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  1. #1
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    knee replacement advice

    Hi folks,

    I'm hoping to hear from those with experience about their knee replacements. I had the miniscus removed in '72 after a softball injury, and it's way bone-on-bone now. I've done tons of physical therapy, synvisc shots, then an arthoscopic surgery in december, which found an area about the size of a quarter without cartiledge on the bone. the doc said "knee replacement", even though he's a sports injury doc, who does everything to avoid replacement, and doesn't perform replacements himself.

    It's severely limited my riding--25 miles is too far at this point, though that would have been a light ride this time last year. 15 miles is the most i can do, and it's painful during and after. I do recover quickly, the next day it's stiff but not too sore. I can walk, but have pain after a mile or so. I've not been able to train for my favorite ride--a 2 day AIDS ride in April--and have had to give up dancing.

    I was leaning towards replacement more because of quality of life than pain. If I restrict myself in these ways--ride but only short rides, few hills, little dancing, short walks--I can continue without the surgery. On the other hand, the only hope for recovering these things, which are very valuable to me, are by having the replacement.

    My concern is that the people who report being happiest with their replacements are those in real pain, which i am not. i can walk around normally, though it never leaves my mind. Also, professionals recommend putting it off as long as possible, both for the sake of improved prosthetics as well as the possibility of having to have it done again later in life. I'm 52 now.

    Any other cyclists have knowledge/experience with this? and could render informed advice?

    I'd be interested in input.

    thanks,

    filmgrrrl
    austin, texas

  2. #2
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    filmgrrrl,

    While I'm not to that point yet, I do have knee issues, so I feel your pain. The reason I responded is to say that there is a doctor in California who takes tissue out of the knee, somehow increases the volumn, and then re-inplants the tissue.

    I have the link bookmarked at home and will send you another note from there. It might not be something you can consider, but I feel that an artificial joint should be the option of last resort. I will search around to see if I can find the link before I go home.

    BTW, I shoot video.

  3. #3
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    Found it...................

    http://www.stoneclinic.com/index.htm

    Good luck.

  4. #4
    Senior Member late's Avatar
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    I am a knee surgery candidate. I actually got an appointment, sat in the surgeon's
    office, and then thought 'Nope, not ready' and left.

    If I was bone on bone it might be a different story. There is a new replacement knee designed for athletes. If you decide to go that route, it's something you might consider.

  5. #5
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    stone clinic link

    hi,

    i've seen this procedure, but i'm not a candidate, sadly. too much damage--the area is too big to have a good bond. i'm sure this will improve over time, in terms of the procedure being used on more people, but i'm out of the picture for that.

    thanks, though.

    btw i shoot mostly stills now, but did film and video for a long long time. thus the name.

    filmgrrrl

  6. #6
    Senior Member Terrierman's Avatar
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    I've got a place about the size of a half dollar in my right knee that is cartilage free. I'm a candidate too and doc says it's up to me for when. GC, cortisone injections (have you tried those yet?) and the bike are letting me continue putting off the inevitable for at least the time being. I'm actually five months out since the last cortisone injection. Up until the bike thing started, they were on 90 day centers and wishing they would give them more often.

    I talk to a lot of people that have had the surgery. I've only heard one person say anything other than they wish they had done it sooner. But I'm still not listening to them as much as the Doc that says wait as long as you can, you're young and active enough that you will likely need at least two knees in your lifetime. The first one is easy, the second a lot harder and he does not even do the third ones, they are for some REAL experts. That advice scares me into waiting longer.
    It's all downhill from here. Except the parts that are uphill.

  7. #7
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    filmgrrrl,

    Are you saying you are not a candidate for the procedure used at the Stone clinic or the procedure mentioned being used with atheletes?


    late,

    What procedure are you talking about, and do you have a link?

  8. #8
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    knee replacement

    Hey last,

    i'm not a candidate for the procedure where they attempt to regrow cartiledge. The bare area is too big.

    filmgrrrl

  9. #9
    Humvee of bikes =Worksman Nightshade's Avatar
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    In 2003 I had both knees replaced. I had gone to the point
    that my left leg would no longer straighten and my right
    leg was a hot ball of pain. I pushed this past the point of
    repair.......almost.

    My ortho doctor was a very compentent man in that by using
    shims he straightend my left leg and madE the right leg
    pain free.

    Was it painful?? Yes, but not that bad provided........
    when you come out of surgury they put you in a leg
    motivator that bends the leg a little bit more each
    day to keep it from getting stiff. Then there is the
    need for ice......LOT'S OF ICE.... to blunt the pain
    and swelling. You MUST get up and walk (shuffle)
    the next day or you WILL be so very sorry.

