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Author Topic: Too young for knee replacement ?  (Read 1343 times)

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Offline Brankon

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Too young for knee replacement ?
« on: March 06, 2018, 03:24:57 PM »
Hi,

Iím 28 years old and have had 10 years of right knee trouble. It started when the kneecap started dislocating while playing football. I got an operation when I was17/18 and honestly canít remember what was done but it was minor. I ended up giving up football but knee issues continued although pain was infrequent and manageable. More recently I had a tibia tubercle osteotomy when I was 25 to correct alignment issues. After this surgery things seemed to be going quite well as inflammation was way down , I was walking better and alignment seemed much improved. The knee however always seemed a little stiff and in the last 8 or 9 months things have just got gradually a lot worse. The knee is incredibly stiff which merges into pain. I find I can only wear runners and slightest bit of stress on the knee causes much pain. I then got a steroid injection and much to my surgeons surprise it was of no benefit at all. I then went for an mri which surgeon advised showed fairly advanced wear and tear directly under kneecap and medial side. He advised I had similar wear and tear to someone twice my age. He sent me for another steroid injection which again isnít working. His next step he advised is a possible knee arthroscope but was very blunt in telling me this will offer very limited relief and looking online at various forums that does seem to be the case. He said i will be loooking at knee replacement by age 50. Itís fairly bleak to think I have to live with frequent pain until I reach 50. Has anyone any experience of having a knee replacement at similar age to myself (28) ? Any feedback be much appreciated

Offline Vickster

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Re: Too young for knee replacement ?
« Reply #1 on: March 06, 2018, 03:36:43 PM »
What country are you in? Iíd get a second opinion from a recognised patella specialist

The issue with replacements in younger patients is that they have a finite lifespan and seem to be reserved for patients who have extensively damaged joint following a severe accident or similar. Have you discussed partial replacement or only total

Also you donít mention Physio therapy. You should find a highly skilled specialist Physio and see if a programme can be developed that helps, could include hydrotherapynas well as land. You may have to pay depending where you are

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
More tears and wear, scope planned in Jan 2019 to tidy up

Offline Brankon

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Re: Too young for knee replacement ?
« Reply #2 on: March 06, 2018, 03:51:53 PM »
Hi,

Thanks for your feedback. Iím from Ireland. I have tried physio and go to gym once or twice a week however building strength has proved difficult. Going to gym and bike are no problem but things like sitting with knee flexed or standing for long period or simply wearing shoes as opposed to runners cause pain and stiffness that can be hard to shake. Iím at a healthy weight so that shouldnít be a factor either. The surgeon has admitted the knee is in bad way but equally admitted he does not want to perform tkr before 50 and conservative management just simply isnít working. I want to discuss partial knee replacement with him but heís hard man to get hold off. I think it may be best to get second opinion however most forums seem to suggest that other surgeons may have a similar view to my original surgeon and thatís what worries me

Offline Vickster

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Re: Too young for knee replacement ?
« Reply #3 on: March 06, 2018, 04:00:09 PM »
That is unfortunately the case due to the lifespan of a replacement although they are improving. Revisions are complex and also have a finite life.

Are there any patella and/or cartilage specialists in Ireland ? Have injections other than steroid been tried (these can also be damaging to cartilage)

Could you afford to travel to the U.K. to see a patella specialist such as Jonathan Eldridge in Bristol or Anan Shetty in Kent? Might be worth the outlay to consult if you donít have any options in Ireland

Otherwise unfortunately pain management may be the best course. Are you under a pain specialist?
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
More tears and wear, scope planned in Jan 2019 to tidy up

Offline Brankon

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Re: Too young for knee replacement ?
« Reply #4 on: March 06, 2018, 05:56:03 PM »
Hi,

Havenít considered travelling to England but I would be open to the idea. My surgeon discussed possibly trying a hyaluronic injection but judging by his the tone I think he was more hopeful of the steroid injection in terms of pain management. Putting aside my age it appears I would tick every box for a knee replacement as in previous surgery hasnít worked , nsaids havenít worked, steroid hasnít worked and it is now having an impact on my daily life. My function and range of motion is still quite good although most active things I do involve pain and visibly from the outside there would be no signs of distress, generally only very small amount of swelling no redness. I feel the only criteria Iím not meeting in order for tkr eligibility is my age and i may have a different attitude if I only had to wait 3 or 4 years but thatís not the case. Iím hoping to meet surgeon again and explain my feelings as last time we spoke it was just him speaking and I didnít really have chance to tell him my opinion. My attitude would be to have the operation for a chance of a pain free life and take on the risks and the fact I will need a complex revision surgery in 15 or so years but convincing my surgeon is the issue

Offline Brandon123

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Re: Too young for knee replacement ?
« Reply #5 on: March 08, 2018, 08:48:08 AM »
Hi brankon,

I'm somewhat in the same situation as you. Severe wear and tear under the kneecap, no improvement from conservative treatment. I'm also having a lot of pain and stiffness from standing, walking, bending etc. I would suggest that you try a hyaluronic injection, it doesn't help me, but it works wonders for some. Some people would tell you to also look into PRP and stem cells, others would say it is not worth wasting any money on.

I had an arthroscopy when I was 27 (I am now 35) and it worked for a few years and quite much of that time the knee felt pretty normal. I could never run or squat etc., but the knee worked very well and pain free in everyday life. Now all my symptoms and problems are back with a revenge, and similarly to you, by most opinions, I am too young for any type of knee replacement.

I wish I had a solution for you, but I'm in the search for one myself, so unfortunately I cannot offer you much more help at this point.

 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

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Re: Too young for knee replacement ?
« Reply #6 on: March 08, 2018, 11:16:09 AM »
Hi,

The hyaluronic injection didn't work for me. It was painful and not beneficial... I've not heard of many people that really benefited from it. You can try... it costs approx. 80 to 100 EUR / shot.

I visited Anan Shetty in Kent, he is very knowlegdeable

Reflex
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Brankon

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Re: Too young for knee replacement ?
« Reply #7 on: March 08, 2018, 07:29:12 PM »
Iím somewhat relieved to hear that arthroscope did have some benefit to you as it appears thatís likely to be my next course of action. Iím not too worried about sporting activities or running but do hope I can find a way to go about my daily life without pain and preferably without taking as much anti inflammatories as I am now. Have heard very mixed reviews on arthroscope , am aware of its limitations but hopefully it may provide some pain relief and allow me an opportunity to rehab surrounding muscles. Feel like itís a catch 22, Iím told to work the muscles to provide better support to the knee but need my knee to be pain/inflammation free to allow me to train.

Offline Brandon123

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Re: Too young for knee replacement ?
« Reply #8 on: March 09, 2018, 08:42:16 AM »
The long-term outlook for arthroscopy (for arthritis) is generally not good. After 5 years or so, people who underwent such procedure, and people who didn't, tend to have similar symptoms. However, short-term it seems to help some people, but the odds are still not very good. Based on what I have read, probably only 50/50 or slightly better. I'm not an expert though so take my estimate with a grain of salt. 

As said, it made a significant difference for me for a few years. But due to the fact that the odds are really not that favorable, and I might not be so lucky again if I did another one, I try to postpone a new arthroscopy for as long as I can.

I have the same catch 22, need to strengthen muscles to relieve the symptoms, but the PF-joint cannot take the load needed for the muscles to build up. Almost any effort to strengthen the surrounding muscles results in inflammation/irritation, redness, heat, pain, stiffness etc. It is a dilemma indeed.       
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment