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Author Topic: abnormal arthritis acceleration??  (Read 2057 times)

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Offline Ladymayin

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abnormal arthritis acceleration??
« on: February 29, 2012, 08:03:39 PM »
A year ago I had lateral miniscus repair. MRI prior to surgery revealed "mild" arthritic changes to that knee. Repeat MRI last week showed severe degenerative arthritis with bone-on-bone on lateral side.
     Second MRI was ordered by a different doctor to see why I was not without pain, still have some swelling, and now am knock-kneed and have "genu valgus".

     So, was original surgery the cause of accelerated degenerative arthritis? At the time the surgeon said the surgery would fix everything and I should be close to normal in a few weeks. I went to P.T. religiously for 4 months and exercised at home also.
     I am now facing impending TKR.  My husband thinks I should contact an attorney....   Has anyone else had such fast progression of arthritis after miniscal repair??
Marion

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Re: abnormal arthritis acceleration??
« Reply #1 on: February 29, 2012, 08:51:22 PM »
I am in a similarish situation, albeit my meniscus was partially removed (about 20% laterally I believe), I have a defect in my lateral femoral condyle (trauma like the meniscus),  I too am knock kneed (probably due to years of being sedentary and overweight as much as the trauma to the knee if I'm honest). My menisectomy was done to fix locking, buckling, grinding and worked almost immediately. 

I have extensive grade 2 softening to tibia, and was told an osteotomy was my next step (I am only 39, way too young for replacement bits now). I had a second surgery about 7 months after the menisectomy and got the impression that the softening was more extensive - but it was there before so assume that the wonkiness was the cause not the meniscus tear.  My MRI only showed the meniscus tear and femoral defect (about 1.5cm2), none of the other damage (also to back of kneecap, grade III, tidied), hence why nothing was noted on your first MRI maybe?  Did your post op notes not make mention of changes to the articular cartilage, the OS would have had a good poke around while sorting the meniscus out?   Was the meniscus damaged by a trauma, I do believe that arthritis can be accelerated by trauma to the bone (surgeon said this to me, basically the forces to the bones, which are pretty rough to tear the meniscus - I came off a bike at 15mph onto concrete).

It also seems odd that if your meniscus was preserved with a repair rather than removed/trimmed that you now have this going on?  How old are you by the way?  Are you into impact sports, e.g. running, I can imagine that would exacerbate damage if knock kneed?  Also, a TKR is normally indicated if there is damage to more than one compartment, you mention lateral damage, perhaps an osteotomy (distal femoral) or partial replacement may be possible (although I assume for the latter, the alignment would need addressing)

From what I have read, people fare less well with lateral meniscus issues and knock knees, than medial meniscus and bowed knees (the lateral meniscus is rather smaller I think).

Why would you see an attorney (I am assuming you are in the US)?   I don't get what if anything the surgeon has done wrong except expect you to be fixed - this forum shows that despite the best efforts of the OS this isn't always the case, surgery and recovery is unpredictable, nothing is 100% certain (well except death and taxes as the old saying goes) ?

 I am from the UK, where we don't often sue doctors unless something catastrophic happens (and then it's normally the hospital or the system rather than an individual doctor).

Good luck, hoping it all works out for you :)
« Last Edit: February 29, 2012, 08:59:54 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline LindaM

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Re: abnormal arthritis acceleration??
« Reply #2 on: February 29, 2012, 10:03:46 PM »
Hi Marion,

Sorry to hear you are bone-on-bone. You and I are the same age, and sad to say, these things happen.

  After I had my medial meniscus trimmed I never got rid of the pain.  Both my rheumatologist and OS (and me) believed that the surgery had caused the arthritis that had been under good control for 20 years to flare.  I tried cortisone shots, a $900 brace, $1000 synvisc, and PT, but by the time we finally gave up and did an x-ray I was bone-on-bone with a divot out and had my first PKR.  My knees are somewhat bowed inward and that contributed to the problem. I had asked my OS right after the meniscus surgery how the cartilage was and he thought it was in surprisingly good shape when he went in, but without the full meniscus it threw off the alignment just that extra little bit. 

My second knee started to hurt this past mid-October and by Christmas it was bone-on-bone. I had my second PKR four weeks ago.  This time I knew what was happening as soon as the pinching and locking started. Once the meniscus started to go so did the cartilage.  And after trying a couple of cortisone shots we went right to x-ray which confirmed bone-on bone. 

Since you have alignment issues, like I do, the meniscus got extra wear over time and may have torn originally in part due to that.   And once the alignment changed a little from the surgery, it caused even more stress on the cartilage that was already wearing due to the mis-alignment.   It is kind of a chicken or the egg situation. I don't think that your doctor or you did anything wrong, just that at 62 things sometimes start wearing out.  I know your husband is outraged that you are still in pain, but I doubt you would get anywhere with an attorney. 

