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Author Topic: Patient age - what does older/younger mean?  (Read 1109 times)

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Offline RevBarbaraG

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Patient age - what does older/younger mean?
« on: August 27, 2012, 09:26:24 PM »
Hi,

I've recently had it confirmed that I have osteoarthritis.... but also discovered that I probably have a medial meniscus tear.  In researching both of these conditions (which is how I found kneeguru, btw), lots of articles talk about different  treatment options for "older" or "younger" patients - but no-one seems to define what they mean by older or younger.

I'm 48 - am I older or younger with respect to meniscal tear, osteoarthritis, or both?

PS I think, looking back, I may have had the tear since I was in my early twenties - I'm assuming I was younger then!

Barbara

Offline Vickster

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Re: Patient age - what does older/younger mean?
« Reply #1 on: August 27, 2012, 09:46:24 PM »
From what I recall when I had my meniscus tear, the tissue starts to degenerate from the age of 35ish, after which time it becomes less repairable and most tears treated surgical end up being trimmed (aka partial menisectomy).  I was 37 when I tore mine and was anticipating a repair of a small tear.  Unfortunately, in the 5 months of trying to let it heal, the tear got worse and according to my OS letter was a complex degerate tear by that time and a part was removed (smaller lateral meniscus in my case).

In terms of arthritis, you are probably a bit in between - young for a replacement - full replacements more likely from age 60 - as the parts have a finite life and doing it more than once is less than ideal.  However, for cartilage repair techniques for small focal defects, you would likely be considered rather old - unfortuantely, as we get older, we heal much more slowly and repairs of this type are less likely to be successful.

It all rather depends on you, your lifestyle, your goals, the effect on your QoL, your surgeon, and in some countries, unfortunately the depth of your pockets (or insurance policy).

The arthritis and meniscus sections in the info hub are very good places to read up :)
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 RevBarbaraG

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Re: Patient age - what does older/younger mean?
« Reply #2 on: August 27, 2012, 10:40:40 PM »
Thanks for the reply - that rather confirms what I was assuming, i.e. Older re the meniscus tear, younger for the OA.  I know several people who have had TKR ops, and they were all in considerably more pain for me, so I don't think that's even a consideration at the moment..... but it may be eventually.

So.... No chance of repairing the meniscus tear (especially since I have had it a long time).  It's a partial meniscectomy or..... a menaflex implant?  Can I even ask for that?  I'm in the UK and currently going down the NHS route (waiting to hear from the surgeon my GP has referred me to), but open to the possibility of going private if it's the only way to get what I need.

I've been very obese most of my life, despite many many attempts at losing weight.  But in recent months, I've found an approach which has dealt with my binge eating, consequently I've cost five and a half stone this year, with more to come.  And part of my new lifestyle is regular exercise.  I've been going to the gym, doing strenth training and no-impact cardio, and in the last few months, building up long distance walks.  We had a couple of weeks in the Lake District, and did some long walks - which were really painful on my knees!  That was what eventually sent me to the doctor.

So, my goals are: to be able to do long distance walks, with hills, and without pain.  Also to be able to do some of the things I've been avoiding  because I didn't know I had a meniscal tear.  And - in an ideal world - to run.

Guess I've got to be patient till the referral comes through.... and make a list of things to ask the surgeon.

Barbara

Offline Vickster

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Re: Patient age - what does older/younger mean?
« Reply #3 on: August 27, 2012, 10:53:04 PM »
It might be repairable, I am sure there are 'older' folks who have repairs, but tends to be the younger sporty peeps

I am not sure if there is menaflex in the UK, there are a very few surgeons who do meniscus transplants, but normally only if they have had a big chunk of meniscus removed

Where in the UK are you?  Any sort of cutting edge treatment costs an arm and a leg in the UK.  A 'simple' scope is around 3k+

I am certainly no lightweight, I find cycling and swimming (crawl) the most knee friendly - myself, never been much of a walker and definitely no runner - cycling much more enjoyable, you can go so much further in the same time and with a correctly set up bike, it's ok for gammy knees!!

Have you had surgery before - are you sure you have OA?  I'll seek out your other posts

Good luck :)
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 RevBarbaraG

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Re: Patient age - what does older/younger mean?
« Reply #4 on: August 28, 2012, 09:36:06 AM »
I'm in Nottinghamshire.  I've asked (or rather, the sports physio I saw has suggested to my GP) to be referred to Mr Hahn at Queens Medical Centre, as apparently he is about the best for knees in this region.

I haven't had surgery before.  The OA has been confirmed on XRay, and is worse in my left knee (the one with the tear) than my right, but I don't have any numbers or grading, so I don't know how bad it is on a scale of 1 to 10.  I can tell you that on a long steep walk (climbing Coniston Old Man) my left knee was pretty painful for the last 1/3 of the endeavour, and stiff and sore for several days afterwards.  My right knee gave me a few sharp pains towards the end of the walk, was mildly sore for a day or two afterwards, but otherwise is fine.

