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  • MRI done - severe osteoarthritis and more - next?

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    Old 11-29-2010, 11:14 AM   #1
    alt4u
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    MRI done - severe osteoarthritis and more - next?

    Hi there - I am an active, fit 51 year old woman - had 3 previous right knee surgeries over 20 years - 1 lateral release and 2 normal arthroscopic clean up the "gunk" etc. Recovery excellent and very active since.

    Since Feb 2010, that same right knee has been "catching" when I cross my ankles or right leg is crossed over top of left - and then pops back to normal on extension. There was no trauma to cause this - I suspect part is aging and wear and tear.

    Just got MRI results as follows and for those of you that have had similiar MRI findings, what was recommended for you?

    1. Large area of full thickness articular cartilage loss in lateral joint associated with subchondral sclerosis, edema and osteophyte formation.
    2. Thinning of patellar tendon but no tear
    3. Lateral meniscus subluxed and reduced volume and irregular body of anterior horn of lateral meniscus.
    4. Advanced lateral compartment osteoarthritis.

     
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    Old 12-16-2010, 07:19 AM   #2
    alt4u
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    Re: MRI done - osteotomy or TKR or PKR?

    It could be up to a 2 year wait to get in to see an OS so I have gone to see my Sports Med Doc in the hopes he can get me in sooner.

    Met with the Sport Med doc yesterday and he thought that as bad as my knee is he still thought I was too young (at 51) for a TKR - sounds like alot of you may have heard the same thing! ...

    anyway, he is going to refer me to an OS but thinks that because my tibia is mialigned and the damage contained just to the lateral complartment, that I would be a good candidate for an osteotomy.

    Has anyone had that procedure? any thoughts on it? has anyone had similar bone on bone with full thickness cartilage loss grade 4 - which is the worst, servere lateral compartment osteoarthritis and a subluxed meniscus - if so, what route was recommended to you?

    sounds even more radical from what I have read than a PKR or TKR!!

    I have had some feedback from posters on another board that say do not do the osteotomy at all!

    In the meantime, until I can get in to see the OS, he recommended that I consider an injection of Durolane (Hyaluronic Acid) - it will act like a lubricant on my bone on bone situation - it will cost $450 (not covered by our extended health care plan) and is only about 70% successful and should last 2-5months.

    Any thoughts on that one?

    Thanks in advance for all your caring advice and the sharing of your experiences.

    April.

     
    Old 02-18-2011, 06:16 PM   #3
    gabster
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    Re: MRI done - severe osteoarthritis and more - next?

    I have bone on bone osteoarthritis. Starts with Sinvisk shots which sound like what you are describing Series of 3 very painful hots that helped not at all. I am now scheduled for PKR. I am 49 and slightly overweight so my dr thinks this is a better way than scope yet I don't need full replacement. Good luck it however you decides to proceed

     
    Old 02-19-2011, 09:13 AM   #4
    jennybyc
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    Re: MRI done - severe osteoarthritis and more - next?

    I had both knees replaced at 47. Yeah, I was young but had lost so much bone in my left knee that I fractured the joint surface(femur slammed into tibia and broke tibial surface) and I was leaking bone marrow into the joint fluid. TKR time.....no choice. So I both done at the same time.

    I had both Hyalgan and Synvisc and Hyalgan was good and Synvisc blew up my knee. Only do it if you can afford it.

    Doc's try to get people to wait as long as possible for TKR but I say, do it. When I had mine done, the implants lasted 10-15 years...now they can last 30. The whole reason they wanted you to wait was that you could only redo the implants once or twice before running out of bone. Now you can get 30 years out of an implant(if you are gentle with them) and at 51, you'd be 80 before you'd need a revision and then another 30 year knee will outlast you. So why not do it before your lack of activity results in other medical problems like weight gain, high blood pressure from the weight and other problems....I got them from 10 years of walking with 2 canes and barely moving if I didn't have to.

    Have the sports med doc get you into a good hip and knee replacement doc. Skip the osteotomy...they offered me one too and I said no and went for the TKR's.....no regrets. I had a type of osteotomy as a teen for a bad knee cap and I can tell you, it is really painful(they do remove a wedge of bone and essentially break your leg) and if it doesn't help, you have to delay the TKR until it is fully healed and that can take a while.

    Do the TKR or PKR.

    Jenny(headed for revisions on 12 year old knees)

     
    Old 02-09-2012, 12:20 PM   #5
    alt4u
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    Re: MRI done - osteotomy or TKR or PKR?

    Follow up to my info below - and input welcome from those of you that have had differing opinions from docs...

    Got in to see 2 OS...

    One OS who deals with alot of elite skiers and has a great rep, says I need a HTO - however, another well respected OS that I went to for a second opinion says, no - it should be a TKR....

    wow - do I need a tie breaking opinion from a third OS?

    thoughts?

    Cheers

    April

    Quote:
    Originally Posted by alt4u View Post
    It could be up to a 2 year wait to get in to see an OS so I have gone to see my Sports Med Doc in the hopes he can get me in sooner.

    Met with the Sport Med doc yesterday and he thought that as bad as my knee is he still thought I was too young (at 51) for a TKR - sounds like alot of you may have heard the same thing! ...

    anyway, he is going to refer me to an OS but thinks that because my tibia is mialigned and the damage contained just to the lateral complartment, that I would be a good candidate for an osteotomy.

    Has anyone had that procedure? any thoughts on it? has anyone had similar bone on bone with full thickness cartilage loss grade 4 - which is the worst, servere lateral compartment osteoarthritis and a subluxed meniscus - if so, what route was recommended to you?

    sounds even more radical from what I have read than a PKR or TKR!!

    I have had some feedback from posters on another board that say do not do the osteotomy at all!

    In the meantime, until I can get in to see the OS, he recommended that I consider an injection of Durolane (Hyaluronic Acid) - it will act like a lubricant on my bone on bone situation - it will cost $450 (not covered by our extended health care plan) and is only about 70% successful and should last 2-5months.

    Any thoughts on that one?

    Thanks in advance for all your caring advice and the sharing of your experiences.

    April.

     
    Old 02-09-2012, 04:58 PM   #6
    jennybyc
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    Re: MRI done - severe osteoarthritis and more - next?

    When I found myself in the same situation as you are now, I went and got a second opinion at Brigham and Women's...the teaching hospital for Harvard Med School...thought that I'd get a good consult there. They told me to skip the high tibial osteotomy and go for the TKR. All the osteotomy does is re-align the leg but does nothing for the joint....just spreads out the pain from the OA all over the surface instead of one particular area. They told me it could actually do more damage as so many bone spurs had developed in the joint that re-aligning it might make me start breaking the bone spurs and driving them into the bone. I, in fact, did this later on. Broke the surface of the joint. Delayed my TKRs by several months as they had to get the joint to stop oozing.

    With the new 35 year joint implants, I'd go for the TKR. It will solve all the problems and trust me, you won't regret it. Everyone I've met who has had it done(as painful as it is) has said they wish they had done it earlier....including me. I waited way too long.

    It was one thing to wait when they only lasted 5-10 years and could only do 2-3 revisions but now they can last up to 35 years so you may never need a revision. You'll love the new knee. You will feel less pain in the joint almost immediately once the surgical pain goes down for a couple of days. It is that dramatic.

    Jenny

     
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