Banner - Hide this banner





Author Topic: Lidocain Injectn 2 Mimic TKR? (Was Bilat TKR? 35yo w/ hereditary birth defect..)  (Read 6545 times)

0 Members and 1 Guest are viewing this topic.

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
For those of you who've read this thread hit PLEASE go to my posting 2/27 to see a NEW TWIST
  Click here to go there quickly


Male, DOB 3/3/1969
Diagnosed with Nail Patella Syndrome in 1969  (see Google for more on the rare birth defect callled 'nail patella syndrome' - or goto www.nailpatella.org )

Several Questions At Bottom.

Patient History Overview:
•   Diagnosed with NPS in 1969; paternal grandmother was a physical education teacher and noticed abnormalities with my knees while bathing me.
•   No known relative has ever been diagnosed with NPS
•   With that said, my father has only one kidney; his left kidney was removed and was hydronephrotic. His doctors believe that the left kidney never functioned.
•   My father also has (had?) glaucoma – which has led to two (2) surgeries that involved draining the vitreous humor (sp?) from his (same) eye.
•   I have one biological sibling – with ZERO problems as of yet; he is now 31 ˝ yrs old. His two children (boy 7 yo & girl 5 yo) seem to have zero problems.
•   I had vasectomy in 1987.
•   In the late 1990s or so I had genetic testing done by an MD @ Stanford that is studying NPS – and was told that I have a mutant version of NPS; I guess meaning that I didn’t inherit it.

Affected Parts of Body:
•   Both knees are affected (more later). Originally had patellae that were approx 1/7th the normal size.
•   Knuckles are sore easily; diagnosed with mild osteo-arthritis
•   Both elbows – the joint space is abnormally close. R elbow clicks routinely … pressure ‘builds’ up and I relieve it by snapping outwards. I AM able to extend fully. Also bony spurs on outsides of each.
•   Pelvis is slightly deformed. the hip sockets are too parallel; sitting on motorcycles, horses, etc is painful after short amount of time.
•   L side of rib cage is slightly deformed; bottom rib bends in.
•   Both shoulders get sore easily – and excessive usage is uncomfortable.
•   Feet routinely sore; I believe this is due to my attempting to absorb blows of walking to ‘save’ impact from my knees.
•   Kidneys: have had proteinuria and other related issues a few times. I do fool blood tests every 6 mo.
•   Teeth: extremely soft teeth; tons of cavities regardless of flossing & 2x per day brushing. Several teeth had 2x adult teeth.
•   Nails: Thumb nails are typical of NPS. Little-toe nails are screwy; thick, small and almost missing.

Knee Overview:
Multiple surgeries:
1.   Total reconstruction surgeries – 1982 - 1985… 4x surgeries that brought my chronically dislocated patellae to be properly located… and track correctly. This was done by criss-crossing the tendons that were attached to the top of my patellae.
2.   In 1990 & 1991 (or so) had patellectomies – as knees had deteriorated extensively.
3.   Over the years have had A LOT of cortisone injections into knees.

Current Situation (Continued Patient History):
Knees deteriorated to extent that I relocated back to the USA (from Asia; China PRC), as I spent one month in 2003 virtually useless. Over a 10 week period I alternated (not combined) Vicodin, Naprosyn, Scotch, Chinese Medicine (acupuncture, acupressure, herbs) and found virtually know release. At end of 10 week period I believe I got ‘accustomed’ to pain.
Having relocated, I’ve sought an MD and have discussed my history, as well as current situation. He has recommended we do a Total Knee Replacement, and we have discussed (and I like) idea of doing them bilaterally (at the same time). He has ‘approved’ the surgery, and we are ‘trying’ to find a 2nd surgeon to handle the other knee. (We’ve discussed using a Depuy Mobile Bearing joint)

THE ISSUE:

