I got a new knee - TKR 10th july 06

[knee deep in Goo]

viscosupplementation is a procedure that involves injecting a thick fluid (hyaluronate) into a knee afflicted with osteoarthritis. Osteoarthritis is a degenerative joint disease affecting 21 million Americans and typically involves the weight-bearing joint of the knees as well as other joints. According to the American College of Rheumatology, nearly 70 percent of people over age 70 have x-ray evidence of the disease although only half ever develop symptoms.

Why might I need viscosupplementation?
Osteoarthritis is a joint disease that mostly affects the cartilage. Cartilage is the tissue that covers the ends of bones in a joint. When healthy, cartilage allows bones to glide over one another and provides a shock absorber function. The normal knee joint also contains a small amount of fluid called synovial fluid, which is a thick, gel-like substance that cushions the joint and provides lubrication to reduce friction. In osteoarthritis, the surface layer of cartilage breaks down and wears away. Adding to the problem, the synovial fluid in your knees loses its viscosity (ability to lubricate or "oil" the joint). This combination of the deterioration of the cartilage along with the loss of lubrication from changes in the synovial fluid contribute to the pain and stiffness, limitation of joint motion, and some inflammation (for example, redness and swelling) in your knees.

Pharmaceutical companies in the United States have developed three hyaluronic acid-based products (one of the two natural lubricants in synovial fluid) for injection into the knee. These are known by the brand names Hyalgan, Synvisc, and Supartz.

Will viscosupplementation cure my osteoarthritis of the knee?
No, the procedure is not a cure. Currently, there are no cures for osteoarthritis. The theory behind the use of viscosupplementation is based on the belief that this type of product will:

    * Improve the lubricating properties of the synovial fluid
    * Reduce or stop the pain from osteoarthritis of the knee, and
    * Improve mobility and provide a higher and more comfortable level of activity


When are the viscosupplements given?
The benefits are probably greatest in early osteoarthritis, but viscosupplements can be used at any stage of disease. However, they are usually reserved until other treatment options have been tried and fail to relieve your pain. The supplement is injected directly into your knee joint. Injections can be given in one knee or both knees at the same time or at different times as determined necessary by your doctor. The injection is given in your doctor’s office and the procedure just takes a few minutes to complete. To help make your injection as comfortable as possible, your doctor may apply a local, topical anesthetic first.

How many injections are needed?
To receive a complete course of treatment with Synvisc, your knee must be injected three separate times, 1 week apart. Five injections, each given a week apart, are required for Hyalgan and Supartz.

What results can I expect?
Whether or not these products "work" is somewhat controversial. While some studies have found these products to improve the pain and function in some people with mild to moderate osteoarthritis of the knee, some clinicians have argued that the design of the clinical trials have been flawed or included too few patients, making interpretation of the results difficult. Other clinicians state that the real questions – do the viscosupplementation products work better than corticosteroid injections or NSAIDs and do they have a role in severe osteoarthritis – have yet to be convincingly answered. Further, there’s no proof that viscosupplementation delays or reverses the underlying course of osteoarthritis.

Of patients who seem to be helped by the injections, many report feeling some pain relief during the course of the injections; pain relief is delayed in others. Most patients report the greatest pain relief 8 to 12 weeks after beginning treatment. According to studies reported in the products’ package inserts (studies upon which FDA approval is based), Synvisc and Hyalgan have been proven to provide pain relief from osteoarthritis of the knee for up to 6 months. Some patients have reported benefit beyond 6 months. Supartz was shown to provide pain relief up to 4½ months following the final injection (of the 5 injection series). A small study in patients receiving Hyalgan showed the viscosupplement to be well tolerated by patients when treated every 6 months (with a complete treatment course of five injections) for up to 30 months.

What are the risks or side effects?
The most commonly reported side effects associated with the injections are temporary injection-site pain, swelling, heat and/or redness, rash and itching, bruising around the joint and/or fluid accumulation in the injected knee. These reactions are usually mild (but occasionally are severe) and do not last long. You should avoid any strenuous activities or prolonged (more than 1 hour) weight-bearing activities (such as jogging or tennis) for 48 hours following the injection.