Fortunately, we are repairable.  I  am very satisfied with my 2 PKR's.  Yes I still have arthritis in the other compartment, but only the medial half had damage.  Do both portions actually have damage, or could you go with a PKR instead of a total?  It might be work asking instead of just assuming that it has to be a total.

Hang in there Marion.

Linda

>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline Ladymayin

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Re: abnormal arthritis acceleration??
« Reply #3 on: March 01, 2012, 08:14:28 PM »
Thanks Linda.... It feels good to hear someone my age has similar problems. I have calmed down a bit and don't really want to contact an attorney. I guess I was going through the anger phase.
   Besides lateral bone-onbone, the medial has significant damage. I also have moderate degenerative changes to right hip (opposite of knee). Sincecortisone shot to hip last week, it does feel significantly better. I am able to exercise a lot more with longer duration. Hoping to improve muscle in both knees and hips to prepare for surgery.
   I wear a hinged brace on knee most of the day. It helps a lot.
   Do you think it's ok to postpone this surgery or will I just make it worse? It seems a lot of people feel much better after surgery. My doctor says it's up to me...when I can't stand not being active anymore. He has a point.
Marion

Offline LindaM

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Re: abnormal arthritis acceleration??
« Reply #4 on: March 01, 2012, 09:54:09 PM »
Dear Marion,

I'm glad to hear your brace helps, mine never really did.  I guess the key question I would ask is- how well are you walking?  My guess that your hip is extra aggravated by you favoring your knee and limping when it gets tired or sore.  That limping causes issues of its own.  After 9 months of limping before my first PKR I went into surgery not having full extension of the bad knee.  And after surgery and PT I still was limping, not from pain but from habit and because my hamstring had shortened, I had hip bursitis, my back was off, etc.  You know the old song, the knee bone is connected to the hip bone...  After therapy was over I worked another 6 months with an athletic trainer who was trained in gait analysis.  He gave me more exercises and helped me re-learn to walk evenly.  This time as soon as I was bone-on-bone I scheduled surgery.  I didn't want to go through months of pain and limping again and take another year to walk properly.  In fact I went onto crutches for about a month before the surgery because I could walk more evenly and without pain that way.

The knee is going to get worse, that is a given.  Your brace is changing the angle of your knee a little and helping to delay things, but the wear of bone-on-bone will gradually continue.  For some people like me it is fast and painful, for some very gradual over a long time.  And bone-on-bone for some folks is relatively painless.  My 87 yr. old mother has knees that look like they would never support her they are so bowed and damaged by arthritis-about a 25 degree angle inward, yet she has no pain, just instability that she helps with a brace.

I think your doctor gave you a good thought-how is this affecting your life as a whole?  It sounds as if you have been active up to now.  Is your knee holding you back?  If you are spending your evening sitting and icing instead of doing what you would like to, if you are starting to lose muscle tone and energy from being inactive, then you know the answer.

I have had two very boring, very successful PKRs. My sister has 2 TKRs and after the first one harassed her OS until he moved up her surgery date for the second one because the difference in her quality of life was so spectacular. Most people are very happy with the results.  This time, because I didn't wait as long, I hadn't lost muscle strength and right now at 4 weeks my PT says I am at what would be the goal for 6 weeks post-op.  I will be back teaching in 2 more weeks and know I will be ready by then.  I know that with a surgery there are no guarantees (I talked with my financial adviser today and he almost bled to death two weeks ago after having his tonsils out!) and especially after reading some of the posts here you could get worried, but the success rate is really so high.

I hope I haven't blabbed on too long and bored you and I hope this helps you in making the decision for when you should have surgery.  I am glad you are trying to build up your strength, that will help whether you delay or go ahead with it soon.

Good luck on your decision.

Linda   
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline ladyeleanor

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Re: abnormal arthritis acceleration??
« Reply #5 on: March 02, 2012, 04:51:23 PM »
Yes me, my story is near enough same as yours Ladymayin. I feel as though i have been mis-informed over my last 2 years of this journey.
I had a maniscus removal, the lateral side, about a 3rd i think in August 2010.
I am 39 and play sport daliy. From the onset of pain in March 2010, not one person said stop the sport till the arthroscopy in August, (which also showed grade 4 OA) even then it was reduce sport but go away and come back when it gets too bad. I ask for a second opinion as the pain is so bad, had another arthroscopy in October 2011 and that surgeon says i need a partial reaplacement. I don't get it....
Al
« Last Edit: March 02, 2012, 05:00:48 PM by ladyeleanor »