Without going into the minutia, let’s assume:
•   The provider is fairly well known for (semi?) systematic attempts at slowing down patient treatment
•   I’m very good at being nice, or an ass – depending on requirements of ‘the system’
I met one of the surgeons (Dr P) we were trying to get to do the ‘other’ knee
•   First meeting was in August; it resulted with him sending me to Rheumatology for an eval (spurred I think by my saying that in the mornings when I awake my feet are usually sore).
o   No rheumatoid arthritis, nor any other joint disease found by testing
•   He sent me to MRI, Nuclear Bone Scan, X-ray, and CT scan.
•   I recently returned to see him (2 wks ago)… and was (I think) understandably PISSED about the amt of time that has passed.
•   All of my file was in another center (about 60miles away) – so all we had in front of us was each other an the computer terminal.
•   Dr. P. proceeded to tell me many things, including:
o   My knees are ‘average’ for a 35 yo male
o   According to the Radiologists report, I have mild arthritis in each knee
o   He ‘doesn’t recall’ that I have any structural abnormalities of my knees – and went so far as to call them ‘normal.’
o   My cartilage is basically intact, and not bad, as per his recollection (6 months since seeing my x-rays)
•   We discussed how some people with no cartilage at all occasionally have no/little pain and therefore don’t merit total knee replacements … and vice versa how some people with some cartilage have LOTS of pain.
•   We finished off our merry chat by me asking him for next steps. He tried to not answer…. Which I didn’t allow; I stood in front of the door.
•   He proscribed a cortisone shot in my ® knee – and for me to come back for a review in 3 wks. I concurred. I asked what the next steps would be –as one can’t have cortisone for ever.  He didn’t answer.
•   Having had about 1 wk go by since the shot – and frankly it did almost nothing for the pain – I’m fed up, slightly confused, and continue to feel like I’m in need of some righteousness.

I don’t want another surgery … but I’m tired of not being able to play with my kids, do anything physical, etc.

As per NORMAL, I’m afraid of more surgery, but it’s SO EASY to have done – it’s the Physical Therapy I don’t want.

My opinion has always been that I definitely don’t want 3 mo of PT, then 2nd surgery with 3mo of more PT. (I’d rather do both @ once, and then 4 mo of PT).


So, I’d LOVE some feedback:
1.   Have you had Total Knee Replacements? Know someone who has? Have strong feelings about them?
2.   What experience/thoughts do you have about doing both knees at the same time?
3.   What VIABLE alternatives are there to TKRs? (Cortisone isn’t working, and I’m not doing a Darvocet like narc for the rest of time– had a horrible experience)
4.   How much pain do you allow yourself to absorb before you realize that putting in metal knees for 15+ yrs and having a (more) normal life is SO worth it. (Especially as I have two boys (not my DNA) with whom I’d love to run around & play)


Looking forward to your feedback, questions.


Thanks,

Rawsushi
Quote
« Last Edit: February 27, 2005, 08:57:03 AM by rawsushi »
Carpe Diem

Offline kath

  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 2087
  • Liked: 0
  • User's Text
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #1 on: February 16, 2005, 03:24:27 PM »
Hi Rawshusi....I found your history very interesting.  I wasn't aware of NPS and visited the website you provided to learn more.

You may wish to read the post on Feb 7th by Marilyn under General Knee Questions and Comments.  She also is asking the merits of having bilateral TKR vs one at a time.  People have given various insights...be sure to read the response by Teresa S, as her answer is something important to think about.

I had bilateral PKRs 3 months ago.  While there is a world of difference in recuperating from PKR vs TKR, I can tell you it is very debilitating to be without the use of both legs.  Having said that, it was the right choice for ME and I wouldn't hesitate to do it again. 

I hope you find some answers on this site.  Your history is unlike anyone elses I've read on here, but I know you will get some advice and help!  It may not hurt to also get 2nd or 3rd opinions on your situation...Dr P did not sound at all prepared for your consult!

Good luck!  ...Kath
Bi-lateral unicompartmental Nov 2004

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #2 on: February 16, 2005, 06:47:56 PM »
Thanks for the reply.

Will check out the comments you noted.

Also, do you have thoughts / input on ages? I know that 35/36yo is young to have it ... but every site I visit has a list of questions to which if YES is the answer the result = have the TKR. I get YES on all.. not to mention that my surgeon is the Chief of Ortho... and Dr P is the only MD I've ever run into that has memorized someone else's patient's Xrays from six months prior. (ha ha. Believe that and I've a bridge in Brooklyn for you)

Actually, I went to Member Services to discuss immediately after the consult with Dr P - and they said it was amazing that he'd not have my films, and go onto say he recalled them being anything. Not being an orthopaedic surgeon, i've no idea how many consults he does a week ... but figure it has to be in excess of 25. So 25 x 4.3 wks/month x 6months is in excess of 600 patients besides me.


