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Knee joint deterioration
Old 05-16-2012, 09:52 AM   #1
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Knee joint deterioration

My wife's 81 year old aunt has significant knee deterioration due to arthritis and skiing injuries from the younger years. She is to the point of hobbling and great difficulty balancing (wincing as I type).

She has eschewed the doctor's recommendation of total knee replacements about 6 years ago and now is in significant pain and taking some pain relief.

Does anyone have experience with options other than surgery, such as SynVisc-1?

I googled a bit but found 90% was just propaganda, etc., and no real feedback from patients.
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Old 05-16-2012, 10:05 AM   #2
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My Mother also put off having a Total Knee . She did have SynVisc and it gave her some time but finally at the age of 92 she had the Total knee since the pain was becoming unbearable .She did great .That was four years ago and most of the time she does not even use a cane .
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Old 05-16-2012, 10:13 AM   #3
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My Mother also put off having a Total Knee . She did have SynVisc and it gave her some time but finally at the age of 92 she had the Total knee since the pain was becoming unbearable .She did great .That was four years ago and most of the time she does not even use a cane .
Thanks for the feedback, it's reassuring to hear that the Total Knee can be done at advanced ages. And gosh, at 92 that is quite an accomplishment. This lady is really worried about the major surgery because of "horror" stories from her acquaintances.

I also wonder if knee replacement is covered by Tricare?
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Old 05-16-2012, 12:55 PM   #4
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My wife's 81 year old aunt has significant knee deterioration due to arthritis and skiing injuries from the younger years. She is to the point of hobbling and great difficulty balancing (wincing as I type).

She has eschewed the doctor's recommendation of total knee replacements about 6 years ago and now is in significant pain and taking some pain relief.

Does anyone have experience with options other than surgery, such as SynVisc-1?

I googled a bit but found 90% was just propaganda, etc., and no real feedback from patients.
My mom had a knee replacement this year at 82. She now considers that her "good knee". She spent an extra day in the hospital getting her blood chemistry back to normal (she needed less potassium, more sodium, go figure). The key was doing all the rehab. If you slack off on that you can end up worse off than before. If your mom is motivated, she should consider the full replacement. I have no idea what Mom tried before the knee replacement, but she was really hobbling around, avoided stairs, and in some pain. Fairly close to avoiding air travel to come and visit me or hit Las Vegas.
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Old 05-16-2012, 01:07 PM   #5
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I did Synvisc (before the -1, when it consisted of 4 shots) about 10 years ago. It is basically a lubricant, It will last about 6 months and then you are back where you started.

I just had my 3rd knee surgery last November and will probably get a Synvisc-1 shot this summer. I cannot say enough about rehab, you need to do it, and keep doing it.
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Old 05-16-2012, 06:03 PM   #6
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Thanks for the posts, this is very helpful. I think the DW's aunt can do the rehab but everything I read says that is key.

I am really wondering if Synvisc-1 is a route to go, the results seem so short term.
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Old 05-16-2012, 06:57 PM   #7
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1998 I had arthroscopy on both knees, (no cartilage in either - bone on bone*) - the surgeon sold Synvisc, (or something similar), from his office - but didn't recommend it, (I gathered that he thought it was useless).

*Luckily I'm one of those who suffer 'minimal' discomfort.......or as my grandmother used to say to me "No sense, no feeling".
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Old 05-16-2012, 07:35 PM   #8
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i have chronic knee pain due to a common minor malformation of the kneecap. MSM has worked wonders for me. Cod Liver Oil (unprocessed) is also a help for me - many find it increases bone density. It is contains a natural very absorbable form of Vit D and provides Vit A in a complementary ratio.

Not sure if you've tried or ruled out less invasive measures like this...thought i would suggest them.
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Old 05-16-2012, 07:46 PM   #9
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Thanks for the posts, this is very helpful. I think the DW's aunt can do the rehab but everything I read says that is key.

I am really wondering if Synvisc-1 is a route to go, the results seem so short term.
In my Mom's case I think the Synvisc bought her some time . What made her choose surgery was the physician said she was headed towards a wheelchair permanently . The rehab is the important part and she was very diligent with it . She had no problem with the surgery . With people living longer it is not uncommon for Surgeons to have elderly patients .
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Old 05-16-2012, 08:59 PM   #10
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My right knee joint was damaged in a car wreck in 2004. I had an upper tibia plateau fracture plus the knee joint was compressed. In other words, my knee could move forward past the normal standing position or backwards and would not lock. Standing was impossible.

