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Author Topic: Should I have Another Operation?  (Read 1849 times)

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Offline William

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Should I have Another Operation?
« on: June 12, 2006, 02:44:08 PM »
Hello
Itís about two years now since I had a Arthroscopy on my right knee which had a tear through the posterior horn of the medial meniscus, and having the torn meniscus remove.
But unfortunately the operation was not that much of a success :( and I have been thinking of having a another operation on the knee, but am undecided at the moment.
I ask my physio about this, and he felt that any more operations will cause trauma to the knee, making the knee much more suspect to Arthritis, with no guarantee of success. I am still getting pains and swelling of my right knee, and get good and bad periods. Just wonder if anybody on here could be kind enough to offer me advice. :-\

Best Regards
William
« Last Edit: June 16, 2006, 02:19:35 PM by William »

Offline emphatic

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Re: Should I have Another Operation?
« Reply #1 on: June 12, 2006, 09:02:50 PM »
Have you seen your orthopedic surgeon to try to determine what went wrong with your previous menisectomy and what the problem might be now? I think you'd be far better off trying to figure out what's going on with your knee before you worry about a further surgery. Hopefully, it won't be necessary and you solve your issues in other ways.

The first step, though, is getting in to see your doctor and finding out what he thinks is going on now.

Good luck!

Meg

Offline Pen

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Re: Should I have Another Operation?
« Reply #2 on: June 12, 2006, 10:23:00 PM »
Hi William
do you have limited movement of the knee?  Just wondering as I have tear of medial meniscus posterior horn and OS is wanting to repair it rather than cut it out.  THe OS said that if you cut it out, you run higher risk of arthritis, whereas a repair does not run that risk, although a repair does not always work I am told. I can't squat or sit on my heels, and occasionally have pain on front of kneecap.  ANything similar?  ANother OS told me that it was best to avoid scopes if you can (unless you were going to have an ACLR done) so i assume that is the same view as your physio.  (I am assuming your ACL is fine)? x

Offline William

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Re: Should I have Another Operation?
« Reply #3 on: June 16, 2006, 02:18:48 PM »
Hi Pen & Meg,
Sorry about the short delay replying to your advice.

Meg,
Yes I have spoken several times to my Orthopedic Surgeon, he reckons everything is fine!!! Feels that the reason for the pain is weakness around the Quads area, need to exercise more(Not Happy With That Explanation) He is actually listed under the section of Knee Surgeons in the UK on this site, and was recommended by my physio as well. My own GP is not keen on the idea of me having another operation on the knee.

Pen,
According to my Physio there is some limitation of knee movement, but nothing drastic. My pain is intermittent, and can go away for weeks. I can squat without any problems, and do most exercises. I can also run quite fast, but am aware of a slight discomfort in the knee, the pain seems worse if I am very active. My ACL as far as I know is ok.

Best Regards
William

 





« Last Edit: June 16, 2006, 02:20:21 PM by William »

Offline emphatic

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Re: Should I have Another Operation?
« Reply #4 on: June 17, 2006, 03:33:38 AM »
OK... a couple of thoughts to toss out there:

What would you hope to gain from another scope? Do you think you've reinjured the meniscus and have another tear?

It does take a long time to get the leg musculature strong enough to manage a meniscus-deficient knee. From your follow-up, it actually sounds like you're doing quite well and you only have pain when you're very active, and the pain is manageable.

I hate to say this, but with some knees, once you've had a menisectomy, you'll never have a totally pain-free knee. Your cushioning is gone or sub-optimal, and if you have even slight osteoarthritis (sometimes called degenerative changes), you will have pain from that. Do you have a copy of your operative notes? Did you ask your surgeon if he saw any OA or degenerative changes?

Is it possible you had really high expectations for the first scope and that your surgeon didn't catch that and try to give you the possibility that you might not have a totally pain-free knee?

Maybe I'm not the best one to answer your question -- to be brutally honest, I'd kill to be back at the point where you are and would be ecstatic with that result.

So, there you have it... I'm happy to answer any questions I can on the course of meniscus surgeries, if that helps.

Meg

Offline Heather M.

