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Author Topic: Meniscal transplant doctor in/near FL  (Read 1360 times)

Offline jaj7963

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Meniscal transplant doctor in/near FL
« on: February 21, 2011, 05:56:53 PM »
My 35 year old husband had 95% of his meniscus removed a year and a half ago and has been in constant pain since then.  His doctor does not recommend meniscal transplantation surgery and has told him that "yes, he can expect to live in pain until he is around 50 when he has knee replacement surgery."  He has also said he will have arthritis.  We have decided to pursue the surgery regardless of his advice as he can not stand the pain any longer.  It seems crazy to us that a 35 year old man with three young children should live in pain for the next 15 years of his life.  I would appreciate any advice anyone could provide about the actual surgery (did it work for you? are you still in pain, recovery, etc) as well as (or more importantly) can anyone recommend a doctor who perfroms the surgery near Tallahassee.  We are able to travel anywhere within the state and possible a state or two over.  Thank you so much for any info provided!

Offline keithap

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Re: Meniscal transplant doctor in/near FL
« Reply #1 on: March 11, 2012, 05:13:50 AM »
Had it in 2006, horrible recovery with close to half a year of rehab if not more.  Mine didn't work and have some nice arthritis pain daily.  I would say its a risky procedure but works for some i suppose.  Im 35 now and just dealing with it.  Best of luck in whatever you decide

Offline joval

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Re: Meniscal transplant doctor in/near FL
« Reply #2 on: March 11, 2012, 01:15:42 PM »
Good luck with your OS search.  I'm in FL but too far South.  The right doctor is very important.  My first doctor missed the obvious, but then again he didn't look too hard.
I found this board after the appointment with the first OS.  I was ready with correct questions when I met with the second OS.  35 seems much too young to be dealing with so much pain. 
When I found my second ortho I googled Knee Ortho and the city I live in.  I then read all reviews on the doctor review sites.  My goal the second time was to find someone that specialized in Knees, my first was a general OS.
Good luck.  I hope your husband finds the help he needs.
Take care.
Jo
01/12  Fell
02/12  MRI ACL tear
04/12  RK ACL recon Allograft, meniscus trim

Offline captainruss

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Re: Meniscal transplant doctor in/near FL
« Reply #3 on: March 12, 2012, 05:13:23 PM »
Hello,

I had my first TKR at 46 2 years ago.  I am in the 1% who have complications including but not limited to AF (arthrofibrosis) and HO (heterotropic ossification).  Dr. Noyes in Cincinnati comes highly recommended by many on this site and does a very good 12 part post on AF that I wish I had read prior to my first surgery.  The post is at:  http://www.kneeguru.co.uk/KNEEnotes/node/633.  Both AF and HO are easily treatable if found early, but devastatingly crippling if left untreated and get a start in your knee.  HO could be prevented with a simple antii inflammatory after surgery.

Your husband sounds like he cannot stand his condition any further??  Is he on pain medication??  Has he tried cortisone shots, lidoderm patches (topical pain relief)??  http://pain-topics.org/pdf/IntractablePainSurvival.pdf  You need to read this pdf on intractable pain.  I wish I was educated on this forum prior to having my surgery.  I was in pain prior to having my first TKR, but was working full time and active.  I could not jog anymore, but losing 50 pounds might have helped that.  Anyway, let a doctor talk me into a TKR.  It was not right from the first day and went thru lots of drama (if you post my screen name you can read all of my drama from other posts) but long story short I was wrongly diagnosed as infected and have underwent 7 TKR's.  I now have HO and went to my OS this morning.  Again, he says there is nothing he can do for me other than taking out the joint and fusing my leg straight to relieve the pain or amputate it above the knee and go with a prosthetic.

IF your husband can treat the pain and live with the knee, I would not have a TKR unless they drug me into the OR kicking and screaming.  If he is suffering from chronic or intractable pain, I say make sure you get as many opinions as needed to convince you the correct path is taken.  Make sure you educate yourself on this forum (lots of different areas and posts and papers) on the different types of treatments etc.

I would seek a minimum of 3-5 TKR specialists opinions prior to any decision.  I would then post here ALL opinions and get some opinions from this site.  I worked with three different OS and all are highly thought of in this area of Florida.  One is the team doctor for the Orlando Magic.  NONE....and I mean not ONE of the THREE caught the complication AF and instead ruined my immune system by treating me for an infection despite EVERY single test coming back negative.  I also had three (3) infectious disease specialists giving opinions to each one of my OS stating that I was infected. 