« Last Edit: February 17, 2005, 07:02:14 AM by rawsushi »
Carpe Diem

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 13
    • Check out my photography!
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #3 on: February 16, 2005, 07:41:41 PM »
I'm in pretty much the same situation, with debilitating knee pain.  There is quite a debate going on about whether to do early TKR's...I've been told I need one, then had that decision reversed when the MRI's showed relatively good cartilage through much of the knee, with a couple areas of deep damage.  So anyway, the story I got was that when the patient has relatively good cartilage (with the exception of a few bad spots) then you can't be certain that the cartilage damage is what is causing the pain.  And so, you could go through the whole TKR and find out it didn't resolve your pain.  Some people on this web page are facing this, and it's very traumatic.

So I was told to continue with my pain management, frequent cleanup scopes, PT, and accepting that I will have knee pain.  I'm not sure how into this plan I am ;) ;)  I am going to see some doctors that do work on focal defects--ACI and OATS procedures--to try to restore focal cartilage damage.

I think the problem your second doctor encountered might have been a lack of certainty that your pain was solely from cartilage lesions.  You might want to read Dr. Grelsamer's web page and book:  http://www.kneehippain.com   He has done extensive work in the field of PF damage and has amazing information on potential causes of patellar pain.  You would do well to read up on that.

One thing I can't comment on is how your genetic syndrome might affect the decision to replace the knees early or not.  You're in uncharted territories there....sorry.  I wish I could help further, but all I can do is point you to the patello-femoral joint section to read threads on articular cartilage damage.  You're in good company there, unfortunately....

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline kath

  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 2087
  • Liked: 0
  • User's Text
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #4 on: February 16, 2005, 08:31:29 PM »
Rawsushi..one thing to keep in mind is that TKR can not be reversed...there is NO going back once done.  Yes, they can be revised but it's said that revisions are not as successful as the originals.  Having said that, technology is improving every day and by the time you need revisions, a better knee or revision may be on the market.

I've suffered from OA since my 30's...I am now just turned 50.  My first appt with an OS was 15 yrs ago...he felt at some stage I would end up in a wheelchair.  He sent me to physiotherapy and ultrasound and I'm afraid to say I discontinued it (didn't like the therapist!)...life went on and I managed with chronic pain for years.  The past 3 years were the worst, and the length of wait time to see an OS had increased tremendously.  When I finally saw one in 2004 it was expedited because my sports medicine doctor thought I had a torn meniscus along with severe OA.  My OS immediately suggested an osteotomy to be done separately on both legs, OR TKRs....BUT, he also recommended I first get a second opinion and see someone whose expertise lay in replacement surgery.  Six months later, this second OS did not feel I was a candidate for an osteotomy as the arthritis was very severe in my right leg, but he felt he may be able to give me PKRs...but wouldn't know until he was actually in the knee.  Bless him, he was able to do the PKR on the right instead of a total, and I feel his expertise is what allowed me this extra time before having TKRs.

There are other options beside total replacements, but it does depend on where your damage is and what else is involved.  Partials can be done if the OA is limited to one of the 3 compartments in the knee (mine was the medial).  Perhaps synvisc is something which can buy you time.

Like Heather says, there is no way to know how your situation would affect you in having your knees replaced this early (not only for your legs, but also your arms...lot of weight taken on by the arms for crutches etc).  Heather is one of the most knowledgable kneegeeks on this site, and I would listen to her advice any day! 

The question you asked regarding how much pain do you allow yourself to absorb before resorting to surgery?...it all depends on the quality of life you wish to have and how happy you are now....only you can decide what is best for you.  I would whole-heartedly recommend doing what you are doing...researching, reading, asking questions.  Total Knees are FINAL...so be certain you have ALL the information you need, including second opinions from OS's who specialize in replacements, in order to make an informed decision!

Kath
« Last Edit: February 16, 2005, 08:33:03 PM by kath »
Bi-lateral unicompartmental Nov 2004

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #5 on: February 16, 2005, 08:48:13 PM »
I'm in pretty much the same situation, with debilitating knee pain. 
Sorry to hear that. 
Quote
There is quite a debate going on about whether to do early TKR's...I've been told I need one, then had that decision reversed when the MRI's showed relatively good cartilage through much of the knee, with a couple areas of deep damage. 
  Thanks for this information - it is the first time i've ever heard of it... and having spent 20+ years in front of MDs it's nice to get new/additional information from whatever source; shame that some of the MDs that are facing patients like us have such a difficult time discussing this information.