What health history does my doctor need to know about before beginning the treatment?
Before beginning treatment, tell your doctor if you are allergic to products from birds (such as feathers, eggs, or poultry). Also, you should not receive the injections if you have:

    * A known allergy to sodium hyaluronate preparations
    * An infection or skin disease in the area of the injection site

Because viscosupplements are not drugs, they should not interfere with medications you may be taking, including pain relievers and/or anti-inflammatory drugs; however, remember to talk with your health care provider about any medications you are taking. The safety and effectiveness of Synvisc, Supartz, and Hyalgan have not been determined in pregnant women.

Can viscosupplements be used in joints other than the knee?
The injections are currently approved by the Food and Drug Administration only for the knee but are being studied for use in joints of the shoulder, hip and ankle. Viscosupplementation is not an appropriate treatment for rheumatoid arthritis.

Will my insurance pay for this procedure?
The United States Food and Drug Administration classifies viscosupplements as a device, not a drug. Medicare and private insurance typically reimburse the cost of devices and procedures that are medically necessary to treat your condition and are used according to the labeled uses approved by the Food and Drug Administration. At the present time, Medicare will provide coverage of hyaluronic acid-based products that are used to treat osteoarthritis of the knee only. In addition, Medicare requires radiographic evidence of the diagnosis of osteoarthritis and the treatment course is covered only if given no more frequently than every 6 months. Private insurance vary widely in the services they cover. Benefits also vary according to the specific plan under which you may be covered. Be sure to talk with your health care provider and insurer to determine the extent to which your insurer may reimburse the costs for this procedure.

[e.lynch]

Where you had a total knee replacement, and everything in there is hardware, can they still do the injections?
Ellenmarie

[knee deep in Goo]

No  This is for a natural knee. 

[L. Thomas.net]

My OS will give cortisone injections after TKA.  I was having some pain that started the day after surgery.  He said it was where the knee was rotated over to put the replacement in.  He said bursitis sometimes develops at that point and that if it continues to bother me he could do a cortisone injection.  I don’t know about synvic though.

[e.lynch]

I would rather live with the pain then to have a cortisone injection.. I HAVE NEEDLES.
Ellenmarie

[UK Girl !]

so does it work annie?

[knee deep in Goo]

progress report.   This morning felt medial pain on left knee.    It's been five hours since shot .. been told not to walk this afternoon and ice it.  So far I feel my knee has a bit less biting pain when I go up stairs.  So instead of my left knee  the old good  knee hurting more.. I am back to the bad old knee the right knee just giving me minor discomfort.

I have four more shots to go...   

This shot was more painful than I recalled.  I think it is because I have more cartlidge in my left knee than I ever did in my right knee.   Which while it sounds weird that it is painful .. I am hoping it will be able to act like the shock absorbers that it played up to be.   PLus the fact when I had injections in my right knee I started to feel the most pain relief the next night and after each additional shot..   So I feel I am in a pretty good spot.

Also my os is so funny .. he asked about my mom and the one and only time she met him was in the hospital.  Her leg is pretty bad and he reminds me that it is only going to get worse and worse .   So I was telling him how frustrating it was to be always asking her to go see the OS.   Than he said why dont you just ask her to go with the next visit so she can be your support.   I said to him..   If she was at all interested in being there for my support she would have been there during those tuff moments prior to my TKA when I was most needed her support.   all and all i found closure to the fact that I do not need people about when I see a doctor. I just find the right doctors and learn all i can..  and I will be fine.

actually this sounds harsh.. but to a certain extent maybe a life lesson on being strong for yourself.   

[L. Thomas.net]

progress report.   This morning felt medial pain on left knee.    It's been five hours since shot .. been told not to walk this afternoon and ice it.  So far I feel my knee has a bit less biting pain when I go up stairs.  So instead of my left knee  the old good  knee hurting more.. I am back to the bad old knee the right knee just giving me minor discomfort.

I have four more shots to go...   

This shot was more painful than I recalled.  I think it is because I have more cartlidge in my left knee than I ever did in my right knee.   Which while it sounds weird that it is painful .. I am hoping it will be able to act like the shock absorbers that it played up to be.   PLus the fact when I had injections in my right knee I started to feel the most pain relief the next night and after each additional shot..   So I feel I am in a pretty good spot.

Also my os is so funny .. he asked about my mom and the one and only time she met him was in the hospital.  Her leg is pretty bad and he reminds me that it is only going to get worse and worse .   So I was telling him how frustrating it was to be always asking her to go see the OS.   Than he said why dont you just ask her to go with the next visit so she can be your support.   I said to him..   If she was at all interested in being there for my support she would have been there during those tuff moments prior to my TKA when I was most needed her support.   all and all i found closure to the fact that I do not need people about when I see a doctor. I just find the right doctors and learn all i can..  and I will be fine.

actually this sounds harsh.. but to a certain extent maybe a life lesson on being strong for yourself.   