My orthopaedic surgeon said he could not do a knee replacement until the tibia healed, which would have left me immobile for several weeks. What he did was to slice into the bone below the knee joint and insert cadaver bone (or coral) to build the knee joint back to the proper place. He repaired the tibia with a mending plate and screws. He said I would probably require a knee replacement within 10 years. It has now been 8 years and my knee is working very well. No pain, no limp, and I can walk as far as I want. (after physical therapy) I hope to prove doc wrong about the 10 years.

The worst part of the whole thing was that I developed blood clots in my upper right leg because my right knee was immobilized for a couple of weeks after surgery. They put me back in the hospital for what they termed "aggressive" treatment to dissolve the clots. This involved lying absolutely flat on my back in ICU for 4 days with meds administered by IV directly onto the clots.
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Old 05-17-2012, 09:27 PM   #11
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I used to work on an orthopedic floor in a hospital. I had lots of patients in their 80s and some even in their 90s with knee replacements. As has already been mentioned rehab after surgery is very important. In my experience those patients who wanted a knee replacement so they could be active again usually worked aggressively at their rehab with the physical therapists and did well. Those patients who did not want the surgery to regain an active lifestyle but instead just wanted pain relief often did not work hard enough with the PTs and had poorer results.
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Old 05-17-2012, 11:52 PM   #12
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Does anyone have experience with options other than surgery, such as SynVisc-1?
I googled a bit but found 90% was just propaganda, etc., and no real feedback from patients.
Several years ago Knee1.com - Comprehensive Knee Information,Blogs,Forums,Treatment,Care Tools,Articles and Videos was a great place to ask questions about ACL injuries/surgery/rehab. You could try the knee-replacement portion of the forum... I can't tell whether it's as good as the ACL forum was a while back.

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Originally Posted by Zero View Post
Thanks for the feedback, it's reassuring to hear that the Total Knee can be done at advanced ages. And gosh, at 92 that is quite an accomplishment. This lady is really worried about the major surgery because of "horror" stories from her acquaintances.
I also wonder if knee replacement is covered by Tricare?
IIRC Douglas Fairbanks also had a pair of knee replacements in his 90s. Of course he didn't get referred back to Tripler Army Medical Center.

But Tricare will pay for it.

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Thanks for the posts, this is very helpful. I think the DW's aunt can do the rehab but everything I read says that is key.
I am really wondering if Synvisc-1 is a route to go, the results seem so short term.
Here's a wacky thought. Do the physical therapy now. Do it with a real physical therapist using the same exercises as if she'd just had the total knee replacement. If she's not feeling an order of magnitude better after 6-8 weeks then do the surgery. Or give it another six weeks. She can always change her mind and do the surgery next month. Changing her mind after the surgery... not so much.

A few years ago in a small controlled study, patients with damage to their meniscii were told that they were going to have arthroscopic surgery. On half of them, the surgery was actually performed. On the other half, the incision was made but nothing else was done. The only people who knew which patient got what were the surgeons.

After completing rehab, the doctors interviewed their patients. (The doctors didn't know who'd actually received the surgery, either.) The results between the two groups were not statistically different.

When athletes tear their ACLs, they start physical therapy as soon as the swelling is brought under control (48-72 hours, continuing with lots of NSAIDs) before having the surgery. Building up their quads & hamstrings helps stabilize the joint and control the relative motion between the bones. When this same treatment was done with "civilians", many of them improved so much that they elected not to have the surgery.

After I tore my ACLs (and then re-injured the knees a couple years later before finally getting a diagnosis), I was nervous about the surgery. After talking to a taekwondo physical-conditioning coach, we elected physical therapy. It took me two years to get back to full strength & flexibility, and I can still feel that hopping on my left leg is weaker than on my right, but today I can do everything in taekwondo that I need to do. I also do full squats (using a 100-pound weight) & full lunges. I can even run a couple miles if I'm feeling particularly testosterone-poisoned. Maybe someday I'll have the surgery in conjunction with whatever miracle goop replaces human cartilage, but until then I'm going to stay ACL-free unless I absolutely have to have the surgery.