I've deliberately cut back on the long walks since the physio identified the tear - it's over 2 weeks since I last did a 10-miler.  My right knee, apart from the grating, is basically OK (pain-free).  My left knee has a background ache, on a scale of 0-10, of between 0 and 2, and "jolts" if I do something silly, of up to 4.  *But* there are some things I physically can't do or find very difficult, such as squatting, getting up off the floor, jumping or hopping.  And I really don't want to give up long distance walks!

Barbara

Offline Lottiefox

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Re: Patient age - what does older/younger mean?
« Reply #5 on: August 28, 2012, 12:12:08 PM »
Aside from the meniscus issue there are non surgical things that can help with early OA. I am 43 with grade 3-4 OA in both knee caps and on the medial side of my left knee too. I have Euflexxa injections which are visco supplements aimed to help lubricate the joint - I've found them fabulous. I am very active doing spinning, strength training, walking etc 5-6 times a week. I can also now do all the normal garden, house jobs etc. A good gait analysis and focused programme to iron out any muscle imbalances can also help reduce the pain and allow you to carry on walking the hills as your legs will be more efficient. Plus don't forget the good old fish oils which certainly don't do any harm (unless you are allergic to them!). I also find a walking pole (or two) to be invaluable on hill walks, and in times of extreme peril I descend very steep slopes/rocky outcrops on my rear end.  :P  Yes I was that person slithering down a cliff in Cornwall last Xmas...

Avoid jumping and hopping. Life rocks on without them, and they are for young person's knees I have decided. Ditto lunges!  ;D

Good luck

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline LindaM

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Re: Patient age - what does older/younger mean?
« Reply #6 on: August 28, 2012, 09:30:05 PM »
Hi Barbara,

Just a thought from someone who is on their feet a lot and overweight- as time goes on your weight put extra strain on your arches.  As they flatten out it shifts the balance in your knee so that there is more stress on the medial side.  If you have not done so already, I would check with a physical therapist if you need orthotic inserts, they can make a real difference.  Also, with all your walking, you should be replacing your shoes very regularly- I replace every three or four months or I pay for it in pain.  Although I have two PKRs that still leaves half a natural knee there to complain if there isn't enough cushion left.  I assume you are wearing good walking shoes, but even those may need an insole replaced with one that has a more durable cushion or gel insert.

I second Lottie on the gait analysis-I did it and it made a world of difference in my gait and got rid of pain in my back, hips, and tush that were due to walking badly.  When there are muscle imbalances or you are responding to pain, your walk changes and you throw off everything else. 

I applaud you on your weight loss and hope you are able to keep up the good progress both with the diet and with your exercise.  Hopefully you will be able to find a variety of ways to strengthen your knees so you delay the TKR a good long time.

Good healing :)

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

Offline RevBarbaraG

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Re: Patient age - what does older/younger mean?
« Reply #7 on: August 28, 2012, 09:47:35 PM »
Hmm.... The physio did talk about the possibility of orthotics in his initial spiel (that was before be had found the meniscus tear).  Basically he was saying that OA is not the real problem - it develops as a consequence of either biomechanical problems or injury - and the better you can get the biomechanics, the less OA you will get.

How do you go about getting a gait analysis? I did come across a service at a private hospital nearby which they called RunReady, or something like that - gait analysis for runners.  But not sure how to access it for walking?

I have started taking fish oils, and also glucosamine, and already use trekking poles on long walks.  I do have proper walking boots, but haven't thought about insoles. I have a lot of faith in this sports physio, though.  I can envisage working with him over a period of time - once my meniscus is sorted and I'm through the rehab, it's then a question of what else aches, and getting him to look at that!

Barbara

Offline Vickster

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Re: Patient age - what does older/younger mean?
« Reply #8 on: August 28, 2012, 09:57:36 PM »
A thorough sports physio should be able to analyse your gait - mine did and I too now have orthotics insoles and don't swing my leg out when I walk.  Seems to have worked a treat, along with 3 jabs of slippery stuff (ostenil) and cycling :)
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: Patient age - what does older/younger mean?
« Reply #9 on: August 28, 2012, 11:01:41 PM »
Hi again,

In my case my OS referred me to an athletic trainer who had studied gait analysis and works in the Physical Therapy department when he is not working with high school sports teams.  He videotaped me walking on a treadmill, then analyzed my gait, prescribed specific exercises, and met with me to add exercises and to tape over a period of about 8 months meeting about once a month.  It was not expensive, but even if it had been it would have been worth every penny.

If your physical therapist suggested orthotics I would go for it.  I have worn them for over 20 years and I think they really helped to delay the need for my PKRs.  When I started having arthritis, by the end of the day I would be nauseated by the pain(I have osteo and inflammatory arthritis). i was afraid I would need to quit working and go on disability. With proper medication and things like my orthotics I spent 20 years with almost no pain.  Hopefully you can put together a few things and manage your knees as well as mine have been.

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

Offline RevBarbaraG

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Re: Patient age - what does older/younger mean?
« Reply #10 on: August 29, 2012, 10:57:00 PM »
Lots of helpful suggestions, thanks everyone.   I dare say I'll be hanging round here for a good while.  Not heard anything about my referral yet.... Gonna ring the surgery tomorrow.

Barbara















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