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Knee replacement questions

sled_mack

Sergeant
Full Member
Minuteman
Oct 31, 2008
751
272
Slatington, PA
I'm 45 years old and facing knee replacements in the very near future. I'm looking for anyone close to my age who has had a knee replacement to get an idea of what to expect.

Quick background: Going back 3 years, orthopedic 1 started with therapy, then cortizone shots, then synovial fluid shots. Nothing helped. He said come back when you are 60 and we'll talk about replacements.
At that point I went to orthopedic 2 for a second opinion. He said "schedule them ASAP". But, I had traveled to see him, and he recommended having it done near home.
Got a recommendation for orthopedic 3. He suggested trying arthroscopic surgery to delay replacements. We did that last March. It helped, but I'm still in pain, still have swelling, still have things I can't do.

Yesterday I went back to see orthopedic 3 to talk about replacements. He hedged a bit. He'd like to see me wait. He's afraid that I won't gain much in terms of range of motion or the things I'm limited in doing right now.

That was a surprise to me. Everyone I've talked to that has had knee replacements has said it's the best thing they've done. They all wish they had done it sooner. But - most everyone I know that has had it done is older, early 60's or more. I would normally say that over 60 isn't that old, but most people at that age are scaling back their physical activity a bit.

Part of yesterday's discussion was that I should consider scaling back my physical activities now to postpone knee replacement because I might have to scale back after the replacement anyway. This is really what I am stuck on. I was expecting that after therapy I'd be able to be "good as new" again, and get back to the higher level of activity I was at 3 years ago. I am not crazy about the idea of scaling back my activities at this age. I'm not looking to do anything crazy. One example was snowmobiling - he said I probably wouldn't be able to ride all day in rough conditions. The other was cutting firewood - he said I should plan on only being able to cut/split for a half day at a time if I have replacements.

I can't tell if he is trying to give me worst case scenario or what? Hell, my Mom had a knee replacement at age 66. She took one year off from skiing and then started skiing again. Granted, she's older and the girls she skis with take it easy, but I think that is pretty impressive for someone her age. And I won't be able to ride a snowmobile all day? I don't get it?

One of his points was also that getting a replacement now will likely mean 2 more surgeries by the time I turn 85. While I understand that concern, who knows if I'll live another 40 years? What medical technology will exist before then? That's just too far out there for me to worry about too much. On the other hand, if I keep limping the way I am now, what else am I going to screw up in my hips/back while waiting to fix my knees.

If anyone has any personal experience, please let me know. If you don't want to post it here, PM me.

Thanks.
 
Re: Knee replacement questions

Now I am no doctor, but I do work with ortho surgeons. If you are in that much pain, go for it. Sure you may have to back off a bit, but you will feel much better and be able to enjoy life. Yes, if you are active, you will need another replacement later on. And if you push yourself in phys therap afterwards, your range of motion will be fine. Do get multiple opinions. I say this, because the guy that finished at the bottom of the class in medical school is still called doctor.
Good luck.

Eric
 
Re: Knee replacement questions

There are three indications for the knee replacement...Pain Pain and Pain
Sounds like U R ready. Remember it is a mechanical joint and unlike your native joint is not alive
Usually U can very comfortably walk swim and sit. Many like your mother did much more, However it was not designed for running skiing tennis etc. Do people do it..yes, but it has a finint lifespan and can be a low as 10 years (98% survivalship) before needing revision for wear or loosening...and for others U could go 15-20 years depending on your demands and activity.

It is a quality of life decision and from what you relate, your QOL now is less than satisfactory. Go for it. However this is a lot like Midas Muffler..have someone do it who does nothing else and does at least 100/year..JMHO from one in the field >35 years
Good luck
 
Re: Knee replacement questions

I had both knees replaced 2 years ago when I was 59. I worked construction all my life. I was having knee problems for a few years, had 1 knee scoped and overtime kept getting worse and worse. was on light pain light killers for a while and then they suggested having the fluid injections which were every 6 months and 1 shot in each knee. they did the shot on Friday so 3 fridays in a row. This went on for 2 years then stated getting fluid on the knee.
He told me he wanted to wait until I was 65 but with all the pain and the fluid started he said it was time
Did 1 knee then the other 9 weeks later. I wanted 1 good knee before I did the other
In hospital 3 days out the 4th. They got me up on my feet the same day I had surgery. Therapy stated right after I got out of the hospital

To me it was the best thing I have ever done as now I can climb tree stand ladders and walking is no problem and NO pain in the knees

He said I can do what ever I want, just no running because of the heavy impact on the knees and no jumping out of an airplane
 
Re: Knee replacement questions

There is no right answer, just your answer.

