. Those thngs wear out and a revision is much more difficult.

Almost undoubtedly the foot problem precipitated the knee problem. I typically treat a torn plantar fascia with a few weeks on crutches.

[skinnerd]

Mad....
I am just like you.
53, 6'2", 205 with bad knees.
Like to be active, playing golf, etc.
Torn meniscus, lose cartiledge bodies, advanced osteo arthritis.
Been scoped a number of times to remove the lose bodies and trim a torn meniscus.
It has all helped, but the arthritis is starting to rule the day.
Have had trouble walking without a limp for the past year.
Sports orthopedic surgeon said surgery likely wouldn't help.
Went for the Synvisc injections.
A series of 3 over two weeks.
The pain immediately gone and am funtioning so much better.
If you are a good candidate, relief can last up to 1 year.
Then just get the injections again.
Not too expensive (less than $2k) and insurance will cover.
Put off that knee replacement as long as possible.
They only have a limited life.
Plus who knows what new cure will come up in the next 10-20 years.
Once you have a knee replacement....it is irreversible.
Bone on bone doesn't matter as long as the pain can be kept in check....pain killers, Synvisc injections, etc.

Good luck.
Also consider using a cart for golf....will save you a lot of wear and tear in the end.