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Author Topic: 40 dealing with life prior to TKR. Next stop PKR May 27th, 2010.  (Read 29769 times)

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Offline bombero1969

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    • 40 dealing with life prior to TKR. Next stop PKR May 27th, 2010.
40 dealing with life prior to TKR. Next stop PKR May 27th, 2010.
« on: November 13, 2009, 02:56:55 PM »
Accidentally posted in the General Arthritis area. Didn't know how to move it.

I am 40 years young and have really been given a shock by my OS. Went in yesterday to get another steroid shot and his advice. This time when I asked about the HTO he stated I am past that and if he did any thing invasive it would be a TKR. I am fine with that if it what I need and when I need it. My profession I have to be in the best shape I can be in. He said I need to push the TKR as far in the future as I can. Said visco-supplements only work 50% of the time. Stated that an unloader does not work and after he informed me I now have OA in 2 of the 3 compartments, I know that an unloader is only uni-compartment.

So I am finding another OS for his advice. He is distinguished in his field, works in a top notch facility and also the team OS for the local professional hockey and football teams. I figure that if he can be an OS for pro athletes that have high dollar contracts with a goal to get them back on the field or rink that he would be good enough for me. Has been published in many forms. Great back ground.

Now this is what I need, I need questions to ask him. I have some of my own to ask but after reading the posts on this site for the last 3 days; I have realized that there is a wealth of information here. Not only is it about the knee but the differences in the personal experiences and demographics makes this site wonderful. I really like how people here seem to understand each other and show real concern. That in it self is awesome.
« Last Edit: May 14, 2010, 01:44:45 AM by bombero1969 »
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline Robin M.

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Hi,

Sorry to hear that you're in the same situation as so many of us. Here is a list of  questions that I asked my new OS at my TKR consultation.

Are there any non-surgical or surgical (other than TKR) treatments that you would recommend?

Why is a TKR my best option?

How many replacements a year do you perform?

What type of implant do you use?

Projected length of time replacement will last?

Length of hospital stay? pain management protocal, in-patient as well as at home?

rehab protocal

How long until I can drive, return to work and normal activity level?

Hope this helps. Good luck with your appointment!

Robin
Lt. knee- 6/04 scope and chondroplasty of MFC,11/04 Synvisc injections, 11/05 mosaicplasty, 3/06 scope,LOA and MUA, 1/08 degeneration entire knee, 5/12/08 TKA, 7/21/08 MUA
Rt.knee- 10/06 scope,,plica removal-OA, 3/07 HTO, 9/09 hardware removal  12/7/09 TKA 1/10,3/10 MUA, 11/10 LOA,partial revision

Offline bombero1969

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    • 40 dealing with life prior to TKR. Next stop PKR May 27th, 2010.
Thanks Robin, I had most of those on my own. Thankfully I am in the medical field and have a pretty good handle on some of this. Reading a lot of the posts here on this site is really where I have learned the most. Going tomorrow for my 2nd opinion, maybe making my 3rd, 4th, 5th and so on appointments for other OS's opinions. This just is not the easiest thing to do. I am used to helping people when they are at their worst, not seeking help for myself though.  :( :-\ :(
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline bombero1969

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    • 40 dealing with life prior to TKR. Next stop PKR May 27th, 2010.
Went for my 2nd opinion, the doc was great, he really tried to connect on a personal level and not one of a business type. He asked me what my ultimate goal is? I simply stated that I want to work in my profession for another 15 years to get a total of 30 years for retirement. Then I asked him his opinion on when I need to get a TKR. His answer was that I am not ready for it at this time. Said that he could do it and would do it when I said I want to do it. So what a relief it was.

Now we are trying different things to delay the big day. Currently he has me in an unloader, the same one he has his pro athletes in. It seems to be helping on reducing the bone on bone rub and pain. Still have the pains from the wet cold weather, but I guess that I will have to rely on what little relief there is in asprin. I don't believe in taking any narcotics or the major NSAIDs. I figure that if they eat the lining of the stomach that they could be eating the rest of the knee also. Plus the constant ringing in the ears is too much, already have trouble sleeping with the arthritic weather pain in it self.

