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Medical Forum / Diseases and Disorders / Arthritis / August 2006

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Returning "Newbie" with TKR issues--need HELP

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Ginnie - 25 Aug 2006 08:56 GMT
Hi, everyone,

I was on this ng briefly, near the time of Larry's passing, but
gave up ngs after getting burned out by asc-p.  But now
arthritis HAS me (DJD, OA, DDD with stenosis in cervical and
lumbar
spine, crud on my facet joints, a few bulging disks here and
there,
but most attention-getting right now - my left knee), and Rosie
Shiver said to introduce myself over here...  and stay!

By way of "introducing" myself, I'm 59, female, tall and about
60 lbs overweight, with chronic daily migraines/tension
headaches,
Fibro, Chronic Fatigue Syndrome, Osteoporosis...  what other
fun stuff did I forget?  Oh, well,  catch up later.

I'm having a current problem with my orthopod.  My left medial
meniscus tore badly when I was about 42, and during the
arthroscopy,
he found the DJD and all of the cartilage on the weight-bearing
end of my thighbone had all turned to hard little chunks of
'concrete'.
Same thing on the back of my patella, which now moves around
from time to time, anywhere but where it belongs.

Back then, he told me I had to get this knee replaced, but I
was "too
young" at the time.  When I was about 50, I asked him to
replace it,
and now he said I had to get down to 220 pounds.

 Weight's always been hard for me to lose, but I lost some
over the
next few years, and when I'd hit 240, I asked him again.
This was
two years ago....  this time he said I'm too young.

My knee at this point aches all the time, I'm Disabled by
it, it's losing
range of motion, both in not going straight like the other
one, and
not able to bend as tight as the other one.  It buckles
under me,
and when that happened the other day, my head struck a concrete
curb.

His explanation of "too young" was that as big-boned and
tall and
slightly bow-legged I am, I would wear out an artificial
joint in 8-10
years, sooner than regular folk, and that I would lose more bone
every time they had to replace the metal ends of the joint.
 He said
eventually I would run out of bone, and be wheelchair-bound.

Here's where I get confused:  another orthopod I had to see
for a
workman's comp claim some years ago showed me a joint made of
metal, with a 'plastic'?  Delrin?  Silicone? hockey-puck
inside the
metal knee that took all the wear, and when it needed
replacing,
they just replaced the puck, and left the metal parts where
they were.

Isn't there an artificial knee out there that's designed to
handle
more load, and not require repositioning the metal parts
every 8-10 years? Nor causing more loss of bone?

Can you all tell me what might help, and PLEASE, if you have
LINKS to artificial joint sites or other sites that explain the
different available types of knee joints?   I scheduled a
face-to-
face with him this next Monday, and will be researching all
weekend to educate myself.

My existing knee is shot, painful in several ways, and limits
what I do, and even screws up my gait.  I walk very oddly to
favor my touchy left knee and my next-on-the-list-for-
replacement right hip.

Well, sorry for such a long intro, but I'm glad to be here.

Ginnie    >^..^<

You can catch more flies with funny than vinegar.
__________________________________
Karen P - 25 Aug 2006 12:38 GMT
why don't you just go find another ortho.  This one does not sound like he
is up on the newer implants and he doesn't seem to want to work with you.
Its a quality of life issue not an age or weight issue. Yes there are risks
but he is not doing a good job of explaining them in realistic terms.  Your
knee may be bowlegged now but TKR will fix that problem.

Get another independent opinion

Karen
> Hi, everyone,
>
[quoted text clipped - 64 lines]
> You can catch more flies with funny than vinegar.
> __________________________________
Cindy - 25 Aug 2006 14:18 GMT
IT is exactly a question of quality of life versus age here...and you are
way too young to be Feeling this Damn old....And how does this Doc think you
can move enough to lose any weight the way you are now...
An OT told me that unless I planned on Running marathons or Skiing...That
the implants they used now would last 20 years or better and quality of life
was more important than age and that you should push for a TKR and I still
have good range of motion and still can walk well... See another Dr...
Cindy
> Hi, everyone,
>
[quoted text clipped - 85 lines]
> You can catch more flies with funny than vinegar.
> __________________________________
Rosemarie Shiver - 25 Aug 2006 16:19 GMT
Yup...

  B4 getting a new knee get a new MD. :-) Tell this one if he doesn't want
your insurance dollars you'll find someone who will sell you a new knee
without jerkin' ya around.

