Grade 4 arthritis....is there treatment?

[lilrosie06]

After over a year and a half of dealing with this knee injury...subluxations, swelling, instability. Going through rounds and rounds of PT, taping, injections, tests, you name it, now they tell me I have grade 4 arthritis, and since I am only 42, there is nothing they can do, as I am too young for a TKR. I am sure there is SOME sort of procedure they can do to give me some stability? To ease the pain? Can anyone shed some light on this??
Thanks.

DONNA

[UK Girl !]

Hi Donna

You are not too young for TKR - has your OS said he won't do it - or is it you that thinks you are too young. I firmly believe that if you are in so much pain and unsafe on your knee then you should do whatever necessary fo your own quality of life. 

If it is your OS who will not do it - find another opinion as to what could be done or one that will do the TKR

There are loads of people younger than you having it done - obviously the longer you can hang on without compromising your own life quality the better - but only you can decide when this is.

keep in touch

anja

[Natalie.D]

Donna,

Has your OS never mentioned a TTT to correct the subluxations?  As far as the arthritis goes, there may be some procedures that can be done to "put off" the TKR until you are older (that's what I'm trying to do just now as I want to leave the TKR as long as I possibly can), I also have grade 4 OA and have so far tried microfracture (which I think has failed) and I am now seeing another OS on Thursday to discuss mosaicplasty/ OATS which, if I'm a suitable candidate and it works, should put off the need for a TKR until later in life (I'm nearly 39).  Maybe you should ask your OS about all the options (OATS, mosaicplasty, ACI, synthentic plugs, graft pasting etc) and if he doesn't give you any possible routes to try then I would think about seeing a different OS.  Good luck.

Natalie.

[lilrosie06]

Thanks Natalie and Anja....it helps to know that someone else is "in the same boat", so to speak. Its not fun, thats for sure. If I had some stability and my kneecap didnt slip so much, I think it would be much better. Stay in touch, please....

Donna

[Natalie.D]

Donna,

Thats why I asked if you'd ever discussed a TTT with your OS, a TTT should stabilise the kneecap, I'm surprised if they haven't mentioned it as a possibility as its one of the most common procedures done for stabilisation.

Natalie.

[Hop skip n jump]

Hi Donna

I'm hopping onto this one....Gunna tell you a little story! There's no bad wolves so don't worry 

My patella was so unstable before my TTT that I was literally terrified to do anything, my major dislocation put me in hospital for a week on morphine and the subs after although no where need as bad worsened the OA to level 3, due to lack of movement etc over the years through fear of more dislocations  I also have early onset of osteo porosis (Can't spell it, doh!) So.....

I got the TTT done and you should see me now! WooHoo. I went to a car boot sale the other day (people selling stuff out of their trunks) in a big field. It was uneven ground and everything. I would never have even considered this before.  I even managed a little jog the other day, albeit only for about 5 metres to catch up with a friend!

Anja has recently had a TKR too and she's only a youngster! Her recvovery still stuns me, she was bouncing up and down stairs like Tigger really early on! (She's hard core! )

Don't wait until you're older to relieve yourself of this pain. You deserve to be active, mobile, pain free and happy whatever the course of treatment may be. Take Shade's advice and go seek an OS.

Good luck

Hop x

[knee deep in Goo]

Hi

I understand that people can live with grade 4  for a long time..  I am not one of those people.     I am only 37 and will have a TKR next week. EEEK.     I started off the year by having a scope for a small tear that the lying mri said I had but when the doctor scoped me omg Grade 4 huge areas of bone being exposed.  Knee cap is crap.  Medial compartment is collapsed bone on bone and the lateral area has OA the worse.  Plus a slanty leg vargus deformity.