Quote
So anyway, the story I got was that when the patient has relatively good cartilage (with the exception of a few bad spots) then you can't be certain that the cartilage damage is what is causing the pain.  And so, you could go through the whole TKR and find out it didn't resolve your pain.  Some people on this web page are facing this, and it's very traumatic.
  Now is when I wish there were an MD consulting on this thread. I don't understand this section at all and truly want to. As i understood/understand? it, the cartilage & other bony areas of the knee are cut-off.

If/as those are cut off, how exactly does the cartilage remain there to cause the pain?
Those images taken from
http://www.jointreplacement.com/xq/ASP.default/pg.list/sel.253/list_id.40/mn.local/newFont.2/joint_id.6/joint_nm.Knee/local_id.36/nav./qx/default.htm

Quote
So I was told to continue with my pain management, frequent cleanup scopes, PT, and accepting that I will have knee pain.  I'm not sure how into this plan I am ;) ;)  I am going to see some doctors that do work on focal defects--ACI and OATS procedures--to try to restore focal cartilage damage.
I"ll read more about ACI and OATS - know idea what they are.

I've done the whole forget about it - it doesn't hurt pain management.... my birthdefects have a kidney component that I don't want to aggrevate; my meds are usually Aleve (naprosyn) or nothing.... of course a few glasses of wine/beer are good too.

I'm done with this mode of pain management - although I have done it successfully for 15 yrs... now my knees hurt all the time - and so much that i' m a complete SOB to be around a lot of the time.
Quote

I think the problem your second doctor encountered might have been a lack of certainty that your pain was solely from cartilage lesions.  You might want to read Dr. Grelsamer's web page and book:  http://www.kneehippain.com   He has done extensive work in the field of PF damage and has amazing information on potential causes of patellar pain.  You would do well to read up on that. 
  Thanks - will do. I wonder how much will be pertinent as I no longer have kneecaps.
Quote

One thing I can't comment on is how your genetic syndrome might affect the decision to replace the knees early or not.  You're in uncharted territories there....sorry.  I wish I could help further, but all I can do is point you to the patello-femoral joint section to read threads on articular cartilage damage.  You're in good company there, unfortunately....

Heather

Thanks again Heather.
Carpe Diem

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 13
    • Check out my photography!
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #6 on: February 16, 2005, 09:36:07 PM »
Hi again.

We do have an MD who reads posts on this board--Dr. Grelsamer.  Of course, there are 7,000+ of us, and only one of him.  So that's why I suggested that you read up on his web page and book, because he's a very, very smart guy.

One thing I wanted to stress again:  the question that Dr. Grelsamer and others raise in folks like us--who have focal defects, but in all have knees that "aren't so bad" when compared to others with massive lesions and bone spurs--is that one cannot be absolutely certain without vigorous testing that the actual patellar lesions themselves are causing our pain.  In my case, you have to look at scar tissue as a culprit, along with severe soft-tissue restrictions due to repeated surgical trauma.  I believe this is called myo-fascial pain syndrome.  And then there is the potential for nerve damage--ruled out in my case, by extensive testing by three separate specialists in the space of two years. 

So anyway, just because a patient has pain AND has chondral defects, it does not mean that the defects cause the pain.  Especially when there are repeated surgeries involved.  Unfortunately there is not a one-to-one relationship between size/depth of defect and pain levels.  A person with severe defects and even bone spurs can have relatively little pain.  Another patient with mild to moderate focal defects might have crippling pain.  There is no straight and inarguable relationship, and this unfortunately means that replacing the knee (and thus removing the lesions) wouldn't guarantee a resolution of the patient's pain.  That's what I meant by TKR surgery not resolving everything.

Usually, it's important for patients like us to be seen in a multi-disciplinary pain clinic.  You don't want to see someone who JUST prescribes meds, or who just tells you to visualize a happy place when you have pain!  You need nutritional therapy, a doctor who treats the whole patient (not just a joint or two), a PT, a great massage therapist, a neurologist to rule out nerve damage or other issues like that, an OS who specializes in PFJ problems, an acupuncturist, and so forth.  I have about six different things I do for my pain on a daily basis, and no one is the silver bullet...but together they help make my situation more bearable.  If you haven't seen a great, talented, caring pain management physician, please don't dismiss the whole specialty!