   Welcome to the ASA sandbox, Ginnie. One thing you'll appreciate is that
everyone plays very nicely together here.<g> Since I referred ya and I'm
mentioning it first I get dibs on ALL your intro chocolate. I prefer the
milk chocolate variety, m'dear...lots of calcium for da ol' bones, eh?<VBG>

Hugs from Rosie

Signature

"If you wanna get it done, you gotta fight for yourself." -- Meat Loaf, Bat
Outta Hell II

> Hi, everyone,
>
[quoted text clipped - 85 lines]
> You can catch more flies with funny than vinegar.
> __________________________________
ladylove77 - 25 Aug 2006 19:02 GMT
Ginnie, I agree with what has already been said: Get another doctor.  This
one should be put out to pasture!
Gwen

> Yup...
>
[quoted text clipped - 99 lines]
>> You can catch more flies with funny than vinegar.
>> __________________________________
Joan Carter - 25 Aug 2006 21:27 GMT
>Ginnie, I agree with what has already been said: Get another doctor.  This
>one should be put out to pasture!
>Gwen

Oh, I love that, Gwen, I can just picture him out there chewing his bovine cud.
Thanks for the image. :-)
---
Joan
Ginnie - 26 Aug 2006 06:09 GMT
Oh, Rosie, the chocolate sitcheeation will work out nicely
-- I like the
darkest bittersweet ones.  When mine show up, I plan to
break open
the bottom of each one to taste what it's filled with, then
if it's nasty,
it'll look untouched to whoever gets to 'em next! <beg>

And yeah, I DO like the neighbors in this neighborhood.  No
lie, but
when things got their absolute flame-fest worst over in
ASC-P, I'd lurk
here just to be around people who were so caring about each
other.

So, thanks muchly for advising me to sit down and stay here.
 I come
in peace, all flamed out.  And really needing ASA's help.

Ginnie      >^..^<    (and Clooney)

You can catch more flies with funny than vinegar.
_________________________________

> Yup...
>
[quoted text clipped - 8 lines]
>
> Hugs from Rosie
spodosaurus - 25 Aug 2006 19:21 GMT
> Back then, he told me I had to get this knee replaced, but I was "too
> young" at the time.  When I was about 50, I asked him to replace it,
> and now he said I had to get down to 220 pounds.

I had both my THRs at about 220 pounds. No issues there. That said, I do
a helluva lot better 55 pounds lighter!

>  Weight's always been hard for me to lose, but I lost some over the
> next few years, and when I'd hit 240, I asked him again. This was
> two years ago....  this time he said I'm too young.

Do you have an underlying metabolic or hormonal problem? For years
weight was 'hard for me to lose' too, but then I actually started
applying myself more. Unless you're going to commit to it, it's going to
be hard. And not just commit for a few weeks or months: commit
permanently. It doesn't have to be a herculean effort, either - set a
goal for a few pounds per month and only weigh in once a week at the
same time each week on the same scale. Keep records. Slowly improve
dietary habits. One small improvement every week or two. And add
exercise. you can do water exercise or even just weight training
involving only the upper body, with stretching and range of motion work.
Be creative and do what you can.

Even given what I've just said being able to exercise better after
having a TKR is going to help a lot, too!

> My knee at this point aches all the time, I'm Disabled by it,

Well then how is the doctor's position that you are too young and will
end up in a wheelchair valid? You're already disabled by it: better to
have several years NOW when you can enjoy them and improve your health
than when you're too old (and with health problems from having your
activities restricted by the bad knees) to even have the surgery!

> Here's where I get confused:  another orthopod I had to see for a
> workman's comp claim some years ago showed me a joint made of
> metal, with a 'plastic'?  Delrin?  Silicone? hockey-puck inside the
> metal knee that took all the wear, and when it needed replacing,
> they just replaced the puck, and left the metal parts where they were.

I'm not familiar with this, but in general you do NOT want such things
wearing out. This was the problem with plastic coated hip replacements:
the micro-particles from the wear of the artificial joint serface caused
inflamation of the soft tissue around the artificial joints and also
bone loss around the implants (leading to loosening of the metal and
bone deterioration!). If this prosthesis isn't in common usage these may
be the reasons why.

> Isn't there an artificial knee out there that's designed to handle
> more load, and not require repositioning the metal parts
> every 8-10 years?

I'm not up on the TKR technologies, sorry, but I suspect that there is.
However, longevity of the joints is proportional to the wear they take
(which your doctor has pointed out already).

> Nor causing more loss of bone?

It's the revision surgery that leads to the bone loss usually: some has
to be damaged when they remove the old parts each revision.

> Can you all tell me what might help, and PLEASE, if you have
> LINKS to artificial joint sites or other sites that explain the
> different available types of knee joints?   I scheduled a face-to-
> face with him this next Monday, and will be researching all
> weekend to educate myself.