AMEN
You know what really gets me?  They say they will "be there for you" and in a couple of days they don't want to be there anymore.  I know now the only person I can depend on being there is me.

[UK Girl !]

That is really sad, guess I am just lucky - my husband and kids are GREAT!!

[Janet]

Anja, I'm lucky, too. My husband and daughter are great. My son, not as much, but he's 28 and very busy with career and girlfriend. For several months when I couldn't drive, my husband and daughter changed their schedules around so they could take me to PT, to my many doctor appointments, etc. My sweet daughter (she's 22) would even take me to Target or somewhere in the evening and push me in the wheelchair just to get me out of the house. Now that I'm back to work every afternoon, I have a really hard time coming and making dinner, so we either go out or my husband cooks. I really appreciate their support and can't imagine going through this without my family!

I'm glad your son finally got his appointment. Just next week, too!

Annie: I hope the injections work for you. I have the Synvisc injections and they didn't do anything for me. My husband had them and had great results. It really does depend on the person. My OS told me there was a 50/50 chance it would help, and that it was usually more successful when the deterioration was not as bad. I was glad I tried it because we were looking for anything that would help and delay my need for the TKR.

Ellenmarie: I would keep after your doctor/nurse until you get an answer for your leg fluid. They don't seem worried about it, but I would keep pushing and pushing. You know, the squeaky wheel gets the grease thing.

Janet

[e.lynch]

I finally heard from the OS office late Friday afternoon.  From what i described to him regarding the pain and fluid, he said it is tendenitis.  It is very painful could last anywhere from 6-8 months and there is no cure.  try not to use it, ice, elevate, anti-inflammatory.  he said that he had it and knows what i am going through.  I told him that i take the pain killers (2 twice a day) and he said that was fine.  I thold him i wish that i had never had the surgery and he was like i know but we cant predict what happens after surgery.  So, here i lay in bed, pillow under knee waiting for the pain killers to kick in so that i can start my Saturday chores
Ellenmarie

[L. Thomas.net]

I didn’t think I would see the day I could say I was glad I had TKA.  I will have to admit I can tell an improvement in  quality of life.  There are still days that I wonder if I will be “normal”. I don’t know how you feel but I know how frustrating it I was to me to think it was a bad deal.

The only time I have pain is weather prediction and when I over do it.  I wonder, will I ever figure out how to stop before I have overdone it?  On Tuesday for 3 month check my OS said I should continue to see improvement for a year.  I think I will get the ful 155 ROM since I already have 130.  I can also sit on my knees.  I still have to take it slow and getting up is a struggle but I never thought I would be able to do that.

He told me my problems were because I have been able to do things that most people don’t do until 8-10 months.  Now get this, he wants to keep a closer watch than usual because of the great ROM. 

I think if I keep this progress rate I will feel everything was worth the effort.  I know that when they told me that I had overcompensated and messed up my other knee I was thinking no way will I agree to this surgery again.

[knee deep in Goo]

You are funny..  How to figure when to stop before overdoing it!!!!!   I have the same exact problem.  That fine line between doing too much and just enough.  I suppose we have to remember we are still in the early side of recovery.    Well thats what I keep trying to tell myself.

[L. Thomas.net]

Now that's a HOOT. I guess real time and "knee time" are not in the same zone.  When I think of 3 months in real time it really doesn't seem long. BUT this post-TKA time has reallllly taken a lot of time.

[Janet]

You're right about the time. I learned early on with my original injury that MY idea of a long time and my doctor's idea of a long time were two totally different things. I'm thinking weeks and he's thinnking months! I am now four and a half months post-TKA and just starting to feel more "normal." Last week I had two days in a row where I felt really good. I even walked half a mile on our track at work. But then I have a day (like yesterday) where I'm really sore. I'm also starting to think it's somewhat weather related. The two days I felt great it was nice and sunny. Yesterday it was cooler and there was rain coming. Now more than ever I'm really looking forward to summer when the weather is warm. I'm not quite at the point yet where I can say I'm glad I had the surgery done. I feel better than before when I'm sitting, but walking is still painful and I still use my cane outside of the house. I guess I'm surprised I don't feel better than I do. I'm waiting for the magical six-month mark where my doctor says I should feel good!!

Janet