KNEE ARTHRITIS - Unicompartmental knee replacement :
Buying Me Time?!?!?? - - Posted by wendy (wendy), 20 October 2002
Well, I have seen and heard quite a few people who have been told this. I was 18 when I was told "we are just going to buy you some time." Well, now I am 28 and we are still buying time. As many other I am too young for a TKR so my OS luckily has experience with the PKR. I will be trying to buy time with this procedure in about 8 days.
We are not sure if the PKR will work, but at this time it is the best option. According to tests and all I am too young for the TKR, but I will need it eventually in both legs. My OS is ready to do the TKR if things don't look good when he goes in.
My question is why do so many young athletes get to have TKR's and none of us do
They say they wear out and that is why we are too young. Well, I would bet we are less active than your professional athletes and we would be more gentle and careful with our replacements than they would. So why not? Many of us have been in discomfort or down right pain for years. I could handle living a somewhat normal life for the next 10 - 15 years and then be in a wheelchair vs. what I have now.
Just a thought!
Wendy
Posted by NJDan (NJDan), 20 October 2002
Ya know I used to feel the same way! I had my kneecap out in 1999 and since then have had major loss of cartilage. I am a prime candidate for a TKR, two excellent OS have told me so. When I had my OP two weeks ago he again told me this is the case, but a PKR will buy time and you can still allow 2-3 TKR's. Ultimately the decision should be yours. From what I have heard and read PKR's can buy time but are only a "bandaid" for the real problem. A TKR will last between 5 and 15 years depending on your level of activity and your weight. After three they fuse your leg. I am trying to hold out until I am at least 45 ( another 10 years) but I think I'll be lucky to make 40!
Wendy, I hope you post the results and that I can ask for feedback if you get a TKR, cause I will be headed that way in 2-3 years, or sooner if my microfracture from two weeks ago fails!
Good luck
Dan
Posted by enuff81020 (enuff81020), 20 October 2002
Hi!
This "buying me time" stuff is exactly what has gotten on my nerves completely. I am 47 and we've been in the market for time for over two years.
However, I have a new understanding of all of this and that has added a new element to my knee issues. The way the folks at the university explained it to me, we have 3 compartments in our knee--and a TKR will help the outside two areas. However, it won't do anything for the level of damage that I have in that middle compartment (translate--patella) My docs have both mentioned that one thing done for a situation like mine is to remove the patella, but I'm not actually a candidate for that because the patella is needed to stabilize the new joint when the tkr is done. They also have all told me that they do not believe the bulk of my pain will go awy with a tkr, because it is actually being caused by the damage and breakage to the patella and the damage to the femur from the bbanging in there. My ortho mentioned this raising the patella off of there as a possibility and was taking that under advisement.
All I really know is that people who I graduated from high school with have had tkr's. this mess hurts all of the time with little to no let up, my therapist thinks I need a surgical intervention, my doc feels really bad that we haven't been able to control this, I have done everything under the sun that they have told me to do plus some extra things (losing weight and extra work with my therapy exercises), and 2+ years later, 4 surgeries later, umpteen cortisone injections later, 6 SynVisc injections later, 60+ therapy sessions later--I am still walking with crutches, continue to have these little surprises and emergencies where I can't bear weight or extend my leg, need frequent pain meds that do not always take the bite off of the pain, and my life is not what I want it to be.
Yes, we are "buying me time" but I wonder what the cost of that is...It isn't that I am craving a big intervention like a tkr, it is that I am reaching the end of my rope and do not have any other ideas on how to help myself. I feel like the people who have been supporting me personally and medically and in every other way are starting to be as frustrated as I am and need to get something moving here.
If I had a few nights of good sleep, a day off from my knees, something go right with my knees--well, this whole idea might be easier--but I haven't had any of those things yet...
I think that was a vent--sorry, Sylvia
Posted by hmaxwell (Heather M.), 20 October 2002
I agree with you Wendy. Unfortunately, I'm in the same situation as Sylvia, i.e., the majority of my damage is on the back of the patella, so a TKR wouldn't necessarily help my pain. We know the kneecap has sunk into the joint and is compressed right now due to scar tissue, but even when it wasn't I still had pain. Not as bad as now, but it was still there.
I do wonder what I'm buying time for--I mean, I'm in the prime of life right now (age 32). Why would I want to 'save myself' for when I'm 60?? Anyway, no one has yet mentioned TKR or PKR to me, except to say that I'll need TKR "some day" but that I'm way too young. Also, my articular cartilage damage, while severe (grade IV) is not quite enough to do something about along the lines of TKR or PKR. The route my new doctors seem to be going is osteotomy, and I'm curious as to why that's not the logical step before PKR--was there a reason your surgeon didn't want to do that on you, Wendy?
I think it was Sue who chose PKR over an osteotomy and was curious why no one has mentioned this to me. All I know about PKR is that if you don't address the alignment problems when you do it, the chance for a successful outcome is much lower. I've been doing lots of medical journal review (mostly abstracts on line) and that fact is mentioned again and again.
Anyway, enough rambling. I'd be interested to hear back from those who, like me, are facing some type of open procedure or having to live with daily severe pain. Do you go for the aggressive procedure and hope that it will work because your damage isn't tooooo extensive, or do you suck it up and wait until you can find someone to do a TKR? That seems to be the question quite a few of us in the age range of 25-50 are facing.....
Heather
Posted by Grace (Grace), 20 October 2002
I don't follow that train of thought either...there is a woman at my PT who had a TKR and she is only 34...don't know what the story is there...but it seems alot of people here need thema nd should get them!