Shop around and get a doctor you like who can help you get out of the
disabling joint damage trap, even if it means TKR surgery.

Regards,

Ari

Signature

spammage trappage: remove the underscores to reply

I'm going to die rather sooner than I'd like. I tried to protect my
neighbours from crime, and became the victim of it. Complications in
hospital following this resulted in a serious illness. I now need a bone
marrow transplant. Many people around the world are waiting for a marrow
transplant, too. Please volunteer to be a marrow donor:
http://www.abmdr.org.au/
http://www.marrow.org/

Joan Carter - 25 Aug 2006 21:24 GMT
>Well, sorry for such a long intro, but I'm glad to be here.

Ginnie, I vaguely remember your name from a while ago, I think. I can't tell you
about types of knees, but I can tell you the doctor is full of bull hockey. You
are NOT too young. That's a cop-out.

Stick around here and we'll encourage you in your weight loss, which of course,
will help you, but dammit, is not easy, and learn from the wise folk here.
---
Joan
Fire Chief - 25 Aug 2006 23:37 GMT
> Back then, he told me I had to get this knee replaced, but
> I was "too young" at the time.

> I asked him again.  This was two years ago....  this time
> he said I'm too young.

You should march into his office and tell him he's too
old to be practicing medicine.  He's about 1,000 years
behind in knowledge - living with his head stuck in the
sand.

THERE IS NO SUCH THING AS "BEING TOO YOUNG!"

Teens and folks in their 20's and 30's are now getting
joint replacements - sometimes multiple ones.

Drop this jerk.   Find another doctor, pronto.  I did in
2000 and had my THR within 6 months.

... I'm outgrowing my birthday suit.
Bud - 26 Aug 2006 01:16 GMT
Just to echo the other smart replies. Find another orthopod and weight
loss is easier if you can get around better with new knees. A
no-brainer really... the choices AND your Doctor. LOL!
Ginnie - 26 Aug 2006 02:27 GMT
What *really* flummoxes me about this doc is that he's
considered THE
joint-replacement mensch in this large city, plus he and his
partner are
the team physicians for a Major League baseball team.  He's
SO conspicuous
that -- like I said -- it boggles me that I get these kind
of throw-back, out-
of-it responses from him.  And he's not an old fart - he's a
few years
younger than me...  and I'm only 8 1/2...

okay, that's in dog years, but still...

Thank all of you for your thoughts.  I appreciate them, and
fersure, you
guys are in consensus!

One more time, though...  any good links to TKR info that
will educate
me about types of available knee joints and TKR procedures?
 Or are
you gonna make me 'Google' and take my chances?

Ginnie    >^..^<

You can catch more flies with funny than vinegar.
_________________________________

> Just to echo the other smart replies. Find another orthopod and weight
> loss is easier if you can get around better with new knees. A no-brainer
> really... the choices AND your Doctor. LOL!
Joan Carter - 26 Aug 2006 02:44 GMT
>What *really* flummoxes me about this doc is that he's
>considered THE
[quoted text clipped - 7 lines]
>few years
>younger than me...  

Old farts come in all ages, shapes and sizes. This guy definitely fits the old
fart mode, or if you want to be really suave, olde phart. ;-)
---
Joan
Harvey R. Stone - 26 Aug 2006 17:59 GMT
> Old farts come in all ages, shapes and sizes. This guy definitely fits the
> old
> fart mode, or if you want to be really suave, olde phart. ;-)
> ---
> Joan

LOLOL well said,,,, been there,,, been that,,, learned from it. LOL
Harv
Karen P - 26 Aug 2006 12:38 GMT
Ginnie,
One thing I discovered through all my interviews of orthos for my various
joint replacement surgeries (including both knees at age 37) is that
sometimes sports specialists may not the best ones to choose for joint
replacements if the degeneration was not caused by a sports related injury.
Their , and this is a generalization, interests lie in getting their
patients back to a sports active life.

What area of the country are you in..maybe someone can recommend a surgeon
or you can visit
http://forums.delphiforums.com/onourfeet/start  this is a website devoted to
joint, mainly knee, replacements. Its an international community with people
of all ages participating.  There might be someone who can recommend a
surgeon for you.  There are a lot of people there who would be glad to chime
in with an opinion and offer support through this

Karen
> What *really* flummoxes me about this doc is that he's considered THE
> joint-replacement mensch in this large city, plus he and his partner are
[quoted text clipped - 21 lines]
>> loss is easier if you can get around better with new knees. A no-brainer
>> really... the choices AND your Doctor. LOL!
Thumper - 26 Aug 2006 18:50 GMT
>Ginnie,
>One thing I discovered through all my interviews of orthos for my various
[quoted text clipped - 3 lines]
>Their , and this is a generalization, interests lie in getting their
>patients back to a sports active life.

