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Medical Forum / Diseases and Disorders / Arthritis / February 2008

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Bad knee arthritis--ideas re: surgery?

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MZB - 13 Feb 2008 03:08 GMT
I've had knee problems for many years. We know from the MRI that I have torn
cartilege. But x-rays show pretty bad arthritis (both knees, but the
pain/problems are mostly in my right knee). The arthritis is called
something like chondrocalcinosis. (I think there are calcium shards in the
cartilege/knee).

Anyway, the orthopedic guy says the first thing would be the clean-out
(relatively easy scope) surgery. But he is not sure if that will help too
much, but it might. Regardless, it won't stop the disease process and
eventually a TKR will probably be advisable. I went to a rheumatolagist and
he pretty much says the same thing (he is a bit more skeptical about surgery
but all he offers is pain medication-- I also have intestinal problems so
would like to avoid too many drugs and it doesn't help all that much).

I am going to see another orthopedic guy in 2 weeks, so I'll get one more
opinion. I'm hoping that he will be more hopeful about the scope surgery.

So, I guess my question is: has scope knee surgery been helpful for anyone
(this is NOT OA; it is more of an inflammatory process).

I am 61 years old, male. So, I figure I have a lot of crap built up in my
knee so maybe surgery will help -- but maybe that's just wishful thinking!

Mel
spodosaurus - 13 Feb 2008 08:37 GMT
> I've had knee problems for many years. We know from the MRI that I have torn
> cartilege. But x-rays show pretty bad arthritis (both knees, but the
> pain/problems are mostly in my right knee). The arthritis is called
> something like chondrocalcinosis. (I think there are calcium shards in the
> cartilege/knee).

You should ask them to write it down for you! :)

> Anyway, the orthopedic guy says the first thing would be the clean-out
> (relatively easy scope) surgery. But he is not sure if that will help too
[quoted text clipped - 9 lines]
> So, I guess my question is: has scope knee surgery been helpful for anyone
> (this is NOT OA; it is more of an inflammatory process).

OA gets inflamation from tissue destruction. RA gets destruction from
the inflamation. Unless you have an autoimmune arthritis your type is
likely more similar to OA than RA.

> I am 61 years old, male. So, I figure I have a lot of crap built up in my
> knee so maybe surgery will help -- but maybe that's just wishful thinking!

If it puts off a TKR for 5 years then that's five more years you'll have
before you need a revision of the TKR...

> Mel

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MZB - 14 Feb 2008 00:57 GMT
Spoo:

Well, obviously, I would do the scope surgery before doing a TKR.

Mel
>> I've had knee problems for many years. We know from the MRI that I have
>> torn cartilege. But x-rays show pretty bad arthritis (both knees, but the
[quoted text clipped - 31 lines]
>
>> Mel
Donna G. - 14 Feb 2008 08:35 GMT
You know, back a few years ago, I had a knee that had several tears in
the meniscus and had fluid build up and was just a mess.   The first
orthopedic guy I saw said he could scope it but thought I'd get very
little if any relief from the surgery, so he thought it better not to do
it and just use pain meds.   My rheumatolgist did not agree with that
assessment, so sent me to another orthopedic guy.   Second orthopedic
guy said he thought I would get about 85% relief if he scoped it and
took care of things.   I went ahead and had him do the arthroscopic
surgery.   He told me after the surgery that the knee was in pretty bad
shape, and he thought I'd be back in a year for a total knee
replacement.  That was about 4-5 years ago.   That knee has been great
since he did the surgery and I hardly have any pain with it at all
unless I really over do it.    

I'm actually going to see him again in a couple of weeks to have him now
assess my other knee which has become equally as problematic as the
first one was.

Good luck in what ever you decide!

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Donna
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1.)   ANGELS EXIST, but some times, since they don't all have wings, we
call them FRIENDS......

2.)    J.K.M.A.
MZB - 17 Feb 2008 23:46 GMT
Donna:

Yep--I have several tears in the meniscus plus a lot of calcium (ie:
arthritis).

It is hard to say whether or not my problems are due to the tears or the
arthritis or both!

I'm hoping the 2nd orthoped. guy is a bit more positive about the possible
results of the scope. I think the scope will serve a dx. purpose too.