The doc wants me to come back in after 6 weeks with the brace to see how it is helping. Then he will decide if I need the supplement shots, which he says he gives his pro athletes also.

Yes I understand that pro athletes totally wreck their bodies and are limited on what they can do after their career. I also feel that what I want is to last as long as possible before I have to get the TKR. If that means that I have to deal with extra pain and the possibility of wrecking my knee by the time I retire that is fine. I will just have to deal with the outcome then. The ability to make a difference in peoples lives now while I can in my career is well worth it.

Not saying that I am not afraid of what is to come, just learning to look adversity in the eye and live with the hand I have been dealt.
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline Plumb

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #4 on: December 08, 2009, 04:31:36 AM »
Good luck with the unloader.   Personally  I have done the Viscosupplements for many years along with cortizone.   I also take a nsaid and an opiod and some good old lidocaine.   I think the sweet spot for a TKR is when you have tried all these things and still the pain becomes unbearable.  Think of it as you sunk pretty far and it is hard tredding water exhaustion time .. when your ready for a TKR.     Pain is serious stuff.  Sometimes we can cope with it sometimes we cant.   Ice the knee is the best advice I can give you.   Post  TKR  is wonderful.   However not worth getting one if you have not sunk to your lowest low.

Offline bombero1969

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #5 on: December 12, 2009, 12:30:34 AM »
Plumb, thanks for you words of encouragement. Yes the pain can be pretty unbearable at times. I am not at the point that it is an ever persistent pain. Though the day will come, and hopefully not any day to soon. It is my belief that one should go as far as they can without causing too much damage on the quality of life. I have been employed now for 15 years and want to get to 30 years before I retire. Starting over in a new career is not what I want to do, not now. So I am open to try anything to prolong what little life my knee has. My doc stated that he would and could do the TKR now, that the scan and xrays show quite a bit of bone on bone. But he will not do it until I am ready.

I have not done the supplement shots yet, I refuse to take anything to manage the pain stronger than an aspirin. I just deal with the pain, have a pretty high tolerance for it now. It is just a necessary evil to stay where I am in my life right now.

This site has been awesome on obtaining knowledge and to strengthen my attitude. I have read a lot of the forums and the personal journeys that others have been through. I have also learned that there are more younger patients than I could have imagined. One of my closest friends has had bi-latteral TKRs, she was the first I turned to but she is also 25 years senior than me. She was very helpful on keeping me on track, but it is different to hear from those closer to my age found on this site.

Again, thanks.
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline Plumb

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #6 on: December 12, 2009, 12:45:58 AM »
I just started to take arthrotec.   I am in shock on how well it works.   
Yes there are alot of youngins on this site with TKR's  and it is cool to read that there is away out of this incredible pain by having a TKR.   Keep your body parts as long as you can.  You will know when your ready

Offline bombero1969

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #7 on: January 06, 2010, 11:37:51 PM »
Ok so I went to my follow up appointment after having an unloader since a week before Thanksgiving. The OS asked how I liked the brace and how I am doing. I told him that the brace was very effective for the first 2-3 weeks but the last 2-3 weeks was a pain, and I mean a royal pain. The brace support on the medial side was pushing upon the very spot that my knee is literally killing me. Almost feels the same when I tore my meniscus but a lot worse. The doc checked out my knee, read his notes from all of the x-rays and the MRI (a year old) and stated that he wants a new MRI. He thinks that I have formed another tear in the meniscus and also says that I am almost bone on bone. That was Monday, now I am sitting here as patiently as I can till I see him Friday. He said that there are 2 highly probable approaches and then the 3rd approach. The first 2 is another Arthroscopic to see if he can fix the meniscus if in fact it is torn, says that also gets his eyes inside to see what is left. The second is to have a PKR, which after research I would be open to entertain that option also. But the 3rd is what I am dreading and that is the TKR. I know that there has been great advances in the field of TKRs, but I need to be able to run if I absolutely need it, and will be a bit more aggressive on my knees till retirement. So I do worry about the longevity of the TKR and if it would hold up to my profession. I haven't heard from many in my field that has had a TKR. I would be the first where I work.