I have the impression from the times I've seen a sports ortho is that
they are awfully quick to put you under the knife.  Perhaps it's
because they are so used to athletes that aren't any use to them with
an injury that may heal itself over time.
Thumper
>What area of the country are you in..maybe someone can recommend a surgeon
>or you can visit
[quoted text clipped - 30 lines]
>>> loss is easier if you can get around better with new knees. A no-brainer
>>> really... the choices AND your Doctor. LOL!
Donald Whitely - 26 Aug 2006 05:14 GMT
Ginnie,

In 1980 at age 46 I had bilateral TKR at the Cleveland Clinic,  The
youngest they had done to that date. It was the old fashioned (by
today's standards) plastics and titanium with super glue.  Next part of
the deal at that time was the use of staples (new state of the art at
the time) instead of stitches. Nurses argued over who would  get the
privilege of removing them.

Prior to the TKR I was hobbling around with a very unsteady gait and
using a cane to steady myself and increasing pain.  Made my very first
RD appointment (never refereed by my PCP) Using various NSIADs for my
RA.  He injected my knees with cortisone, did X-rays and said they are
bad. At my followup he said if I did not follow his advice and referral
to an Orthopedic Surgeon at Cleveland Clinic within six months I would
be in a wheel chair.

Within a month I had two new knees. I was so fortunate because I never
heard the  ---- your too young--- from any one.

Go for it and get a good Ortho who knows and does knees with a good
reputation.  You deserve the quality of life that goes with that new knee.

BTW mine are still doing great with no revisions or new parts ever.

Don Whitely

> My existing knee is shot, painful in several ways, and limits
> what I do, and even screws up my gait.  I walk very oddly to
[quoted text clipped - 7 lines]
> You can catch more flies with funny than vinegar.
> __________________________________
RoseB - 26 Aug 2006 05:48 GMT
. I was so fortunate because I never hear you are too young from
anybody.

Neither did I and I was 24 when I had my first knee replaced, 27 for
the hip, 28 for the next knee, and 29 for the revision of the first
knee as well as an elbow dynovectomy. Never was age mentioned to me. I
am now over 50, and have had no surgery since.

     Rose @}->--
Being educated means that rather than fearing the unknown,
one seeks to understand it.

Please remove "Ima" to reply.
Ginnie - 26 Aug 2006 06:14 GMT
26 years on 'old-fashioned' parts??  Wow, you won big!
Thanks for
the encouragement.  And you're another one in consensus that my
doc sucks.  And here I thought he was the best...

Ginnie    >^..^<

You can catch more flies with funny than vinegar.
__________________________________

> Ginnie,
>
[quoted text clipped - 34 lines]
>> You can catch more flies with funny than vinegar.
>> __________________________________
Nann Bell - 26 Aug 2006 15:35 GMT
Of course I agree with everyone else and wasn't going to chime in as they
were all saying it so well.  A further thought occurred to me though - it
seems to me that with modern replacements being longer-lived, youth should be
a reason TO GET the surgery!  After all, one should be able to enjoy greater
mobility and higher activity levels in one's earlier years, to enhance one's
physical and mental health in later years.  And of course 59 is quite
youthful, being that my time before entering my 50s is now number in
months....

Signature

Nann
remove the Gator cheer to email me
Simply the thing I am shall make me live --- William Shakespeare

Squirrely - 27 Aug 2006 16:47 GMT
Ginnie,

Welcome to the group. I am sure you will like it here. Most times it is
pretty mellow around here. The most that usually goes on is someone trying
to steal your choc. ;-)

I don't have any suggestions but do hope something works out for you soon.

Signature

  Love and hugs Jo

   (\__/)  .~    ~. ))
  /O O  ./      .'
 {O__,   \    {
   / .  . )    \
   |-| '-' \    } ))      Warning: squirrels.
  .(   _(   )_.'
 '---.~_ _ _&

> Hi, everyone,
>
[quoted text clipped - 64 lines]
> You can catch more flies with funny than vinegar.
> __________________________________
Ginnie - 28 Aug 2006 03:54 GMT
Thanks, Squirrely, and I think any chocolate shenanigans
will come
from a usual suspect...   Dame Shiver has already made a move on
the milk chocolate variety.  ;-)

Ginnie   >^..^<   (and Clooney)

You can catch more flies with funny than vinegar.
__________________________________

> Ginnie,
>
[quoted text clipped - 3 lines]
>
> I don't have any suggestions but do hope something works out for you soon.
 
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