Mel

> You know, back a few years ago, I had a knee that had several tears in
> the meniscus and had fluid build up and was just a mess.   The first
[quoted text clipped - 30 lines]
>
> 2.)    J.K.M.A.
Jayne - 13 Feb 2008 17:07 GMT
I had an arthroscopy on my right knee, where it was bone on bone on the
inside and a general clean up, trimming some cartilage etc.  The relief it
brought was only temporary and I had a tkr14 months later.

Jayne

> I've had knee problems for many years. We know from the MRI that I have
> torn cartilege. But x-rays show pretty bad arthritis (both knees, but the
[quoted text clipped - 21 lines]
>
> Mel
MZB - 14 Feb 2008 01:01 GMT
Jayne:

And how are you after the TKR??

Also, am I correct that recovery from the scope clean out is on the easy
side.

From what I've read, recovery from TKR is pretty tough. Is that correct?

Mel
>I had an arthroscopy on my right knee, where it was bone on bone on the
>inside and a general clean up, trimming some cartilage etc.  The relief it
[quoted text clipped - 28 lines]
>>
>> Mel
Jayne - 14 Feb 2008 16:53 GMT
> Jayne:
>
[quoted text clipped - 6 lines]
>
> Mel

I am in the UK, so my experiences / terminology may be different, but here
goes.  I have had two each - arthroscopies and tkr's.  The first arthroscopy
was just fine, and I was back to work a few days later.  Apart from the fact
that I had an extra load to carry because my husband chose that time to
dislocate his ankle and break his leg the weekend after, recovery was fine -
a bit sore but nothing much.

The arthroscopy last year on my right knee was a little different - much
more of a clean up and trimming up.  The main difference I noticed was in
bruising - I didn't have much with the first one but the second was a
different matter - quite dark bruising, a bit sore and the joint hurt a
little for a week or so, but really nothing to write home about.  However
once that was over the knee felt better for a few months.

There are lots of people here who have had tkr's, but I will tell you my
experience.  Both times I had my operation on Mondays, and both times I went
home on the Thursday after, so just a short stay in hospital.  I found the
main thing was just how weak the leg muscles are afterwards - you have to
work really hard to lift that leg in a straight leg lift, and for the first
few days lifting the leg from the floor to the bed just seems to defeat you
(I cheated and used the hand end of my walking stick!).  The physio is hard,
but most definitely worth the effort.  When you give up the walking stick(s)
it feels like a great moment.  I wish I'd kept a diary as to when all of
these things happened, but I can tell you that the improvements just keep
happening for months and months.  I had my right one done in the middle of
September and a few weeks ago I suddenly realised that I was walking up and
down stairs like a normal person, and today I sort of ran down them at work
with no problem, which was lovely.  Oh, and I also discovered that I can hop
for the first time in years lately!  (What use that is going to be to me I
don't know!)

As far as pain is concerned after, I didn't find it bad at all really - I
expected much worse.  Immediately after, the spinal anaesthetic took care of
any pain, and that was followed by the morphine pump.  However that made me
feel nausious so I asked for it to be taken off after 12 hours.  After that,
I took paracetamol, codeine and tramadol if needed.  What I found worse than
anything was how difficult sleep was for the first few weeks.  I would say
it was 6 weeks before I could sleep through the night properly.  Oh and the
scar on my second knee for some reason was much more sore and itchy than the
first knee, but thats all long gone now.

Both times I went back to (office) work just over 3 weeks later.  First time
I couldn't drive at that stage (left foot, clutch, manual car), but second
time I could drive by then.

It was most definitely worth it both times, and to be able to walk and do
stuff without that horrible grinding pain is wonderful.

I remember being so surprised the day after the op, when the physios got me
out of bed for the first time and standing and walking with the frame.  The
surprise was that although the knee was sore, and the leg weak, there was no
"deep" pain anymore.

Sorry this turned out to be a bit long and rambling, but the very best of
luck to you.

Jayne
David O Smith - 15 Feb 2008 10:05 GMT
> From what I've read, recovery from TKR is pretty tough. Is that correct?

I want to echo some of what Jayne said. I had a right TKR in early
October. Had the op on Wednesday morning and was home again the
following Monday. Yes, the first few days were rough. I, too, had
problems sleeping through for quite a while.

Improvements are continuing, though the knee still hurts from time to
time - nothing like as badly as it did before the op, though! I've given
up sticks to walk with - except when I want to take the dog out for a
long stroll. The knee seems to be happy going a few hundred yards
without a stick, but further than that the extra help stops it hurting
so much.