It's been over a decade now; so far so good. I'll never play basketball or ski a downhill slalom ever again, but I suspect that your spouse's aunt has retired from those sports too...
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Old 05-18-2012, 10:24 AM   #13
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I've got a Grade IV chondral defect on the medial side and increasing wear in the other 2 compartments. My doc says that ~20 years without an ACL repair (I had a "workaround" procedure instead to stabilize the knee) accelerated the wear to the medial side cartilage.

About 5 years ago I re-injured it in a short (10"?) fall resulting in the ~.75" diameter Gr IV defect. 2 weeks later I had surgery to install a cadaver ACL and perform a abrasive procedure to stimulate the formation of "psuedo-cartilage" (the idea being that ground Gr IV defect zone 'scabs over', providing a covering to the exposed nerve endings)

That worked well... 6 weeks non-weight-bearing, and a few months of PT, and finally after ~6 months or so I was able to walk for an hour or so without a limp and without pain. I play bass & guitar in a few bands, and after load-in my bad knee is aching pretty good, so I keep a small folding stool at the back of the stage in the event that my good leg gets tired of bearing 80% of the load by the third set.

I'm 52 now, and I'm certain my quality of life would be better with a TKR, but my docs and I are trying to get closer to 60 on the original equipment. TKR's seem to last 15-20 years, and the revision surgeries (replacement of the replacement) rarely turn out as well. So I'm sacrificing quality of life during my 50's to reduce the prospect of a wheelchair if I'm still around in 30-40 years.

So for now, I take a lot of Ibuprofen, ice after activity several times a week, and get Synvisc 1 injections twice a year. 2-3 weeks after an injection I feel a modest benefit, and that lasts about 3-4 months. I probably wouldn't pay $1400 myself a year for Synvisc, but for $25 co-pays why not?

Cb
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Old 05-18-2012, 12:12 PM   #14
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Nords, thanks for the link to the website, very interesting reads and scared the crap out of me. It sounds like the Total Knee Replacement is a decision worth weighing carefully.

Some of the posts were not for the squeamish. Sounds like the PT after surgery is a key element and yet very taxing.

This lady is very petite and frail. I'm worried about this for that reason.
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Old 05-18-2012, 01:17 PM   #15
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My husband had both knees replaced at the same time in his mid-60s. He did extensive PT before surgery to strengthen his upper body. He has had a great result.

The key, other than overall health, would be her weight and strength. Has her physician suggested a senior fitness program first?
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Old 05-18-2012, 03:41 PM   #16
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Brat, my best info is second hand via the DW and it sounds like the aunt is pretty sedentary but is also thin. So I suspect that she will have a difficult time with PT.
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Old 05-18-2012, 05:24 PM   #17
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Brat, my best info is second hand via the DW and it sounds like the aunt is pretty sedentary but is also thin. So I suspect that she will have a difficult time with PT.
There are also factors that can't be known ahead of time.

About 15 years ago I had a tibial transfer. At the time I was a little bit overweight but did exercise a few times a week but was certainly no athlete and was in my 40s.

When I got ready to leave the hospital they gave me crutches (my surgeon said I didn't need to use them if I could walk without pain) and I left holding them rather than using them.

I did several weeks of very extensive physical therapy. Here's the thing...from day one it was actually very easy for me. I had zero problems and one day after surgery was more like someone 3 weeks after surgery. I didn't actually realize I was exceptional until I had been going a few weeks and saw this athletic looking young woman -- very fit looking -- come in
who was obviously in pain and could barely walk and struggled to do anything. Turned out she had had the same surgery I had and her response was more on the negative end and I was more on the actually extraordinary end.

I actually enjoyed my PT and had zero problems. The thing is that the PT told me that sometimes there are just individual variations in response to PT that you can't predict. On paper, I would have been more likely to have the negative results and the other woman the easy PT, but it was just the opposite. It was actually the only time in my life that I felt like an athletic star as for a few months I was the "star" of the PT place.
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Old 05-18-2012, 10:19 PM   #18
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Brat, my best info is second hand via the DW and it sounds like the aunt is pretty sedentary but is also thin. So I suspect that she will have a difficult time with PT.
I am no health care professional but I question whether or not surgery would improve her quality of life.
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Old 05-19-2012, 01:01 AM   #19
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So I suspect that she will have a difficult time with PT.
Only one way to find out, and it's probably less catastrophic than surgery.
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Old 05-19-2012, 10:46 AM   #20
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If she can't handle pre-surgery PT she shouldn't undertake the surgery IMHO.
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