Heather
« Last Edit: February 17, 2005, 08:07:24 AM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
Re: Bilat TKR for 35yo male with hereditary birth defect? Advice pls!
« Reply #7 on: February 17, 2005, 03:19:19 AM »

We do have an MD who reads posts on this board--Dr. Grelsamer.  Of course, there are 7,000+ of us, and only one of him.  So that's why I suggested that you read up on his web page and book, because he's a very, very smart guy.

I'd just finished reading his site - and ordering his book. 
Quote

One thing I wanted to stress again:  the question that Dr. Grelsamer and others raise in folks like us--who have focal defects, but in all have knees that "aren't so bad" when compared to others with massive lesions and bone spurs--is that one cannot be absolutely certain without vigorous testing that the actual patellar lesions themselves are causing our pain. 

I wish I knew how I'm supposed to get the pain diagnosed accurately. I mean, I only worked in ORs and ERs for five years as an EMT - I have never done anything but retain info from conversing with OSs, and other MDs.... certainly I shouldnot need to be the one to go to any Orthopaedic Surgeon (OS) at Kaiser and say you need to do X Y and Z more. (Although I'll definitly be doing just that the next time, but i shouldn't NEED to.

I'm to the point now where I feel like i'm piloting an airplane, and all I've ever really done is fly first class and economy class a bunch.

« Last Edit: February 19, 2005, 02:52:06 AM by rawsushi »
Carpe Diem

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
Sitting down hurts
« Reply #8 on: February 17, 2005, 03:33:05 AM »
As I just had the cortisone shot last week, i've now been doing the opposite of my normal. Instead of having my brain ignore pain/discomfort from my knees I've been actively analyzing my 'feelings'.

Dawned on me tonight driving home in my truck that just sitting in the bucket seat really aggravates my knee after about 10 minutes. I get increasingly sharp pain in the middle of my R knee, radiating out towards the medial condyle, up my femur, and down the outside of my tibia.

Weird. Strike any bells for anyone?
Carpe Diem

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 13
    • Check out my photography!
It does indeed ring several bells....look up "theatre sign" and "movie goer's knee" to look up the problem.  Basically, when you have damaged cartilage on the back of your patella, and when you sit with legs bent almost to 90 degrees or more, then the damaged area is 'loaded' or in contact with the joint...this puts pressure on damaged cartilage, causing pain and swelling in some people.

It's the main thing keeping me from working full time...as an author, there is simply no way to finesse the need to sit at a computer in order to work, though I'm trying some alternative workstations (without great success, I might add).

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline AndrewC

  • SuperKNEEgeek
  • *****
  • Posts: 535
  • Liked: 2
  • User's Text
Hi...Just a quick point that Im not sure Heather has realised?!

Quote
Basically, when you have damaged cartilage on the back of your patella

As rawsushi has had Bilateral Patellectomies (eg/ has NO PATELLAS) this type of scenario is not really relevant I don't think...but it does Significantly change the ballpark in terms of TKR difficulty as I have read a number of articles on the extra difficulty this adds to the equation (I will scan and post them if you are interested rawsushi as they are in medical "tomes" rather than the web :)  )

Also, I too do not understand the relevance of cartilage pain / bone spurs after TKR since the end of the Tibia and Fibia are sawn off.....and all cartilage between is removed during a TKR??.....

All the best
Big bucket handle tear to lateral meniscus from sporting injury. Arthroscopy and meniscal repair carried out June 2004. sloooowwww recovery!!

2018 - torn medial meniscus in RH knee, partial extrusion. ongoing issues,

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
Hi...Just a quick point that Im not sure Heather has realised?!

Quote
Basically, when you have damaged cartilage on the back of your patella

As rawsushi has had Bilateral Patellectomies (eg/ has NO PATELLAS) this type of scenario is not really relevant I don't think...

I wonder if it is still relevant or not.

In my particular instance, due to my birth defects, http://www.healthatoz.com/healthatoz/Atoz/ency/nail-patella_syndrome.jsp I had great trauma done to my knee joint for the first 13 yrs of life due to permanently dislocated patellae. Then in my early 20s I had both removed.  What doesn't make sense is that the pain has increased over the last 15 yrs (since patellectomies).

Quote

but it does Significantly change the ballpark in terms of TKR difficulty as I have read a number of articles on the extra difficulty this adds to the equation (I will scan and post them if you are interested rawsushi as they are in medical "tomes" rather than the web :)  )

Pls scan them and post - and email me a copy if you would / could.  I'm very interested in them.