Took me 6 weeks before the doctors would let me drive, and as long again
before they'd let me drive for a living. I'm over that, now, and
wouldn't go back to the pre-op days for anything. I'm left now with only
2 real concerns over my arthritis.

1. I presume that, because I've improved so much, they'll take away my
DLA, and hence my car.

2. Now my left knee is starting to play up after only a few steps. I
have a bit of a dread of that one going the same way as the right. If it
does I've got years of pain ahead of me again. Oh, well!

Cheers all,

Dave
MZB - 17 Feb 2008 23:22 GMT
David:

Do you need the stick just when you are walking the dog, or in general when
walking?

Mel

>> From what I've read, recovery from TKR is pretty tough. Is that correct?
>
[quoted text clipped - 25 lines]
>
> Dave
nanny - 14 Feb 2008 04:52 GMT
>I had an arthroscopy on my right knee, where it was bone on bone on the
>inside and a general clean up, trimming some cartilage etc.  The relief it
[quoted text clipped - 28 lines]
>>
>> Mel
Jayne - 14 Feb 2008 16:54 GMT
> Sounds like my experience too, Jayne - in that order.  Nanny

I have spoken to others who say the same Nanny - when it gets so bad,
cleaning up is purely short term.  The main reason for both was to let the
surgeon have a good look around pre-tkr.

Jayne
MZB - 17 Feb 2008 23:16 GMT
I have a follow-up questiion for those who have had the knee surgeries.

My goal is to be able to walk at a good pace without pain. I would like to
be able to resume working on the treadmill. I don't need to job. But I'd
like to be able to walk at 3.0-3.6 (0% incline).

I'd also like to be able, in general, to be able to walk briskly (or at
least at a normal pace) say for a mile with no pain.

Is that unrealistic?

Mel

>> Sounds like my experience too, Jayne - in that order.  Nanny
>
[quoted text clipped - 3 lines]
>
> Jayne
Jayne - 18 Feb 2008 16:55 GMT
>I have a follow-up questiion for those who have had the knee surgeries.
>
[quoted text clipped - 8 lines]
>
> Mel

I don't think so Mel - I suppose it depends on age / fitness.  I can walk a
mile with no pain without a problem.  I'm 46 / slightly unfit.

Jayne
Donna G. - 18 Feb 2008 22:10 GMT
Mel,

A lot will depend on not only age and fitness, but also how much they
have to do in that knee and how much damage there is that might not be
repairable.  You may also find that you have an easier time walking
without the use of the treadmill.  I don't know what it is about the
treadmill, but the treadmill really really bothers my knees and my
rheumatologist actually told me to stay away from treadmills---he
doesn't like them for his patients at all.  But you will have to try and
see how those things work for you once you get past the healing process.
Perhaps going to PT after your surgery to strengthen the proper areas
and such will be of some help.

Best of luck to you!

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Donna
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1.)   ANGELS EXIST, but some times, since they don't all have wings, we
call them FRIENDS......

2.)    J.K.M.A.
Hooch - 13 Feb 2008 20:10 GMT
Mel,

I have psoriatic arthitis and had my right knee scoped in 2006.
I had one small and one major tear the surgeon blamed entirely
on my arthritis.  My rheumotologist was in favor of the surgery
per the MRI revealing major issues untreatable with meds.
After a few weeks, my knee was stronger and relatively free of
pain.  I do have normal pains associated with arthritis, but no
major problems.  I had little choice and the surgery may expidite
future issues, but I had litttle choice.  I am glad I had it done at
this point, but belive at 41 years of age, I am looking at future
knee surgeries.

Hooch

> I've had knee problems for many years. We know from the MRI that I have
> torn cartilege. But x-rays show pretty bad arthritis (both knees, but the
[quoted text clipped - 21 lines]
>
> Mel
MZB - 14 Feb 2008 00:56 GMT
Interesting reading the answers. It sounds like a crapshoot.

Well, if it delays TKR for 5 years then that means it will be helpful.

One problem is this damn knee pain has made me quite sedentary. It HURTS to
walk. I can't do my treadmill any more.

Obviously, some improvement with a scope should result in my being more
active again.

Mel

> Mel,
>
[quoted text clipped - 37 lines]
>>
>> Mel
 
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