KNEE ARTHRITIS - General principles of managing Osteoarthritis of the knee :
No Hope! - - Posted by missymoo (missymoo), 22 April 2003
My knee trouble started about three years ago when I decided to take up running. I began to notice pain and grinding sensations in both knees. I had X-rays done and MRI's which showed nothing. Finally I got an OS to do an exploratory arthro to see what was going on and he saw that I had damage on medial femoral condyle which he shaved down. He referred to it as Chondro Malacia but said it was grade II. At that time all I wanted was to continue running and playing tennis and I was desperate for a cure. He told me there was none. I gave up, quit running and doing anything that might damage my knees further. This was three years ago. I was reading thru all the posts here of you having OATS and Carticel and I'm wondering if medical science has progressed in these areas and maybe I could be helped. Do you think it's worth going to see an OS for an opionion? I just constantly fear the damage going on making me ever closer to PKR or TKR and I'm only 35. If there was something that could help my pain and fix my damage I'd jump on that operating table in a heart beat - but then again all of us here would wouldn't we? It just seems to me that the folks on this board have the same kind of damage I do and yet they are getting offered choices. I was told take Glucosamine, stop doing anything damaging, and learn to live with it.
Posted by JG (JG), 22 April 2003
You should definitely go see someone. I just had OATS/mosaicplasty on April 2. I had grade IV in all three compartments (PF, medial, lateral). Mine was widespread so something as focal as your medial condyle should be doable. Go see someone that has some knowledge of the procedures for cartilage restoration. If you are interested I can give you more detail. There are a few posts in the discussion area that focus on ACI, microfracture, and OATS/mosaicplasty with autograft and allograft.
Janice
Posted by missymoo (missymoo), 23 April 2003
Janice,
Thanks so much for the reply. It was devastating to me to learn nothing could be done and to quit doing the things I once loved so well. I am now to the point that not running or playing tennis is okay - I just want to get up out of the movie theatre without hurting. I just want to walk up and down stairs without pain. The way the OS explained to me was that it was over such a wide area that they could do nothing since OATS, carticel, etc were all for small isolated defects. I was hopeful reading here that three years of medical advances means they are fixing people like me now. To think I could get knees back that don't ache, grind, and pop is beyond my comprehension. Please send me any info you have. The bad part is this will have to wait as my active duty husband has orders to San Diego (from Norfolk, big move) so we will be moving in September. I will have to get comfy enough in my new job out there before asking for time off to recover. That's okay though, just to know there is possible hope for me means more than I can say. What procedures have you had done? Are you happy with the results? What were you expecting from it - I mean going back to running or just being able to walk without pain?
Thanks again,
Steph
Posted by JG (JG), 23 April 2003
Steph,
To me Grade II on your medial femoral chondyle doesn't sound "widespread". Are you in a lot of pain? Or just achy. Are you limited by the knee or by surgeons advise. How are you staing active?
I'm grade IV (to the bone) pretty much everywhere plus some necrosis of the lateral femur and patella. The only surface not damage is my medial tibial plateau. I am fortunate because I was very functional prior to the surgery. I was cycling, running (only 5 - 10 miles per week - against OS advise, but he knew I was doint this), and swimming. The more I did the better I felt...kept synovial fluid health and swelling minimal. Overall, my pain was not as bad when I was running. Kept my legs strong. Keep in mind I have a very very high tolerance for pain. OS said I should have had problems walking, so that fact that I was running was impressive (or crazy).
You really need to see someone who specializes in this type of thing. Dr. William Bugbee is in San Diego and is one of the most respected specialists in this field. Dr. Mandelbaum is a specialist using Carticel. He is located in Los Angeles somewhere. My physician referred me to both of them for second opinions.
I had OATS/mosaicplasty (used for larger areas) using an osteochondral allograft. Basically, I had a biological knee replacement (as my surgeon calls it). It covered the entire trochlea area extending lateral to the chondyle and a somewhat large spot on my medical femoral chondyle. He did not fix the lateral tibial plateau. Very few MDs actually do that (access is difficult). He said he could, but it would be another procedure. I got second opinions from a number of the specialists in this field and more said I was not a good candidate than was a good candidate. Two said they would do it, but it would be by far the largest OATS/mosaicplasty procedure they had ever done. I figured that if this works, I might avoid a TKR for some time. Even with the amount of damage I had, I was years from a TKR (I am young (35), functional, and show no joint space narrowing).
I expect to be on crutches (non-weight bearing) for 8 weeks total and patial weight bearing for another 4 after. I figure I have a 50 or 60% chance of success since I had basically a good portion of my femur resurfaced. I am fit, strong, young, and dedicated, so hopefully my chance of success goes up. If it doesn't work, I am not sure what the next step is. My surgeon is great, so we will figure something out.
If you want to email me off the board, contact me at jg4565@yahoo.com.
Janice
Posted by cm (cm), 23 April 2003
Janice - you are AMAZING!
Good luck with your upcoming procedure!
And Steph - hope you find a great OS who can help!
Posted by missymoo (missymoo), 24 April 2003
Janice,
I hope that your surgery is a complete success!! It's funny that you and I are exactly the same age. I take it you are in S. California? I'm excited about moving and think it's going to be a great place to live for a while, nothing is ever permanent in the military.
It's hard for me to decide really what to do - truthfully I wish I had the mental outlook I do now and would have never got on the operating table. I think the debridement kinda set the stage for more destruction. I was so upset after the first round of surgery I went to another doctor and he went back in to take a look and removed my plica. Still, nothing gained whatsoever! I've been to PT's who McConnell taped, suggested braces, orthotics, etc...which after the surgeries weren't going to do much to stop the grinding. I was told that the next course of action for me would be high tibial osteotomy - no thanks, I'm not that bad off yet!
I am not really in pain unless I am overstressing the joint. I don't sit at my desk here in pain but if I thought about running, a few steps would tell me to quit. I adopted the attitude that I definitely didn't want to do anything to help out the degeneration. I can ride my bicycle or roller blade with really little pain at all, sometimes if I walk too far or too fast I will get jabs of pain (probably a 5 on the pain scale). A very big part of me thinks I should just wait until the level of pain is unbearable before rolling the surgery dice again - but there is also a big part of me that longs to be able to run if I want or play tennis again (oh how great that would be!!!) . I'm so very happy you gave me the names of the surgeons, it's definitely worth going to talk to them and get their opinions. Who knows, they may tell me I'm the perfect candidate and they are confident they can restore my knees. Positive thinking never hurts!
Take care of yourself and your knees!! I'll bet 8 weeks non weight bearing will seem like an eternity. Oh how great for you that you may get your old knees back - I'm praying for ya!!
Steph
Posted by cat123 (cat123), 20 January 2004
hi missymoo
i am new to this site and all the symptoms you describe about your knee are just like mine i ran for 20yrs but have had pain for 3yrs in march 2004 im due to get a a.c.i due to damage in my articular cartlige, my decisionwas very hard but as im only 35 i wouldnt like it to get worse and this op not to be possible any more. like you i couldnt run 10mtrs even if i really wanted to so the chance to change this is my only option.im getting this done in the uk its my os first time , but he is a great surgeon . cat
Updated Sat Nov 21 2009
