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Author Topic: TOO YOUNG FOR SURGERY????  (Read 11808 times)

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Offline jswatton

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TOO YOUNG FOR SURGERY????
« on: August 03, 2006, 03:58:24 AM »
I am so confused now.  I just saw my OS and they actually gave me pills (anti-inflammatory) to take every day for one week and then they will discuss surgery options with me.  Can you say I've been "blown-off" today or what??!!!  I have practically zero cartiledge left in the Left KNEE seen in x-rays taken as recently as 3 months ago.  I'm in a full leg brace which I religiously wear atleast 8 hours a day which is suppost to separate the bones to relieve discomfort.  I have Rheumatoid Arthritis and was diagnosed (slowly) about a year ago.  The OS did a scope one year ago or so and removed 8 cysts and fluid at the time.  I am allergic to the crystaline or the fillers in Steroid inections so that is not at option for me.  I am on pain meds which of course help, but I am young and don't want to be in a brace for the rest of my life.  I feel the surgeon is just blowing me off and delaying the surgery for no good reason.  I've never heard a surgeon not want to dive in and do surgery!!LOL  For the past 6 months or so they keep asking me "how old are you???"  Well, I am 37 years old...I have 4 young children that I have to chase around, and I just want my so called "normal" life back.  I know surgery IS a big deal, but if I have zero cartiledge, why wouldn't they just DO the surgery????  Am I missing something here???  I am calling to get a 2nd and maybe 3rd opinion tomorrow and see my Rheumatologist early next week....in fact...even my last visit 3 months ago my Rheumie even said I needed to have surgery!!!!!!!  Any thoughts anyone???!!!!!!!  Boy I would love to wear high heels again, walk around the block, ride a bike etc.......in my current condition I am in tennies, a huge honking' ugly leg brace and darn pain pills. 

Jennifer
jswatton

Offline kera4

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Re: TOO YOUNG FOR SURGERY????
« Reply #1 on: August 03, 2006, 05:38:49 PM »
Hi! I am sorry about your OS appointment! I can totally relate to your experience. I have 4 kids, and have a type of inflammatory arthritis similar to rheumatoid called "spondyloarthropathy." I have had 4 knee surgeries, related to my patellas over the years. However, I always felt that my OS delayed my last 2 surgeries, because he was worried about my arthritis involvement. He made me wait a year and a half, with huge gobs of scar tissue in my knees, because he wanted me to try more aggressive arthritis drugs. (Just in case the scar tissue was really inflammation, I guess). Well, we tried sulfasalazine (I am allergic to it), methotrexate (did nothing), Humira, and finally Enbrel (which helped my hands). None of these helped my knees, so he finally did 2 scopes and removed the scar tissue. There was no "inflammatory arthritis" in my knees, just scar tissue left from my previous surgeries. I felt that he did not treat me as aggressively, because I had an "auto-immune" type of arthritis. Anyway, it was very frustrating! It can help if your rheumatologist calls your OS and discusses things. Although, my rheumy did not get along so well with my OS. I am contemplating another knee surgery now, and my rheumy is against it. I think she wants to solve everything with medication, but my problems are mostly mechanical in my knees. So, no medicine is going to fix the abnormal mechanics of my patella. Hang in there, it is not easy! Let me know how it is going! Kera

Offline Jules

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Re: TOO YOUNG FOR SURGERY????
« Reply #2 on: January 27, 2008, 12:46:35 PM »
I totally understand what you are going through, it all happened to me!
I have OA in both knees and had 13 operations over a 5 year period, including ACI that didn't work for me!
I now have right TKR and left PFR and they were both done when I was just 40 years old!
I really had to fight to get it done and the final straw was when I ended up being in a wheelchair for 5 months as my knees were constantly giving way and I was falling all over the place, having to take an ambulance to hospital about 5 times during that perid as the falls were soooo bad!
I know its really frustrating, and I got to an all time low at that point and was even put on antidepressants!
All I can say is you have to fight! Don't be fobbed off at all, its your life! Your in that pain every day! They sometimes really haven't a clue what you go through day in day out!
Be strong and go for what you need!!

