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Author Topic: What To Do?  (Read 1188 times)

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Offline marzydotes

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What To Do?
« on: April 12, 2005, 08:42:02 PM »
Hi!
I'm new to this site/board and not sure if this is the right place to post this message.  I just had an MRI of my left knee and I have a torn menicus and arthritis.  My PCP is recommending tkr but I would like a second opinion.  I have not been on any pain meds nor have I had any PT and I have not seen an orthopedist as yet.  The whole leg hurts now and I've noticed it's starting to hurt going up stairs.  Down is not so bad.  So I guess my real question is what do do and how to start?  I think that tkr would be after I exhaust all further options, but if anyone wants to write, please send some advice.  Many thanks.

Offline Heather M.

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Re: What To Do?
« Reply #1 on: April 12, 2005, 08:54:43 PM »
If you have no pain...well, if it ain't broke, don't fix it!!  TKR is only to be done when, as you've said, every other option has been done and the patient is still in life-altering, daily agony.  To do it for any other reason is odd.  And frankly, your PCP isn't qualified to say what you need!  It may be that with some PT you'll strengthen the joint and do great.  Or you may need the torn bit of meniscus removed--it could be that is responsible for your pain.  The level of arthritic damage you have is RARELY directly correllated with the amount of pain you have.  Meaning that just because you show some arthritis on the MRI, it doesn't mean that is responsible for your pain.

I'm not sure what your insurance situation or requirements are.  And I can only speak to the US system--If you are on an HMO in the US, often you need to get a referral from your GP/PCP to see an orthopedic surgeon.  If you have a PPO plan, often you don't need to do this referral.  So I would take my MRI and find a good surgeon in your local area and talk with him/her about your knee situation.  Believe me, if you are not taking any painkillers and are only getting twinges when you go on stairs, that is not usually something that would indicate surgery!  Try PT and strengthening work (under the supervision of a specialist) first to see if you can get things better.  Stop impact exercise and try riding a bike or swimming for a while.  OTC's like advil or aleve can be helpful, if your GP says they are okay for you to take.  A Cox-2 like Celebrex makes a huge difference in the amount of daily pain that I have.

I recommend that you read up on the subject by picking up Dr. Grelsamer's book:  What your doctor may not tell you about knee pain and surgery.  You can get it on Amazon.com.  Dr. Grelsamer's web page is http://www.kneehippain.com  Go to 'for patients' and read up on the arthritis and meniscus topics.  Depending on your age, the chances are quite good that you can avoid a TKR for years, since you don't have severe daily pain.  That's really the best news possible!

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
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Offline ATsoccergirl

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Re: What To Do?
« Reply #2 on: April 13, 2005, 02:53:26 AM »
Your first step should be to get an orthopedic referral.  GP's are by no means qualified to make such a recommendation. 

The treatment of mensicus tears are changing now because OSs are now beginning to realize how detrimental removing part of the menisus is.  The newest recommendation is to attempt a repair first, and only remove the tear if the repair fails.  Although the rehab is slightly longer, the long term outcome is much more favorable.  It also keeps the door open for other interventions in the future which aren't possible without a fully intact mensicus.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline marzydotes

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Re: What To Do?
« Reply #3 on: April 13, 2005, 02:36:31 PM »
Thanks to both of you for your quick replies.  Your advice does make me feel a little better and I will consult w/my PCP tomorrow.  But I would certainly go to a specialist before making any kind of move for surgery.  Today the knee feels almost 'normal' but who knows when it can 'flare' up again.
After reading alot of articles on tkr, it sound very scary and, hopefully, I will be able not to have it done yet.  My age is 57 and from what I've been told, I'm a little young for that operation.  Does anyone have any thoughts on age range for tkr's?   :D

Offline hottubpam

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Re: What To Do?
« Reply #4 on: April 13, 2005, 03:02:20 PM »
From what little I know about TKR's (my brother-in-law had one), the older you are the better.  My understanding is that TKR's "last" for 10-15 years and can only be revised once, after that you may be wheelchair bound.  I'd delay it as  long as possible.

Use the search engine on this bulletin board, type in TKR and you should find a lot of info.

Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline marzydotes

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Re: What To Do?
« Reply #5 on: April 13, 2005, 07:06:42 PM »
Thanks, Pam.  Good advice.  I'll try that.  Everyone has been soooo helpful here.  This is a good site and I'm glad I found it.  Hope all is well w/everyone.

Offline Teresa_S

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Re: What To Do?
« Reply #6 on: April 13, 2005, 07:51:08 PM »
With no research, and materials for the prosthesis they are hoping the prosthesis will last 20-30 years now. BUT the first thing would be some therapy, and an unloader brace might really help, I wore mine for 3 years. A scope might help with the arthritis and buy you over a year before the need for tkr, even should it turn out to be imminent per the OS. Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline marzydotes

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Re: What To Do?
« Reply #7 on: April 13, 2005, 08:23:18 PM »
Okay.  Please excuse for being so 'uninformed' or 'dumb', but what is an "unloader brace"?
Thanks for the advice.   :D