Getting anxious and nervous about the Doc's findings and ideas. But such is life. Just gotta keep on going.
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline bombero1969

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #8 on: January 08, 2010, 09:21:45 PM »
Went for follow-up today, have two issues. 1st: I now have another tear in my miniscus. 2nd: OA is not getting better (like it ever would).  The doc said that my constant pain is likely due to the OA. If it was the tear it would be intermittent. So he suggested Eufflxa shots (visco-supplement) to see if the OA pain is masking the pain from the tear. Then in 6 weeks after the series of 3 gel shots we will see how I am doing. If I have intermittent pain he says I need arthroscopic, if it doesn't decrease the constant pain the we will do an osteotomy. OR best case the pain is relieved and I have More time. Stated PKR is out because of my profession. So I opted for the gel shots and asking for time.

Anyone have any thoughts, comments, warnings or personal stories along this line?

Just nervous and concerned.
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline Plumb

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #9 on: January 09, 2010, 02:31:59 AM »
Interesting that you have enough joint space to do a scope..  Jealous..   You have hope ...   Go for the viscosupplement shots  !!!  Just one step that you tried before you go any surgical route.

Offline bombero1969

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #10 on: January 09, 2010, 03:25:00 PM »
Don't know how to posts images, it would be interesting on how my knee compares to others. I know that there is still a bit of room for it to get worse. It is not lying right on each other yet. The tear is on the outside of the medial aspect of the knee, that is also where the foreign body is. Did not even think about if there was enough space to do the scope or not. That sounds like a good thing, also a good question for the Doc. Man after all of my years in the medical field one would have believed that I could have come up with that yesterday in his office. That is why I think that this site is so awesome, many many years of experience putting everyone together. Each has their own experiences and stories.  ;)

I did get the shot yesterday while at his office. now it is a hurry up and wait thing. Being informed about everything is what I want and also exhausting every avenue on the way down this journey before I get to the TKR.

Thannks, Plumb for your assistance.

June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline bombero1969

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Re: 40 y/o went for 2nd opinion - now dealing with life prior to TKR.
« Reply #11 on: January 09, 2010, 03:26:10 PM »
Wow, said I didn't know how to post images and got one to go!?!  :o
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline Plumb

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Dunno.  My joint space is just about the same.. and  I am 40 with one  TKR already.   My OS said he would not want to do a scope. I had a scope in 2006 on my right knee.. where he saw the bomb that went off in the knee with OA and had chrondroplasty on  MFC and LFC in weight bearing spots..  As he put it .. I was clawing my way around for a year after that..  He agreed with me that is not worth the risk of putting oneself in more pain when you can see how far you can go until the TKR.   Don't get me wrong..  If you feel it is worth your time for your doctor to attempt a scope and go into your knee and get a visual of what is going on in there to see if he can give you a bandaid that .. may or may not help you..   For me and my personal past experience..  I can walk for a few hours and if I overdo it..  sure there are things to help with the pain.  Far better than gritting my teeth and crying each day until I would get strong enough for a TKR to recover from the fall out of a scope procedure that made me worse..   The funny thing about joint space and pain  is .. You may have narrow joint space and your pain levels  may not be as bad as the next persons.  From my personal experience. I encourage anyone to keep their body parts as long as they can.  I also would encourage someone to be aware when the joint space is that low..  the risk that a bandaid procedure.. could make them worse off and miserable...  While I know a TKR is painful.. It is far more painful to endure additional pain that you do not have to subject yourself too prior to a TKR.    If his goal is to check out the compartments to see if a PKR is a better route to go.. I would suggest you to read some of the posters who had PKR's.    My OS went back and forth on whether to do a PKR or TKR... and so I started to see a few OS for their thoughts on what to do with a 30 something young woman..  and even than if you ever want to see people torn on how to best treat your condition..  You find out that it is not easy for them to even decide so they take the wait and see approach..   Wait and see how you can personally take pain.  Each person has their own fall line so to speak and it is tricky..  Bcos I tell you in Nov I was in so much pain.. I thought.. This left knee is not going to last long..   I had visco supplements in Oct..  a Hip MRI with a cortizone shot in OCT   .. was going into a What the hell is going on moment.. on why so much pain..  Than had a cortizone shot.. that Voltaren medication and some loracet and my beloved lidocaine patches and now have reduced pain levels.   Its the inflamation that gets me.. Its the bone pain that gets me..   And for the bone pain..  Ice is the best ..  Not the best get up and go life.. but like I said everyone has their own breaking point..  Best to get the TKR done when you reached your lowest low..  in our youth.. It is a harder decision..   but it is a blessing if all goes right..    If you see some of the posts who have horror stories..  they all had high hopes that they would not be that one who had the struggle ... and nobody can promise you a rose garden after a tkr  and for how long this sweetness will last you..    Hopefully 30 years... 