Best of luck
Jules
x
Apr 01 - bi-lat debride
Dec 01 - bi-lat mircrofracture & LR
Nov 02 - bi-lat debride & LR
Oct 04 - bi-lat A'scopy & harvest
Nov 04 - R ACI
June 05 - R A'scopy/shave
May 06 - R TKR
Aug 06 - L  PFJR
Jan 07 - L open LR
Oct 08 - L open LR
Feb 09 - L A'scopy/shave
July 09 - L TKR......
20 ops in 13 years

Offline jathib

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Re: TOO YOUNG FOR SURGERY????
« Reply #3 on: January 27, 2008, 03:10:25 PM »
I think your surgeon is just looking out for your wellbeing. They don't like to do TKRs at a young age simply because you'll need perhaps several revisions in your life. Each time the result is worse. Contrary to belief, most surgeons have plenty of surgeries booked so they don't need to push people into surgery. Your surgeon may well want to make sure you're completely ready to have a TKR because there is no turning back. He may also be one of those surgeons that just won't perform the surgery until you reach some magic age. Whatever his reasons you need to ask him what his motives are instead of judging too soon. There may be other reasons for his reluctance. Don't be afraid to ask. That being said, it's always always advisable to get as many more opinions as possible. Some surgeons simply won't do the surgery because they don't want to be a part of removing a young person's knee. Other surgeons realize that it's a quality of life issue and people want to live their lives when they're young. So talk to your surgeon and do make the appointments for the 2nd and 3rd opinion. You might like one of the other surgeons better anyway.

Offline Plumb

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Re: TOO YOUNG FOR SURGERY????
« Reply #4 on: January 27, 2008, 06:53:40 PM »
The old magic age debate.  I been in an unloader  brace.  I walked that walk of getting no where fast.  If your surgeon won't do it because he feels you will have a revision sometime in your life time. heck you can slip on ice and hurt yourself even greater not being on two stable joints.

One doctor is not the end all be all in life.  We may get attached to a doctor but there comes a time and place where being in constant pain causes more emotional issues and combine that with the physical issue is not justification that your age is the only factor.


I would say to the doctor .. I rather have 10 good years and see my children grow up with a happy mother than to have remorse and have the children deeply affected by a disabled mother. 
I could slip and fall on ice and totally toast my knee or in 20 years the cement or spacer may need to be updated . Life is for the living and  I once had a doctor tell me to wait till I am 40 before he could consider. But I also found two other doctors who saw that I was limited and wanted a quality of life for me .. just as I wanted a quality of life for me..

Perhaps it is time to see a doctor who has the same goals as you do .

Offline kimmyxs

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Re: TOO YOUNG FOR SURGERY????
« Reply #5 on: February 25, 2008, 04:06:03 AM »
I have both RA and OA.  My OS thinks that I am young for a TKR, but he is willing to do it when I feel that I am ready.  Right now my hands and wrists are more of a problem than the knees, but I assume that I will be there in the next several years.   His thought is that I will know when my quality of life is such that I need to change it.  I am not yet there. 

I am lucky in that my children are essentially grown so I don't have to chase them around any longer.  Who knew that 50 is considered young!
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline Plumb

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Re: TOO YOUNG FOR SURGERY????
« Reply #6 on: February 25, 2008, 04:35:42 PM »
Good Point,  There is a quality of life balance.   Can you manage with the pain you have?  Can you get around and do things? 

One doctor may say its when you stop doing the things you love is a bench mark.  Another doctor will bench mark you on can you walk three blocks unaided. And if things do not go well is the patient ready to accept the outcome.   

Multiple Revisions, Loss of movement.  Knee fusion, Amputation.   All valid reasons for people to stop and say  Have I hit rock bottom??  Has this young patient hit rock bottom?? Is there a procedure out there that can be done to give them more time with the knee???   Can they modify activity to cease pain?  Can they loose weight?   

I also want to point out there is alot of changing of habits you as a patient must undertake like exercise diet. activity modification. before you get into the OR to have an implant.  At times it is all about joint space.


Offline kimmyxs

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Re: TOO YOUNG FOR SURGERY????
« Reply #7 on: February 25, 2008, 07:16:14 PM »
Plumb, well said.  I am not sure that even with a TKR you will or should wear heels.  I do on occasion, and I pay for it later.  They put alot of strain on the forward part of your knee.  When I wear them it is only for special occasions and then they go back in the closet. 