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Re: Should I have Another Operation?
« Reply #5 on: June 17, 2006, 06:00:23 AM »
If you have limited motion post-op--even a little bit, as compared to the other leg--you should be evaluated for excess scar tissue.  It's something not every doctor looks for, especially if you have decent ROM, but it can be pretty crippling.  The proper name for this is arthrofibrosis, but of course there are varying degrees of scar tissue following surgery.  Some scarring is aboslutely normal following surgery, but even a little tiny flip of scarring in the wrong place can cause serious problems in your mechanics.

Just something to think about.  I seriously would get another opinion.  The fact that the doctor's name appears on the list here means little.  Check out FAQ's to see how the kneeguru list was compiled.  It is by no means an exhaustive list of top surgeons, nor does it mean that any surgeon who appears on it is a top surgeon.

Hang in there.  You might also want to have a more in-depth discussion with your PT, because they are your first stop in the knee continuum.  Ask her (I think?) what she would do in your position....

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 William

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Re: Should I have Another Operation?
« Reply #6 on: June 19, 2006, 03:49:57 PM »
Hi

Meg,
I suppose I did expect to be back to normal or 100% after the operation. It is also true that compare to some other people on here, like yourself, my problem is only minor, and I should grateful for small mercies.
My second MRI show very little evidence of Arthritis, and only the normal wear and tear for someone aged fifty. (Degenerative Changes)

Heather,
I have never been evaluated for excess scar tissue, although thiinking about now, I will bear this in mine.
Regarding getting another opinion, I am a little concern about this, because some surgeons have a monetary incentive to advise more operations. Also my physio told me, that the latest evidence on Knee Arthscopy was that it was no more effective that a placebo, so not sure what to do here.

Thank you both, your advice much appreciated.

William




Offline Linds

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Re: Should I have Another Operation?
« Reply #7 on: June 19, 2006, 04:10:34 PM »
Hi William. If you are very concerned and still struggling you may want to think about another opinion. If your OS figures everything is fine and you feel that it isn't, you might want to have someone else look at the knee. Unfortunately, sometimes, getting rid of pain isn't really an option. YOur PT Is right, the more times you expose the knee joint to air and surgical instruments the higher the risk of having Osteoarthritis, not to mention the risk of infection and such everytime you have a surgical procedure.
I wonder if there is any real benefit to having another surgery... unless you really know what is wrong?  Although I suppose a diagnostic scop would be helpful. Have you had a CT, MRI, Bone Scan, XrayS? 
Sounds like it might be time for a second opinion.
Linds
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline William

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Re: Should I have Another Operation?
« Reply #8 on: June 19, 2006, 04:42:23 PM »
Hi Linds,
I have had two MRI Scans and X-Rays. And according to the X-Ray done on the NHS, there was some Arthritis noted, but again this has to be taken into context, with the fact that nearly everybody over the age of fifty willl shown some signs of degenerative Changes in the knee joints. And according to the MRI scans, hardly any signs at all.

I will now see how things go, and try to manage my condition first, through physiotherapy, injections (Not Too Many), and of course exercises for the time being.

Thanks
William
« Last Edit: June 19, 2006, 04:45:54 PM by William »

Offline emphatic

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Re: Should I have Another Operation?
« Reply #9 on: June 20, 2006, 12:51:47 AM »
William,

I don't want to sound like I'm discouraging you from seeking further medical care if you think something continues to be a problem. I'm just suggesting (strongly) that you really try hard to clarify what you think the problem is, then seek another opinion, if you think you need it. It's much easier to get better second opinion care if you are quite clear about what the continued problem is.

The other suggestions about first-round steps are good, and it sounds like you've done the Xrays, MRI's and such, with no further clarity about the problem. That usually means you have to go with your gut -- do you really feel like something is still a big problem and needs further care (or a different opinion), or do you feel like you can give your knee more time to sort itself out.

Your original question was "do I need another surgery" and it was hard for me to figure out what you would have another surgery for... thus my questions back to you. Additional surgeries for vague problems nearly always fail (or cause further problems!).

With the further information that you're 50 and have clean tests (Xrays, MRI), and having been in your exact same boat (albeit at a good deal younger age than you), I would highly recommend really tackling a good PT program again and seeing if you can get some results. Also, plain 'ol rest -- a lesson which has long eluded me, I might add -- is an amazing healer. I'm just now learning to get fitter by smarter, rather than harder.  ;)

Stay away from the injections (unless you mean the visco-supplements, such as Synvisc, Hyalgan, etc to try to settle some arthritis symptoms).... they are bad news in the long run. Really.