Quote
Also, I too do not understand the relevance of cartilage pain / bone spurs after TKR since the end of the Tibia and Fibia are sawn off.....and all cartilage between is removed during a TKR??.....


Still looking for this kernel of information. Anyone?

Carpe Diem

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 13
    • Check out my photography!
Yep, I missed that whole patellectomy thing--yikes.  Sorry.  It was late, what can I say.

I still think the pain mechanisms might hold, however, patellae or not.  Those who have a patellectomy are at risk of anterior tibio-femoral lesions from the ligaments rubbing relentlessly back and forth.  I'm no expert on biomechanics, but I would think that having the legs bent at 90 degrees would increase the rub?  Maybe not.  Maybe I should get more sleep....;)

If you want to look up articles, try http://www.findarticles.com  The search engine can be a little snarky--sometimes it works, sometimes it returns nothing, even when you have the full article title.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline rawsushi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 39
  • Liked: 0
Lots of New Info - Bilat TKR
« Reply #13 on: February 27, 2005, 08:06:34 AM »
So it's ten days since I made my first post to this board ...  and I have a BIG update to the thread.

On Tue Feb 15th I started taking Darvocet @ night for pain – as I hadn’t been sleeping. I took it Tue, Wed & Thur nights.

On Fri Feb 18th my OS called  – Dr. W.  :) I feel that not only is Dr W a good doctor, but I like him too. Anyway, we discussed my situation,  and my frustrations. Frustrations with Dr P, as well as my overall concerns and fears. While discussing with him we rehashed how/ why my pain might not go away with a TKR.

Paraphrasing, the reasons for knee pain are (and not limited to):
  o cartilage
  o bone (the bones have nerves too)
  o sinovial (sp?) pain (I understand this to be the sack around the whole joint)
  o tendon / ligament
So, as in a TKR, the cartilage and some of the bone is removed … if the pain is generated by anything else, the patient is in a worse situation. (hope I’m recalling it well).

So, I said, I wish there was a way that we could “be more sure” of the situation – and I asked if there wasn’t some way that we could test the scenario.  He suggested that we do an intra-knee joint injection of lidocaine – as the lidocaine will numb up the cartilage pain receptors and therefore my knee will mimic one that had a TKR[/b].  I love the idea. 

So, I was to go on the following Tuesday to have the injection….  Boy was I excited.

And then enter the Partially Obstructed Bowel. Joy joy joy. And not my first time. I’m sensitive to many of the stronger meds and had forgotten that fact ( I don’t like to take the strong stuff at all) and in addition, had basically been eating an Atkins diet…. So with my digestive track slowed down @ night due to the Darvocet, and the copius amts of steak & chicken sans veggies, I found myself horribly constipated, hello liquid diet. Sunday the fevers started. By Monday I did the math, and realized I had retained 4+ days of food. Monday night I vomited food – some of which had been eaten 24hrs earlier. Tuesday morning, having sweat thru 4 tshirts I went in and had xrays. As I’d put myself on liquids (except for Sunday’s dinner) on Saturday, my General Physician (GP) was ok with not admitting me, as it appeared that I had suffered the worse of it. My GP put me on a very imaginatively named “clear diet” of his own:
The OK List:
-   apple juice
-   water
-   soup broth
-   boiled chicken soup (including the boiled chicken)
-   mashed potatoes
-   white rice
(There was TONS OF discussion about how he conceived of the name .... and the best part was he , GP, is totally againste orange juice on this diet).

Wednesday was great – a BM…. Ah, the simple things in life.


So, while I’m now, thankfully off of the ‘Clear Diet” – I’m not 100% back to normal.  But getting there. And who really wants to read this drivel... this isn't a website for diarrhea, nor other nastiness.... Sorry.


Then on Friday 2/25, I received an email from someone I've never met... but who has heard about me from another internet site - GR, who is an Orthopaedic Nurse that works for a mfg of prosthetic knees. He’s in the OR daily for TKRs…. And his comments in Bold Blue follow my questions in black bold

Have you had Total Knee Replacements? Know someone who has? Have strong feelings about them?