I will stop here...but willing to give you as many more details as you can stand.  First, get your husband pain relief.  It is very important that you understand what he is going thru so please look at the pain guide.  Second, get multiple opinions on where to go.  No matter how good his operation turns out, if he is active, 10 years is the maximum for a TKR in most cases....that means if he is very very lucky, he will be needing another TKR at 45 or earlier.  The second TKR is supposedly 50% effective compared to TKR #1.  The second TKR because of bone loss and other complications is rated at five (5) years of life.  That means by a maximum of age 50 he will be needing TKR #3.

There are great options.....denervation....which a couple of KG's here underwent with a doctor up north where he cut out the nerve causing all the pain.  I did not know about that option.  There are all kinds of treatments.....I really believe in accupuncture which I am now trying and deep tissue massage.....so many different kinds of medications.  I find the pain medications really screw with my body.  I put on weight big time with oxycontin and have to watch my diet......also pain medication makes me very emotional.....I am a 300 pound man who thought he was fairly manly.....but found myself feeling much better with an anti depressant.  It is not for everyone, but my OS put me on the one he takes....actually told me he cries like a baby if he does not take it.

Also....just a tip but my OS#3 who has also done my back and shoulder.....he gives me his direct cell number.  He texts me every couple of days just to check on me....he puts his cell number on my chart when I am in the hospital and takes my call at 4 am when some nurse on a power trip tries to cut back my pain meds.  I think that is very very important.  If he has any surgery Ice is my favorite....I have a Breg Polar Cooler that pumps ice water around my knee (cryocuff).  All this stuff is on posts.  Many KG's have posted diaries of their post op experiences....I found them helpful.

At the very least, we are all here for moral support.  The only dumb question is the one you don't ask.

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline captainruss

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Re: Meniscal transplant doctor in/near FL
« Reply #4 on: March 12, 2012, 05:14:38 PM »
By the way....I am in St. Pete Florida.  I think you might try Florida State University orthopedics or the Mayo Clinic in Jacksonville plus the TKR specialists listed on this site.

80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline Snowy

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Re: Meniscal transplant doctor in/near FL
« Reply #5 on: March 13, 2012, 05:50:08 AM »
Captainruss, I think you may have misread the question - the poster is asking about meniscal transplant surgery, not TKR. Her husband's surgeon is saying that TKR is at least fifteen years off and so they're looking at meniscal transplant as a possible way of reducing his pain in the meantime. I do understand that your first TKR led to unusual and devastating complications and you're keen to raise awareness of these, but please be careful when you're replying to posts like this - your story is a very scary one for a new poster to read, and they may not realize that you're not referring to the same surgery that they're asking about.

Jaj7963 - I would suggest reposting this in the Meniscus section of the board (http://www.kneeguru.co.uk/KNEEtalk/index.php?board=19.0). I'm afraid I don't have any personal experience with this particular surgery to share with you, but I have seen it referred to in the post-op diaries so it may also be worth taking a look there. Best of luck to you and your husband - I hope he's able to find a way to relieve his current pain.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline The KNEEguru

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Re: Meniscal transplant doctor in/near FL
« Reply #6 on: March 13, 2012, 10:04:17 AM »
When 95% of the meniscus has been removed, it is likely that there is only a small outer rim left. Although this is the part of the meniscus that has the greatest strength, once so much of the meniscus is gone osteoarthritis (OA) is likely to be the outcome.

Now, one meniscus being involved like this usually means that any joint damage (such as in OA) is what they call 'unicompartmental'. The choices are -

1. Live with the pain and get progressive joint damage and maybe eventually bowing of the knee
2. Consider, as you are, a meniscal transplantation. Here is a list of surgeons with a special interest in this subject - http://www.kneeguru.co.uk/KNEEnotes/node/419

There is also the option of reconstruction using scaffolds rather than transplants.
3. Think of buying time with an osteotomy to realign the forces in the joint (here is another list of surgeons with a special interest in this subject - http://www.kneeguru.co.uk/KNEEnotes/node/418
4. Consider a unicompartmental (partial) knee replacement (just replacing the one compartment)
5. Consider an 'offloader' brace which realigns the forces in the knee to protect the damaged area.

and yes, eventually a total knee replacement might be an option.

captainruss is ringing alarm bells inappropriately here, as he had bad experiences with knee replacement. But the procedures here are options to buy time before knee replacement is considered (and it might put it off forever).