Posted by enuff81020 (enuff81020), 20 October 2002
You know, I had thought that that "buying some time" phrase was one my ortho dreamed up to explain this to me. Maybe they have a book of those kind of phrases--and that's why they are being heard all around the world...
Maybe we need to put our heads together and come up with universal responses to them 
That could be good...We are pretty clever, and obviously good with words. Toss in a little pain medicine, frustration, and some fatigue, and I'm willing to bet we could put reason to this...
OK, my son is right--I am cynical.
Just a thought, Sylvia
Posted by hmaxwell (Heather M.), 20 October 2002
Sylvia,
In response to "we're just trying to buy you some time," we could say "Sorry, doc, but it's too darned expensive." Or my personal favorite, "Sorry, doc, but life is short. I'm the type who prefers to eat desert first."
Frankly, I feel like I'm on a budget with respect to time....buying years of knee health when I'm 60+ just doesn't seem appealing right now. At that point I'll be a grouchy, lonely, childless old person with a good knee! That is not something that sounds like fun.
Life is for living right now. Who knows, while waiting for the age of 60 to get a TKR, I could get hit by a bus or something.
Feeling a little bitter and cynical myself....
Heather
Posted by enuff81020 (enuff81020), 20 October 2002
LOL, Heather.
I agree with you though. This is the only part of my life where I'm hearing that I'm "only 47." The thing is that right now, I have a 4 year old and a job and kids and so on and so on and so on. i need to get around now--when I'm 70, I'm expecting all of these kids to be running for me--tee hee.
Here's another of my favorite phrases, "I know this is making your life h#ll." anyone have a good answer to that? (I have more too... 
)
I've got to run--oops, I know the smart answer to that! Sylvia
Posted by Tizzy953 (Tizzy953), 20 October 2002
Heather and Sylvia,
That is a great idea, make our own book of quotes. Heather I really like you "Doc, Life is too short". That couldn't be better. I just dont get it. What are we waiting for? We are young right now and if we had healthy knees, we would be doing so much more. when we are 60+ what are we going to be doing. I know at that age I won't be able to play softball, go hiking, bike riding. I won't be real young any more. I want to be able to enjoy being young. Live life to the fullest. I probably won't be able to do that at 60. What are we waiting for?
Kenzie
Posted by enuff81020 (enuff81020), 21 October 2002
Hey Sue,
We have so much knee stuff in common. I told my therapist that "I don't want to play anymore." and he didn't know what to say either. Maybe that needs to go on my Tuesday list for the OS...Last time, I mde a flow sheet for him to show him why this was a problem, but he gave me that line about knowing this was h#ll for me before I could pull it out.
Another of my favorites is when he asks me. "What are we going to do with your knees?" I can't think of any response to that that doesn't sound cynical.
Hey Wendy,
Are you feeling better? Iknow your big day is closing in and wanted you to know that I'm praying that this goes well and you get some relief from all of this fun.
Everybody, take care! Sylvia
Posted by enuff81020 (enuff81020), 22 October 2002
$80. washers--kind of sounds like the army's famous $100 hammers...
Who are they kidding--the days of anything to make a buck are gone?
good luck with your appointment as well--I'm sure praying for something here--since my doc keeps asking me what are we going to do with my knees. If he's not careful, I'm going to give him the spoon answer I give my husband! Sylvia
Posted by wendy (wendy), 22 October 2002
Isn't it amazing what they charge you for things that cost pennies at the hardware store. Sometimes I think I might just take a few nuts and bolts in with me. I'm sure I could sterilize them myself!
Really, I agree with needing to have some absolutley rediculous, yet serious, responses for these doctors. Come on, why are we asking the patient what to do? Maybe that OS should pay the patient for the consult rather than the patient paying him.
Good Luck witth the appointments for the week!!
Wendy
Posted by tazmanian_devil (tazmanian_devil), 22 October 2002
Has the OS ever said this to you? He said this to me when discussing a scope surgery,"Why don't you ask your husband what he thinks." I almost said, sure I'll ask my husband what he thinks, if you'll ask your wife what she thinks causes my knee problems. 
Theresa
Posted by Jennifer (Jennifer), 22 October 2002
It could be worse...I am unmarried, so my OS asks me to see what my parents think 
I am in my mid thirties 
I have gotten the buying time homily. My favorite are the philisophical statements...my OS said that I "would always be in pain, but I shouldn't become disabled" (Okay isn't pain disabling ? ? ?) He also said that I "would always have this PFS stuff". Then there was the lovely "it could be worse" which I responded to with "I'll trade you !" He declined way too quickly
Then a few months later I got a bad DX or my hips and he said that he "thought he could keep me comfortable". I asked him when he thought he might be sure...
Funny thing...I have Amer. with Disabilities Accommodations at work...I guess that means I am disabled.
We should all schedule to see our OSs on one day and give them all what for...could you see the phone lines lighting up across the world...it could be the international day of the knee patient...we just won't warn them
Jennifer
Posted by enuff81020 (enuff81020), 22 October 2002
LOL!!!
Can you see the conference rooms and phones when one doc says to the other, "Do you know what Ms. Knee said to me?" and the other doc says, "No, but Mrs, Knee told me that she didn't want to play anymore." And that doc gets a surprised look on his face and says, "Yeah, that 's exactly what Ms. Knee said." and then about that time, another doc walks in and says, "Now I've heard everything--Mr. Knee told me" and the other docs answer, "That he doesn't want to play anymore!" Tee Hee--do you think they'd smell a conspiracy?
I may sleep soundly considering how this could unfold...
Thanks for the laugh, Sylvia
Updated Sat Nov 21 2009