I would hold off on the TKR if I wasnt in so much pain.  I use crutches now and cant really balance well on two legs lately..  My OS is willing to do this operation for me at a young age so I will not have years and years of pain and well he fears that being in so much pain all the time is not good mentally and .. bitting the bullet  early and dealing with revisions later in life will be something we look at when that time comes.  Right now quality of life and explaining to your OS what your quality of life is and what you cant do anymore will help you and your doctor work on your treatment plan.    It may be pain killers canes and crutches..  braces and injections..  But if he can get u up and running..  all worth it.. before you go down the surgery path.

Also if you do not feel comfortable with your OS.. Please find another .. 

[Nick_Knack]

Hi Donna,

I had a Fulkerson (TTT) and ACI for a grade IV trochlear lesion about seven months ago and feel 120% better.  After living w/ nagging pain for the previous two years, I have only had very sporadic pain since surgery and keep progressing. 

The ACI gurus in the U.S. are:

L.A. Burt Mandelbaum
Chicago: Brian Cole
Boston: Tom Minas
Atlanta: Scott Gillogly

My surgeon was Andrew Levy in Summit, NJ and I would recommend him.


Best of Luck and email me w/ questions,


Nick

P.S. check out the ACI section of the board.

[lilrosie06]

Thanks everyone. I am now 11 days post op from a LR/debridement, so I guess too early to tell if it helped. All I do know right at the moment is I am in severe pain from sitting at my daughters banquet tonight. I propped it up, but it swelled right up, and i am now in severe pain. So, I guess time will tell and I will know if this worked, or if I possiblly do need a TTT or even an earlier TKR.

DONNA

[amy1]

In my case, there is almost no cartlidge left.  Three different knee specialists said that the chances of a TTT working was 50/50 at the best.  They felt that the surgery was too invasive to justify such low odds.  I went to a patella femoral specialist in NYC.  Instead of a distal realignmet, he did a proximal realignment. He felt that the proximal is much less invasive than the distal and was worth a shot.  It has helped, but my knee is still far from pain free. I still have a lot of grinding and popping, severe lateral tracking and intermittent muscle spasms on either side of the knee cap.  Three weeks ago I finished a series of synvesc shots.  I am just trying to wait as long as possible for a TKR. I am still able to make it through a day at work.

[lilrosie06]

Hi Amy....Sounds like you are going through alot.  Good luck. Hang in there.

My last post to this subject was Feb. 4, about 2 weeks post op LR. Since then, I have had a TKR...just had it on the 22nd of June. I was bone on bone. At this point, I am saying oh my gosh, if I had known it would be this painful, I wouldnt have had it done. But everyone assures me it will change, and in the long run, I will be happy I did it.

Please keep in touch and let me know what happens with your knee.

Good luck to you....

DONNA

[lis1]

Donna

I am 39 and had grade 4 arthiritis which was avctually worse than they though when they went in, i am too young for a new knee.  They did mosaicplasty in June this year, i had 12 plugs!!  The rehab and recoevry is still ongoing, i have had 18 weeks off owkr, (have just gone back 2 weeks ago).  However i have not had one single arthiritc pain since..........pain yes but arthiritic no, so there are things that can be done................

Lisa

[lilrosie06]

WOW, Lisa, thats great.

I had a TKR in June 07, and it has been downhill from there. Although the joint pain is gone, I have had so many other issues with this knee. I had a MUA in July 07, a revision in Oct 07, an infection cleanout in Nov 07, another revision in April 08, and will have a 3rd revision, due to loosening after the holidays. Just a long,long road. I already know my right knee has arthritis, and am praying it doesnt bother me for a long long time.

DONNA

[digginit]

Hey!  Haven't read the whole thread, but just wanted to let you know that I'm 42 and am 7 weeks post-op with right TKA.  I'm so VERY glad to have had this done. 

~dig

[lilrosie06]

Hey dig....Im so glad you are having such good results with your TKR!! Thats great! And please, dont let my problems scare you. This doesnt happen to everyone. They actually think I am allergic to the metal, but are having problems getting an allergy test from the company who does them. SO, will probably end up just putting in titanium and porcelain to be on the safe side.

Please keep me updated.

DONNA