Finally, I think you might read Dr Stones's article here, about these concepts of being more biologic with management - http://www.kneeguru.co.uk/KNEEnotes/node/2168 . It won't all be relevant but it will be strong background reading.
« Last Edit: March 13, 2012, 10:22:07 AM by The KNEEguru »
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KNEEguru

Offline captainruss

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Re: Meniscal transplant doctor in/near FL
« Reply #7 on: March 13, 2012, 12:56:20 PM »
Keith,

The moderator is correct.  I sometimes get too caught up in my own situation and forget that my circumstance certainly below 1% of all TKR cases and probably my complications are closer to 1/10th of 1% of all TKR's done world wide.  I apologize as even yesterday I went to my OS and meet very elderly folks who had both knees replaced at the same time and were active 6 weeks later.  This lady was still playing tennis at 74!

So, while my case is a reason to research and understand your particular knee, I am the absolute exception to a procedure which is successfully completed thousands or more times every year.

As I did try to point out, if you are patient the very smart people on this site will give you directions to research and there will always be people like me who look forward to hearing your progress and offer an encouraging word when needed.

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline Pdreamers

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Re: Meniscal transplant doctor in/near FL
« Reply #8 on: March 16, 2012, 04:07:14 AM »
jaj7963, I definitely understand what your husband is going thru and the best advice I can provide is that IMO it is worth taking whatever shot is within your means to salvage his joint as long as possible.  While I was doing my research for knee options, I came across this outfit in the clearwater area (http://fla-ortho.com/l/meniscal-allograft/).  Since I will always knee a good ortho, I kept the link since I hope to move there when I get older.  I had virtually no lateral meniscus (which was partially removed when I was 16 and then again at 23) and numerous full chondral defects to my articular cartilage with arthritis set in.  Not the ideal.

I am now 18 months from my lateral meniscus and ACL transplants, and so far it has been well worth the recovery time and efforts that I have had to put in.   I also had multiple microfractures and paste grafting 19 months ago, as part of a 2 stage surgical approach with Dr Stone in San Fran.  I was 44 when I had my surgeries and had been living with extreme 24-7 pain for multiple years due to the lack of meniscus and the articular cartilage damage.  I got to the point where I was unable to do anything, including going up/down stairs and couldn't sit, stand, sleep, walk without ridiculous pain.  My only local option in Mass was a TKR based on all the experts I met with, but decided to give the biological approach a shot as I wanted to keep metal and plastic out of my knee as long as possible.  Worst case if that approach failed, I could always go the TKR route.  The surgery and initial recovery is painful and challenging, but when compared to the pain I was in pre-surgery it was honestly a walk in the park for me.  I worked hard every day at the clinic and kept focused so I could make this worth.

I continue to work hard every day to strengthen my leg/knee, improve my flexion, keep my weight down, etc.  Even after surgery, I had a long way to go on top of the recovery from the transplants due to the degeneration to my leg/knee after about 25 years of inactivity after severe trauma to my knee from a football injury when I was 16.  It is definitely a long haul project to restore and maintain my knee, but I believe restoration is my best alternative versus a TKR at my age.  At a minimum I am hoping to get to 50 (actually older but I don't want to jinx myself) and will continue down my restoration path as long as I can.  While I am cautious with my knee every day, I am also able to golf again.  I can also walk, sit, work, stand, sleep, go up/down stairs, etc. without pain.  I am able to exercise on a bike, eliptical, light weights, etc. with no issues.  I can also go out for a nice dinner with my wife without complaining about pain, and also enjoy many of the other normal activities that life brings, so I can't compain. 

Let me know if you have any questions.  I recommend not waiting until 50 for TKR as meniscus transplants do work.  The key is to have a combination of the right doctor, the right patient, and luck.  Of course, a doctor can advise you best regarding his situation.  For me, I am not looking to run or do anything to active.  Living without pain and the other things I mention enough works just fine for me, as long as I am keeping my joint in tact.

PD
'82 - ruptured left knee ACL, PCL, MCL; ~25% lateral meniscus removed
'89 - removal of majority of remaining lateral meniscus
'07-10: knee degnereration progressed to severe
'10-microfracture-paste grafting to repair full chondral defects; lateral meniscus and ACL transplants

 















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