I tore an ACL in the mid-80s and the military cobbled it back together, saying I'd need a replacement in 10 years.

Just forward 22 years and I could no longer stand dependable in slick conditions (and the wife claims I was cranky) so off to the doctors I went.

Doc one said well, we could....
My GP simply said I was too young
Doc three asked how I walked in after seeing the x-rays and loose stuff in there...

When I started the question in mind was not if but when and where; three months later (full schedule), I had it done.

Was not easy but I expected that after the first go-around, but it darn well was worth it. Yes, the plastic part will probably need replaced sometime as I am active and carry around some extra pounds. But remember - cost, quality, quantity; you can only get 2 of the 3.

Most will say wait as long as you can. I wonder about the recover being "easier" while you are younger. Whatever you decide, find a doctor you feel good about.

Anyway, build up the leg muscles before the procedure, ask questions about what to expect, and be ready to SERIOUSLY work at recovery afterwards.

Best wishes.
 
Re: Knee replacement questions

Thanks guys. I go back in a few weeks. I'll certainly have more questions about this for him. The list of questions I took this week were based on the surgery and recovery. I wasn't prepared for him saying "maybe not".

Thanks.
 
Re: Knee replacement questions

I ran my own special trans business for 7 years. I hauled medically and mentally disabled clients to their medical appointments and back home again.

99% of Doctors don't know their ass from a hole in the ground.

Alot of your mobility questions will depend greatly on your bodies ability to heal. Alot of that depends on your diet and your testosterone level. Scar tissue will stretch out IF you work at it.

As for the doctor involved: You WILL get what you pay for...

You MUST find a doctor that works with Pro sports teams. Yes they're more expensive but you're looking at living another 40 years with the results of their work.

I'm 40 and I've had bad knees all my life, trust me I know exactly how you feel.
 
Re: Knee replacement questions

Can you post pictures (Blocking out Name/ID) of your x-rays? How many compartments are involved in arthritis? Knee replacements are a very good surgery for knee arthritis pain not relieved exhaustively with non-operative management.
 
Re: Knee replacement questions

Can you post pictures (Blocking out Name/ID) of your x-rays? How many compartments are involved in arthritis? Knee replacements are a very good surgery for knee arthritis pain not relieved exhaustively with non-operative management.
 
Re: Knee replacement questions

my granmother had knee replacement about 2 years ago, she was 86 at the time, it din't bother her to much, they do abit of in-home therapy and thats about it.
 
Re: Knee replacement questions

The reason the docs want one to wait until as long as possible, is due to wear.
The younger more active person will wallow out the femur where the pin goes up (thigh bone) too soon. The older guy is not going to do that. One hopes. it doesn't leave a person with many alternatives.
Look up an image of the device. The upper portion is the problem.
Can't jump our of pickups and heavy equipment or hike into the back country to drag out an elk, like when you were 25.
 
Re: Knee replacement questions

Richard, I don't have a copy of the xrays. It is all three compartments of the knee that are in bad shape. The bumped my Meloxicam dose up to 15mg/day. That's another issue - the longer that I'm on these anti-inflammitories, the more damage they are doing to my stomach/liver. No free lunches.

Minarix, I know a lot of people that are older that have done well after replacement surgery. But I think they tend to not be as hard on them as someone younger.

hankpac, I know why he wants to wait. It's just a balance of waiting/suffering or doing it sooner and ending the suffering. I know there will be some limits. I just wonder if the limits will be as much as he indicated.
 