For me the goal is to lose some weight - I don't have a weight problem, but any extra weight is a problem.  I also religiously exercise to keep the muscles firing - quad strength is so important.  I am lucky, I have great muscle tone, but I am still afraid of a TKR that may not solve my problems.  I was at the county courthouse this morning and woman came in who had had a TRK recently.  She set of the metal detector, she was limping very badly.  It that better than I have it today - no - I walk without a limp unless the OA and RA are causing problems.  I would really rather wait right now.  I have a bit of time.

You can go doctor shopping, but you need a OS that you trust and who takes time to know you.  One who will isten to you - that applies to your rheumy as well.  No one wants to wear an unloader brace forever, but ...  I would take time to talk to young TKR receiptants before you really decide that is your option.  They can help you decide and also recommend a great OS to do the surgery.  I know that I will still have issues with my knees even should I do a TKR.  To be honest right now, I am far more concerned with my hands and wrists.  Maybe because I am used to the knee pain that has been there since my early 30s, the hands are a different story.

Only you can judge your quality of life.  I miss heels, doing back hand springs, running, etc., but no matter what happens, I will still be missing those things even after a TKR. 
6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline Plumb

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Re: TOO YOUNG FOR SURGERY????
« Reply #8 on: February 25, 2008, 10:24:48 PM »
I haven't worn heals since god knows when.   When things were at the worse I had the only option of sneakers because the pain was too intense with normal shoes. 

I am back to wearing flats.  Clarks's  or Aerosoles.  I do have boots with a wedge heel.  Even after 30 minutes  walking in a  normal shoe my nautral knee says what did you think you were doing.  No pain in the other knee. 


I missed walking and independence far too much when I was in healing limbo.  In hind sight I was glad I did at least five months of PT prior to my TKR.  Aqua and Lan.  I believe the aqua help keeping me sane while I couldnt walk normally.  A glimse of what you know you could do when you couldnt do it any more.

I had an unloader brace for seven months.  I had to get it adjusted a few times.  After the Third time the brace adjuster told me that my knee was just too far gone.


Offline hollie9

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Re: TOO YOUNG FOR SURGERY????
« Reply #9 on: April 26, 2008, 06:03:46 AM »
There is now a middle ground....knee resurfacing for "younger, more active patients", where they don't cut the bone but smooth it down and the prostheses are different.  Supposedly one can be much more active than with the traditional TKR.

I already had both hips resurfaced and they work great, not a bad recovery.  I can do anything I ever did except bungy jump. 

It's true that for any patient under the age of 65, the OS will try to get you to put off surgery because the revisions often don't go so well.  But now that resurfacing of hips has proved to be so effective for "younger people" I'm hearing about docs resurfacing knees too. 

I'm currently checking out all these options and the types of prostheses they are using and if they really are just shaving the bone rather than cutting.  But it looks promising.

I'm in California.  Some of the best docs for hip resurfacings are in Belgium and the UK.  I'll be sending XRays and everything to be evaluated to those docs and some here that are doing it.

I think the time to get it done, resurfacing, is when your quality of life has begun to diminish, and  you gradually start letting go of the physical activities that you used to enjoy.  If you walk around too long on bad hips or knees another part of the body will then become effected...like the back, etc.

Hollie

Offline Plumb

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Re: TOO YOUNG FOR SURGERY????
« Reply #10 on: April 26, 2008, 10:24:38 PM »
I had a partical meniscus removal and drilling into my MFC and LFC both in weight bearing spots.  I had tri compartmental OA in my right knee and leg was more than 7 degress varglus.   Been there done it.. I had every bandaid procedure that I was suited for.

 TKR was my best option for my needs long term. The procedures I had done prior to getting the implant was due to extreme pain and locking of the knee. Infact I had pains as a child from OA,

I been told time and time again. I am a pediatric case for a joint replacement.  I know I will need another one in say...  hopefully never..  but if it is time to fix it.. it is time to fix. it.

Something stupid can happen to the knee and I have no control over when or how it will happen.. Just got to learn to enjoy what I have now.. which is freedom again.  with a little foot fashion.

Offline hollie9

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Re: TOO YOUNG FOR SURGERY????
« Reply #11 on: April 26, 2008, 10:50:06 PM »
There are tri compartmental resurfacing prostheses now.  I'll probably need one of those.

I sure wish my surgeon had told me how you don't really recover from those meniscis tear surgeries if they find arthritis.

Hollie