Dont want to scare you..  or tell you not to do the scope..   I wish you pain free and mobility..  and want to make sure your thinking about what you actually have at the moment.

If your past the point of an HTO..  I would question him on why the scope.. If you go in and decide TKR or PKR when he has you fully opened.    Why go for a 14 grand scope now.. Surely he can tell at that stage of the game that you would need one or another  when he has you fully opened.  However I think once in they give you a TKR bcos if your on the cusp.. give you a longer term option at your age

Offline bombero1969

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I couldn't say it any better than you just did. Understanding everything you said and have already been all over this site. I do not like going any where without knowing all I can, especially when it comes down to my body, health, life and family. This all can make ones head spin for hours and many days. The only thing that makes the spinning better is the pain. It keeps me focused and thinking. Its true that every ones pain threshold is different, some pains I can stand some I can't. Even slight pains can become irritating over a long period of time.

I am a firefighter / paramedic so I can understand anatomy and how it works and how people are all different. But it is because of my profession that I am so concerned about the past, present and un-predictable future of my knee. I have been on the job for 15 years now, need only 5 to be eligible for a very small retirement. But desire to have a 30 year retirement to be able to live comfortable in our wonderful economically driven world. I would not know what I would do if one day I could not return to full duty. That in itself makes everything spin in major uncertainty. When and where it will stop is anybody's guess.

Some of these posts and stories is worse than any John Carpenter, Wes Craven horror film. But there is also the other side that has success. Kind of like playing Russian Roulette with you knee, let alone your whole entire life.

Well, I guess I could start taking courses towards a degree, should always have a back up plan anyways.   :)
June 2004 Arthroscopic medial meniscus repair, microfx & PT
    Dx with OA grade III & IV
2008 PT & CS Shots
2009 CS Shots & unloader brace
Jan 2010 Visco-supplement
March 2010 Arthroscopic medial meniscus repair
May 27, 2010 PKR

Offline teachmath912

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It is very tough to know what to do.  I went through that for about 6 months before making a decision, then waited an additional 4 months before having my tkr.  My orthopedic surgeon was worried at first since I was 34 when we first discussed a knee replacement and 35 at the time of the surgery.  The decision came with some worries as I am a soccer and basketball coach at the same high school where I teach math and I knew that things would have to be different after my knee replacement.  I knew that I would no longer be able to play with my athletes and that was tough for me.  I had to learn how to adapt my life and I'll admit that it was extremely hard.
I will say that my ortho is kind of "old school".  He is one of the best orthopedics in Northern Maine (maybe all of Maine!) and does not trust MRIs- even though I did have one on my left knee.  He believes that the best way to make a decision is by taking a look at the knee.   Because of that, I had a scope of my left knee last March in order for him to decide if he wanted to do a partial or a total replacement.  He did not want to take me into surgery in June and then when I woke up to surprise me with a total if he had promised partial (or vice versa.)  The scope gave me a little relief until my tkr last June.  I recovered quickly from the scope- as I always have- and was glad I had it done. 
Right now I am looking at having some things done with my right knee.  We don't know exactly as I have not had an MRI on that knee, just x-rays.  He knows it is in bad shape and I will be having another scope done on the 28th.  After that day, we will decide if I am having a total replacement done in the summer (I am a teacher, so summer is the best bet for my surgeries since I have 9 weeks off!)
Good luck with everything and I hope that the shots work for you!!
~ Kit
Right Knee Lateral Release and Meniscal Repair (9/89)
Left Knee MCL Complete Rupture (11/90)
Left Knee Lateral Release and meniscal repair (5/05)
Left Knee Scope (3/09)
Left TKR  (6/19/09)
Right Knee Scope  (1/10)
Right TKR Scheduled for 6/22/10