KNEE ARTHRITIS - General principles of managing Osteoarthritis of the knee :
35 and no help for a worn out knee - - Posted by damianfawcett (damianfawcett), 31 January 2004
I have knee cap arthritis in both knees and to alleviate it my local hospital recently tried a lateral release (Nov 03). This has not only not worked it seems to have made it worse and now the OS says he can't do anymore as he feels I am too young for a knee cap replacement.
I am currently taking rofecoxib (25mg) but it no longer seems to help the pain and the locking that I experience through the day and, often at, night. I also have cocodomol (500/30) but although they give some respite I am reluctant to stay on these long term.
My next appointment is February next year (05) to determine if the condition has worsened but what do I do now?
Damian Fawcett
Posted by dm (dm), 1 February 2004
Are your kneecaps too damaged for an articular cartilage transplant? Thats where they take out a sample grow it in a lab and put it back in.
Have they gone in there and shaved the kneecap and trochlear groove and smoothed out the arthritic areas? Having a clean up done doesnt fix it, but can relieve the pain for a while, as far as I know.
If they did a lateral release and you haven't been doing any VMO specific exercises to help keep the kneecap pulled over, I don't know what benefit an LR would have. Do they say if the kneecap is still out of postion after the LR. That could have something to do with the pain. Have you tried wearing knee sleeves with patellar buttresses in them to help control the kneecap position?
Has he said anything about the condition of the trochlear groove? That's the channel the patella rides in. If you have a naturally shallow trochlear groove, that could make things worse, from what little I know of kneecap problems.
I really don't know what else might help, as I have some patellar tracking issues, but not as severe. My medial meniscus being almost gone and my joint space collapsed so that the bones ride on each other is my main problem. I'm 32, so I know what you mean by being young and nothing they can do.
Posted by MikeBetts (MikeBetts), 1 February 2004
hello.
just to add to the same line, im 31 and my knee is pretty awful as well.
Im not saying you can't fix it, there are methods, such as has been listed above, but do keep a level head on the perspective that some knee conditions simply can't be fixed and you are better managing with what you have.
That said, I havent given up the fight yet!
Mike
Posted by diaro (diaro), 9 February 2004
hello
in my opinion may help some Synvisc
Posted by damianfawcett (damianfawcett), 13 February 2004
Sorry for my delay in replying to your replies but a week in Amsterdam walking on cobbles nearly finished me off. At least I now know that I am not the only one with knees of a hundred and fifty year old. I apologise for not knowing all the terminology that you guys seem to know but I have just seen my GP and can at least try and have a conversation on your level.
The knee cap is very worn, too much for the articular cartidge transplant as what little was left was at best knackered. He did do a shave this time but what I forgot to mention earlier was that I had both knees shaved when I was only 15 years old due to problems I had been having for quite some time. My OS did a smaller shave this time and also cleaned all the debris away and the groove is quite prominent.
I have seen my GP for further advice but he is not that au fait with kneecap arthritis but tells me my OS is extremely good and would not not treat me further if he didn't have a good reason.
Diaro what is synvisc? I am intrigued.
Cheers,
Damian.
Posted by hmaxwell (Heather M.), 13 February 2004
Damian,
I'm suspicious of doctors who say that they can't help you further because 'nothing can be done.' More correctly, it should be that they don't know how to help you further.
I've discovered a definite branching of schools of thought in orthopedics. One school says that we are all going to get arthritis and the interventions are less than 100%, so those unfortunate few with early arthritis should just learn to live with it until they're old enough for a total knee replacement. I had one doctor from this school of thought who told me to "get a cane and get used to pain" at the age of THIRTY-TWO!!! These doctors are usually good for one or two tries at fixing the problem, but if results aren't good they throw in the towel.
The other school of thought is much more focused on quality of life. These doctors tend to see younger and more athletic patients who have used up their knees or people like me with congenital problems. These types of doctors look at things like cartilage restoration techniques (ACI/Carticel, mosaicplasty, microfracture, etc.) to help improve the quality of life of patients who are too young for a total knee replacement. They often tend to be knee specialists.
So I guess my advice to you would be to see one of the latter types of doctors who is up with the latest treatments for younger patients with worn out knees. There are many non-surgical ways to deal with this problem, SYNVISC or HYALGAN among them.
The best place I've found that explains the situation and options would be: 1) the Steps to Enlightenment on the upper right corner of this page. Read it all, with a focus on Step 5 Patellae. 2) This is a web page for my surgeon, one of the pioneers for non-invasive cartilage restoration http://www.steadman-hawkins.com/patientEducation.asp reaad the sections about knees, especially the chondral defects, patello-femoral pain, and microfracture. Also, the TKR section might be of interest. 3) http://www.patellapain.com This is a fantastic, if slighly technical resource. Slog on through the different sections dealing with patellar damage. This goes through the realignment surgeries that are designed to unload a damaged patella and may be an option for you.
Finally, just an observation: doctors who don't perform these more sophisticated or intensive intervetions for patella damage tend to be very negative about them. The difference between a good doctor and a not so good one is that a good one will TELL you about these other options and even refer you to another surgeon who does them. A not so good doctor will tell you there's nothing else to be done....what he/she means is there's nothing else that he or she can do. BIG DIFFERENCE.
Anyway, you've got a lot of research to do, because it's really best to be well-advised about your condition. That way you can respond if someone gives you crummy advice. It pays to be educated and involved in your case. As I've advised repeatedly on this page, you've got to interview a whole panel of doctors, research your condition, then pick the doctor whom you trust and whose recommended treatment you can live with. That's the most anyone can do.
Heather
Posted by damianfawcett (damianfawcett), 23 February 2004
Sorry for the delay in replying but two young children mean my signing on time is limited.
Heather,
Thank you for your advice ( I bow to your superior knowledge). I am currently reading up on the websites you listed trying to get to a level of understanding that will at least show my doctors that I at least take this seriously, and will take the time to educate myself so the discussions are a two way conversation as opposed to the nodding dog they currently see. I assume that by your level of understanding you must have the same, if not worse, knees that I do so I guess I won't be seeing you on stage in Riverdance/Lord of the dance anytime soon.
Regards,
Damian.
Updated Sat Nov 21 2009