Hang in there!

Meg

Offline William

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Re: Should I have Another Operation?
« Reply #10 on: June 20, 2006, 12:23:05 PM »
Hi Meg,
Thank you again for your excellent information, it has help me a lot to be more objective about my knee problem. Your advice about starting a good PT program again, is one that I will consider.
You say, stay clear of injections, apart from the visco-supplements.† Well do you mean cortisone? I know you only advise to have around three to four injections a year, since they can do more harm then good.

Best Regards
William







Offline emphatic

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Re: Should I have Another Operation?
« Reply #11 on: June 20, 2006, 07:36:34 PM »
William,

I don't advise any cortisone injections. I know the doctors will tell you that you can have up to 3 or 4 per year, but there are considerable studies pointing to cortisone causing connective tissue breakdown over time. That connective tissue is the exact stuff you need to be in the best shape possible!

Yes, cortisone can do wonders immediately when you have a very inflamed knee. And there are times when it is appropriate for that. But, to depend on it, I think, is asking for a major disaster. For me, it is an absolute last resort because of the connective tissue problems I have.

Try another anti-inflammatory route, first. It takes more patience because the results aren't immediate, but the longer term impact on your knee isn't so severe. I'm suggesting oral NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen. Your doctor can recommend a variety of alternatives. They are low-cost and often available over-the-counter (although, the therapeutic dose for your needs will be higher than the dose on the bottle -- just take the exact dose your doctor tells you, rather than what the bottle says). Most people tolerate them extremely well for the short term (3-6 months) and they can really help a lot. Often, people get dramatic pain relief, as well, after about 10-14 days on them. You can't just take them here and there, you have to stick with a dosing schedule because your body needs a steady drug level in the blood in order for the drug to work correctly.

Now, I have no idea how UK physicians, in general, feel about oral NSAIDs, and I have no idea which drugs are available in your country, or what they are called. So, you might have to do a bit of translating... I'm not sure. In the US there is a major turn back towards the first-line NSAIDs (such as ibuprofen) and away from the newer lines like the Cox2 inhibitors, such as Celebrex. I was on Celebrex (and Vioxx, for a short while) for over 5 years, and it made it possible for me to manage the pain (heck, it made it possible for me to live!!) for the last 2 years, especially. Because of the studies finding that the Cox2's seem to cause a higher incidence of stroke and heart attacks (such minor things, eh?† ;) ), we're staying away from them more over here, whereas they had grown to be one of the most prescribed drugs in America before those studies came out. So, two of the Cox2's were pulled off the market -- Vioxx and Bextra.

There you have it... too much information, probably, but I guess I'm trying to help someone prevent happening to them what happened to me.

Meg

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Re: Should I have Another Operation?
« Reply #12 on: June 21, 2006, 05:13:20 AM »
I take mobic which I believe is a combo of cox1 and NSAID.  I did take celebrex when free samples had been offered to me.  but when filling an RX that costs 100.00 for 30 pills and needs all types of precertification. I said ya can take your celebrex and stick it.

I tried Ib 600 mg horse pills. napersyn as well


I have had cortizone injected three times in my life.  One into my right foot.  years ago.   Dec 2005 injected into my right knee. oh boy did that one hurt after.. and only lasted two weeks
and June 2006 and still not feeling pain.

I will tell you all the medical data that I have read warns you of cortizone  I even think that I see my calf muscle looking a bit slim this week ..  and that is not a good thing in my mind after I spent months and months building it up.  The reason I was ok with the cortizone six months after the December shot was simple .   I was selfish and wanted to be pain free and it was a good morale booster to be pain free after six months..
i hope I get many more weeks of relief out of it.  But I fully understand that this is a drug that can only be used once in a blue moon and sometimes only has very short term effects.


The MRI showed I had a small posterior horn tear.  However when the doctor went in I had a ton of OA in my lateral side and yet that never bothered me .  My medial side always bothered me the most and thats where the joint is collapsed now bone on bone. .. The brace maker also mentioned I walk as if I have more OA on my lateral side.  but I have a medial unloader .. Doctor is like you cant fight both fires.


You kinda pick up on the lingo jingo of knees as you read more on this site.  My suggestion is be exact to your doctor .. Where it hurts you the most.  Doctors treat patients not xrays or MRI's  so he or she should listen to you  and dont rush to get a operation try to build up those leg muscles.