    When you come out of the hospital <Im' gonna
    shout this it that important> DO YOUR THERAPY
    EXCATLY AS OFTEN AND THE WAY THEY TELL YOU
    TO IF YOU WANT ANY HOPE OF A PAIN FREE WALKING
    ABILITY. Will it hurt?? sure it will but not so bad that
    you can bear up unless you're a total sissy.

    This is a basic hard choice.......
    therapy done right -or- wheelchair & pain.

    ASK what the after operation plan is for your
    recovery to see to it that you're not just left
    lying in the bed doing noting. YOU DON'T
    WANT THAT AT ALL!!!!!!!!!!!!!!
    My preferred bicycle brand is.......WORKSMAN CYCLES
    I dislike clipless pedals on any city bike since I feel they are unsafe.

    Originally Posted by krazygluon
    Steel: nearly a thousand years of metallurgical development
    Aluminum: barely a hundred, which one would you rather have under your butt at 30mph?

  10. #10
    The Grampster tlc20010's Avatar
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    I had my left knee done three years ago when I was 62 and can join the chorus of those who say they wish they had done it sooner. I did everything else before I had the tkr and it all helped a little, but there was no cure, as you know. I'll +1 or maybe ++1 what Tightwad said about post op PT...it is critical to recovery....it is also boring

    Big issue for me was the ongoing atrophy of muscle in my left leg. My Dr. said that I was probably doing most of my riding with my right leg without even realizing it. If you have not found the Knee Guru, a UK web site, it has worth a look. Especially the message board of people who are deciding, getting ready, just out of the OR and in rehab. Always good to hear what those who are going though it right now are saying. the URL is: http://www.kneeguru.co.uk/index.html

    I do about 150 miles a week and am 100% pain free--have been since about 4weeks post op. OBTW, I was riding my bike to physical therapy a month after surgery (I did not ask permission, so no one could say no).

    I have more to share if you are interested (inlcuding an interesting results photo).

    Tim
    The definition of insanity is doing the same thing over and over and expecting different results.
    --Ben Franklin

  11. #11
    Senior Member airbrake's Avatar
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    I worked with 2 guys at the post office who had knees done. One went back to carrying a route, walking about 12 miles a day. His lasted 9yrs, and when they put the 2nd in they had a lot of trouble with his thigh bone detererating so he couldn't walk a route any more. He died of cancer about 4 yrs later. The other had a riding route, but he didn't do his therepy so he wasn't much better after. He was supposed to get the other one done but never did. He's retired now and will probably limp his way into senility.

  12. #12
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    When you say bone on bone...do you mean no miniscus? None? That seems unlikely but perhaps so. You said the last orthoscope found an osteo area the size of quarter...thats not the full bone. Are you taking any pain meds? Vioxx worked for the vast majority of users, but there are others still out there.

    I have had seven (I think) knee surgeries. Six on the right, and one on the left knee. I'll bet I'm the only one in here who cycles after seven (or was it six???..dementia yes, knee replacment no) knee surgeries. Take that Old Man Time.

    I think surgeons recommend knee replacement far too often. For many people, the very first knee surgery they ever have is the replacment. And of course, physicians make far more $$$ on a knee replacment than an orthoscope. Forget Hippocarates. Do the math. However this may not be the case with your sports physician.

    Two or three of the right knee surgeries were "scopes". The first two were the old style incisions to repair cartilage back in the 70's. The last surgery was an ACL replacement when I was 48. I have had osteoarthritis on the inside of the right femur since I was about 40 years old, as found when the knee was scoped. That was in 1992, at which time they also found a completely severed ACL {"what do you mean you didn't feel it tear"? said the doctor "it must have popped and hurt like hell"**. I was told in 1992that it would take two years to fully rehab an ACL replacement, or I should consider a knee replacement but know that I would need one or two more if I had a normal life span. I eventually had the ACL replaced with a cadaver ligament at age 48, in a minimally invasive procedure (scope and one incision) and I had full recovery in less than 3 months. I mention this only to point out the advancements in the techniques. As mentioned elsewhere, the ice water circulation machines for pain and continuous passive movement machines for rehab are a tremendous advancement over the surgeries I had in the 70's.

    I now have torn cartilage in the right knee but not so bad I can't live with it. This was the result of a slip and fall accident last Christmas at a local restaurant.

    I wear soft soled shoes as much as possible, and flat heeled boots most every day.

    I started taking Celebrex several months ago after an MRI for the above incident and it helps tremendously. It would be even better if I lost some more weight. My doc says we'll try the meds, then cortisone, then maybe another scope/clean out or synvis injections before we think about replacement.