Re: Knee replacement questions

There are two schools of thought regarding joint replacement arthroplasty. Mayo clinic: wait as long as you can to reduce the total number of surgeries the patient will undergo. HSS:Do the surgery earlier to limit patient misery knowing that this may lead to more revision surgery. If the pain in your knee is coming from osteoarthritis then the surgery 90% of the time will provide excellent relief. The replacement is a mechanical part and will eventually fail. Treat it like a 16 y/o male with a mustang and it will fail early. Treat it like a 90 y/o woman with that same mustang and it will last a long time. Disregard the earlier ridiculous post about finding a sports doctor that works with sports teams. It has nothing to do with ability. These doctors pay these teams BIG MONEY (in excess of millions)to be their team doctor. The doctor that replaces your knee should be one that does ALOT of knee replacement a year. Don't have the surgeon that only does one or two a month do your knee. More specifically ask your surgeon which knee system he uses and then go online and research that system to find out any potential problems. I only wish that half of the money that went to entertainment (sports stars, actors/hollywood, musicians) went to medical research.
 
Re: Knee replacement questions

I would say go ahead. But, you need to get real serious about your weight. You should not exceed a BMI of 25. If you are going to commit to artificial joints you need to take care of them. The same force that crushes your knees, hips and ankles now is the same force the replacement joints have to bear. I do not do ortho but I see a lot of people that have joint replacements. All of the lean people do well, all of the fat people do poorly. Across the board. No matter if you are talking about complications (infections, DVT ect) or talking sucess (pain levels, walking distances ect) the skinny people do better.
 
Re: Knee replacement questions

I'm not looking to treat this knee like a kid again. However, I've crossed a threshold where doing things that I think I should be able to do at my age cause me pain. I either avoid those things or suffer badly a few days after. So yes, running is out. But I don't think attending a tactical rifle match should be out? Not something crazy like the 24 hour challenge last year, that's out, but just a normal match with some walking around with gear, standing, and positional shooting.

I understand I need to shed some weight. My knee issues have caused me to gain a good bit over the last few years. It just seems logical that less weight has to be easier on the joint. But no doubt a BMI of 25 will be quite a challenge. That's even lower than my last primary care doc wanted me to get down to. (I just did a BMI calc online, hadn't looked at it in a long time before that.)

In the past I've never had success losing weight on a diet. Instead, my success came from exercising the weight off and just watching what I would eat a little bit. Maybe I need to revisit this as well.
 
Re: Knee replacement questions

Sled
Just happened on your post. Have you gotten any new intel on your knee? I had one done at 57 and my doc really was hoping to put it off until later. I wore it out to failure so he did it. The guy teaches the proceedure here in Omaha.
Short story. It was a royal pain. the first six weeks about drove me nuts. The physical therapy started immediately and I about pissed myself it hurt so bad. I am a work out nut and was doing pull ups and push ups the day I came home from the hospital. After six months I was great. Right now it's my best knee. No regrets. Mike G
 
Re: Knee replacement questions

<div class="ubbcode-block"><div class="ubbcode-header">Originally Posted By: Richard II</div><div class="ubbcode-body">There are two schools of thought regarding joint replacement arthroplasty. Mayo clinic: wait as long as you can to reduce the total number of surgeries the patient will undergo. HSS:Do the surgery earlier to limit patient misery knowing that this may lead to more revision surgery. If the pain in your knee is coming from osteoarthritis then the surgery 90% of the time will provide excellent relief. The replacement is a mechanical part and will eventually fail. Treat it like a 16 y/o male with a mustang and it will fail early. Treat it like a 90 y/o woman with that same mustang and it will last a long time. Disregard the earlier ridiculous post about finding a sports doctor that works with sports teams. It has nothing to do with ability. These doctors pay these teams BIG MONEY (in excess of millions)to be their team doctor. The doctor that replaces your knee should be one that does ALOT of knee replacement a year. Don't have the surgeon that only does one or two a month do your knee. More specifically ask your surgeon which knee system he uses and then go online and research that system to find out any potential problems. I only wish that half of the money that went to entertainment (sports stars, actors/hollywood, musicians) went to medical research.</div></div>

I agree with Richard on this one.