As I said above, I see TKR's on a daily basis (about 250-300/yr. I know many people who have had TKR. TKR is a great surgery in the RIGHT situation. The best candidate is someone older that 60-65 yrs old, who has a sedentary lifestyle.  In the experience of the orthos I spoke with younger people don't do as well after a TKR. It should only be done in someone 35 yrs old as a LAST resort, and even then the results will be unpredictable.
 

What experience/thoughts do you have about doing both knees at the same time?
 

I do know surgeons who do both at the same time.  However, the surgeons I spoke with rarely do both at the same time. The complication rate increases substantially when doing both at the same time. I can actually recall one instance where a patient died after having both knees done at the same time.  Such situations are usually reserved extreme circumstances (such as for people who are wheelchair bound or will be otherwise unable to rehabilitate themselves if only 1 knee is done).
 

What VIABLE alternatives are there to TKRs? (Cortisone isn’t working, and I’m not doing a Darvocet like narc for the rest of time– had a horrible experience)

Here is where the problem lies with regards to your situation. If you have tried "conserative" measures (cortisone/NSAIDS/ physical therapy) then obviously the alternatives are quite limited. You are obviously very young for a TKR due to your activity status and the fact that in the best of situations you would likely need "revision" surgery at a later date.  Also, the past surgical history you discribe (tendon transfers, patellectomies) decreases the likelihood you would have a successful outcome. It is a well documented fact that people with no patella have a poorer outcome after having a TKR.
 

How much pain do you allow yourself to absorb before you realize that putting in metal knees for 15+ yrs and having a (more) normal life is SO worth it. (Especially as I have two boys with whom I’d love to run around & play)
 

This is a question only you can answer. Several things to keep in mind when making a decision to have a TKR, given your situation:
 
1. 35 yrs old is very young for a TKR given the activity status of young people, and the fact that in the best of situations a TKR while usually last an average of 10-15 yrs before needing to be "revised" due to the prosthesis "wearing out".
 
2. When doing both at the same time the complication rate rises significantly.
 
3.  The surgeons I spoke with all agree that your outcome would be very unpredicable. All feel that you could quite possibly have a less than desireable result (such as no pain relief, or even more pain) given your previous surgical history. 
 
Only you can make the decision to have a TKR.  Just keep in mind your outcome will be unpredictable.  Obviously the desired result would be for you to become "pain free", but unfortunately no surgeon can guarantee you that and be telling you the truth.
 
I hope I have answered your questions .
 
Best Wishes,

GR




I post this as many people read & commented, some questioning along with me … and hope that it helps.

Additionally, it’s great to see comments for those of us battling with the confusion of “the next step.” Especially in light of GR’s expertise, caring, and experience; not to mention the 3 OSs that GR spoke with.


So, MY BIGGEST question… what do those of you think of the Lidocaine injection idea to mimic the results of a TKR?


[FYI: My OS and I discussed it with the logic being if it causes the pain to go away then it’s a GO for surgery. If there is still a significant amt of pain then I’ll need to evaluate if the ramifications are appropriate. If same amt of pain then I’m back at square one.]


Rawsushi
Carpe Diem

Offline kath

  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 2087
  • Liked: 0
  • User's Text
Hi Rawshushi, I think the big question you need to ask yourself is "what do I have to lose by trying the lidocaine?".  If indeed it does mimic a TKR...and I've never heard this...maybe someone out there knows the answer...then why not try it.  Providing of course it doesn't have any harmful effects to the knee.  I do wonder though, if lidocaine mimics a TKR, why it's not used frequently to determine options for people considering a TKR?

I think it's important to understand what GR is saying...there are no guarantees with a TKR...that applies to everyone!  How many people on this site do we read about who have had a TKR with varying results?  Some are good to go after several weeks of rehab, and other still suffer to this day.  We are each different in the way our knees and legs are formulated, and what works for one may not work for another.  Dealing with solutions to our knee problems is always a gamble...sometimes for the good, and sometimes not.

Personally, I came to the limit of my pain threshold and was willing to consider all the options given to me.  I researched, (as you are doing), had second opinions, and finally made a decision based on what I felt I could live with.  Guarantee or no guarantee.

If indeed there are no negatives to the Lidocaine, then why not try it?  If it works for you and does indeed mimic what a TKR can do for you, you simply have more information to base your decision on.

Good luck Rawsushi!  I'm glad your other problem is under control!  Keep it in mind when taking those meds! ...Kath

Bi-lateral unicompartmental Nov 2004















support