    I will cycle about 3000 miles or so this year, and though there is always some pain, I live with it and prefer to have some rather than take chances with knee replacment. Everyone has their own thresholds. Unless you can't stand the pain, I recommend against a replacment, for several reasons.

    First, the current crop of artificial knees aren't really knee joints so to speak, they are hinges, and don't allow a full range of motion. You can't twist normally. There are some new ones coming on the market now that are better. I expect it to get even better, but I want to give it as much time as I can and hope for even better, more natural and longer lasting joints. Secondly, far too many knee replacement patients I have known walk like penguins within a couple of years. This tears up the other knee and there you go. Before everyone jumps on me, note that I said many that have known, not everyone. And maybe they didn't do their rehab. Lastly, I have a fear of the blood clot/infection scenario. I had two friends die from blood clots after supposedly total recovery. Enough said on that. I have been told infections are attracted to places where the bone has been disturbed. This last concern about infection and blood clots are low probabilities, but are still my concerns.



    Here is one website: http://www.stoneclinic.com/ you might find interesting, if you haven't checked it Lastplace's post. I had always hoped to live long enough for a cartilage graft but, alas, when I did my bones aren't up to it. Mother Nature's revenge I suppose.

    Opinions run the gamut-------

    Per tcl20010 aka the Grampster " I do about 150 miles a week and am 100% pain free--have been since about 4weeks post op. OBTW, I was riding my bike to physical therapy a month after surgery (I did not ask permission, so no one could say no)."

    Per airbrake "He's retired now and will probably limp his way into senility."----------------


    I'm really giving you the Reader's Digest version of my knee history here. I could go on and on. Feel free to send me a message if you want to discuss further. Not everyone will agree with me, obviously, but I would not recommend the knee replacement until all other avenues have been explored and you can't stand the pain.
    Last edited by Monoborracho; 03-28-07 at 10:28 AM.
    Most economic fallacies derive from the tendency to assume that there is a fixed pie, that one party can gain only at the expense of another.....Milton Friedman

  13. #13
    Humvee of bikes =Worksman Nightshade's Avatar
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    Quote Originally Posted by airbrake
    I worked with 2 guys at the post office who had knees done. One went back to carrying a route, walking about 12 miles a day. His lasted 9yrs, and when they put the 2nd in they had a lot of trouble with his thigh bone detererating so he couldn't walk a route any more. He died of cancer about 4 yrs later. The other had a riding route, but he didn't do his therepy so he wasn't much better after. He was supposed to get the other one done but never did. He's retired now and will probably limp his way into senility.
    This post brings up a little talked about but VERY important aspect of knee repelcments.

    Their life span.

    Knees implants are a man made product and as such have a limited lifespan. Due to the
    agressive way an implant must be installed the success rate the second time around is
    dismal due to bone loss.

    The postman mentioned here,more than likely, thought "new knees I'm cured" with no thought
    to ramping down the use level to extend the lifespan of the implant. Ortho doctors won't tell
    you much if anything about lifespan of the joint because it varies so much from person to person.
    An very active "i'm cured"person will wear out the joint quickly unless they cut back on useage
    somehow. Does that mean living life in stting postion?? No, it means no more races or running
    or boston marathons and limited working/walking on concrete.


    ALL THIS SAID MAKE SURE THAT YOU DISCUSS JOINT LIFESPAN WITH THE ORTHO DOCTOR
    BEFORE YOU GET KNEE IMPLANTS.
    My preferred bicycle brand is.......WORKSMAN CYCLES
    I dislike clipless pedals on any city bike since I feel they are unsafe.

    Originally Posted by krazygluon
    Steel: nearly a thousand years of metallurgical development
    Aluminum: barely a hundred, which one would you rather have under your butt at 30mph?

  14. #14
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    Quote Originally Posted by Tightwad
    This post brings up a little talked about but VERY important aspect of knee repelcments.

    Their life span.
    You are exactly correct. And the younger and more active you are, the shorter the life span of the replacement.
    Most economic fallacies derive from the tendency to assume that there is a fixed pie, that one party can gain only at the expense of another.....Milton Friedman

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    what are your results on knee replacement?

    Hi
    I just joined this site, and read about your knee replacement. I don't know if you are still active in the forum. but here is my story
    I am a female, 64, I was very active and still try to be, biking and skiing.. broke my leg 30 years ago, and have suffered with knee problems ever since. now I have severe arthritis in the knee. I have been getting cortisone shots, but last one I had didn't help me ski very well on my ski trip in January. I have been told by 2 surgeons that when the shots don't work anymore, I am a candidate for knee replacement. but I'm a bit of a wuss, and hear how hard the recovery is. was it worth it? I have not been able to find anyone, my size 5'3" 106 lbs. in good shape that has had the operation to talk to.
    thanks Jane

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