I am retired now, but I was a biomechanical engineering consultant and I specialized in the design of replacemet hips and knees.
I will not discuss the technical side of TKA, but I will say this if I was going to have it done on myself:

Hands down the most important thing I would do is find a doc that specializes in knee replacement procedures and has decades of experience and hundreds of procedures under his or her belt. They have the most experience in measurement, cutting and installing the implant systems. They have the most experience with all the variations in bone condition and how that relates to the installation. They also have the broadest knowledge base for making decisions on the fly in the event there are issues with the procedure (not that that will ever happen).
I would not care how far I had to travel to have that individual work on me. There are more of them out there than you are aware of. Regardless of who I used, I would not be shy and I would ask that person to be specific and tell me how many years of tka experience and how many knees they have replaced. I would research the doc more than the tka system they use.

I wish you the best of luck sled.
DS
 
I'm a potential knee replacement candidate with my right knee. Slowly wearing out my good one. I tore up my knee over 30 years ago and had the meniscus removed. Major stone age reconstruction + 2 subsequent clean outs, one in late 80's, one in the late 90's. I've been active all my life, but had to switch things up when I hit 40 as I could feel things were gettig different. At that time, I had to quit a job I loved as the physical nature of it was pounding my knee. I stopped running, no more contact sports etc. At 48, it's getting worse, but my weight did get up there, not by much but it did. Losing weight will help, doing more biking as well. I am seriously thinking of trying for a meniscus transplant. I am also looking into some other alternative treatments as well. I'd rather stretch out another 10-15 years if I could on the natural knee.
 
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Sled Mack, are you in the proper weight range? Are you able to ride a bike or a stationary bike to help keep your weight in check & give the leg muscles a bit of a work out? I'm 6'1" and around 250 right down. Down from over 260 at Christmas. Hoping to get back under 240, then work on under 235lbs. Dr's gave me poop as they said you don't need to be lineman sized going into mid life. Sometimes I find that even for the 1st ten minutes or so on a bike, the bad knee will be giving me some grief. Using over counter meds & heat at the moment to help. The big thing I have been told is to lose some weight, stay reasonably active, stretch and stay on top of pain management. My GP, who is a female, even told me to try and work a session of yoga into my routine once a week.
 
I'm 56 and had a replacement done in 05. I had bone on bone and the doc said it was worse then he thought after surgery. I'm physicaly active and have a BMI of 28. I lift at least 3 times a week and do an elipitical 2-3x (35 mins and get my heart rate up to 175) per week. The doctor was hesitate at first due to my age. Rehab was tough but worth it. No squats of any kind and moderate leg extentions and leg curls just to keep mass. Beats the crap of constant pain. I did the Synvisc and cortisone route prior to surgery with no results. I used a respected surgeon and still see him.
 
My former father in law 68 had a replacement about 6 years ago. Took him about half year to recover if I remember well. Now he walks couple of miles everyday and nobody could tell he had a surgery.
 
If your pain is to the point you are miserable then do it. I am in my early 40's and have have artificial discs placed in my lumbar and cervical spine and wished each time I would have done it sooner. It doesn't matter what joint it is , if it's done it's done.
A good friend of mine of the same age had his knee replacement at age 40 (two years ago) and he is back playing basketball.
You may hear bad stories about things but it is usually a frame of mind that you have to have that you want to get better.

Good Luck. Feel free to PM me as I work in medicine and may have some more insight.
 
Thanks for all the input.

The orthopedic increased my Meloxicam dosage. That did a lot for reducing my pain.

So, I'm taking advantage of the reduced pain to get my weight down. I'm working with a nutritionist and a physical therapist/personal trainer. So far, I'm down almost 10 pounds. That puts me at 255 and 6 foot tall. My goal is to get to 190. I hope to be there by the end of the year. I hope that the weight loss and work outs will ease the pain and get me a few years before replacements.

For now, my workout is recumbent bike and lifting. The PT guy will adjust that as I make progress and hit plateaus. I've only been at this a few weeks, so at this point I don't really feel any difference. I'm guessing it will be mid-summer before I notice any difference.

Worst case - I'll be healthier in a year and still feel like I need replacements.

Best case - I'll be healthier in a year, and be able to hold off on replacements for a few years.