Knee Replacement

In My Humble Opinion
1

I always thought of it as an “old person” thing (both my mother and uncle had them when they were in their late 60s/early 70s), but an accident last year where I landed smack on both kneecaps presumably dislodged my arthritis and one of my knees is now “severely arthritic”. It’s bone against bone 3/4ths of the way around. The orthopedist mentioned knee replacement. I just sat there and mentally freaked out because…I’m only in my early 50s!

I’m on my feet 8+ hours of day for a living. Sometimes I can ignore it, but there are times where I’m in agony. I dread sitting down, for instance, because it’ll be agony getting up. Ditto going up/down stairs. I’ve been told this is all perfectly “normal” with arthritic knees. I still walk my dogs, but I’ve been putting my husband in charge of the husky more often than not simply because I can’t take the bouncing!

I no longer perform some of my work duties because I can’t squat/kneel. Or, rather, I can, but getting there and getting back is a whole other story :eek:

My orthopedist hasn’t given any kind of timeline as to when I presumably need this replacement. When I ask him, he’s very noncommittal.

I guess what my question is…if you’ve had one or know someone who’s had one, what was your/their benchmark that made you/them say, “OK, I’m going to get it.”

(BTW bad knees are a hallmark of my profession. There are many people like me walking around at Current Employer. A few people have had them, but the majority haven’t because they don’t want to be laid up for weeks on end).

2

Coworker had to have her knee replaced after an accident (she fell through a deck). She decided it was time when she realized she couldn’t walk her dog.

Friend of mine had both knees replaced when even using a walker wasn’t helping, she essentially became a shut in. She had to choose between work and having them done. She was off from work for over a month and a half (complications) but is now back at it and glad she did it.

3

I can still walk our older dog. She’s more gimpy than I am :slight_smile: I can still walk Max The Husky for short bursts, but that’s it.

Right now it’s more of a nuisance than anything else. I was out of work for almost two months after the accident. The first month I basically lived at PT.

I was told that my job is basically killing my knees, so it’s like I’m damned if I do, damned if I don’t :confused:

4

I am not a medical professional.

I have had a hip replaced, not a knee, though I know people who have had it done. The reason your doctor is so non committal is that it is basically up to you when to get it replaced. At your age they like to put it off as much as possible to avoid having to redo it later.

It is possible to put off the replacement by;
[ol]
[li]Injections of hyaluronic acid.[/li][li]Physical therapy.[/li][/ol]
My own evaluation of hyaluronic acid brought me to the conclusion that it was not worth the effort.
Physical therapy will be worth the effort if only to increase your pre operative functioning which will directly effect the post operative result.

My completely unprofessional opinion is that you should get the knee replaced sooner rather than later. Right now you are making adjustments to your gait that means that some muscles are underused and are deteriorating. The longer this goes on, the more difficult your recovery will be.

You will want to do a lot of research before taking that step. First choose a hospital that specializes in joint replacements and has a good reputation. I used the Hospital for Special Surgery in NYC and recommend it enthusiastically (not affiliated in any way). Get a list of Surgeons that work there and choose a doctor that has a lot of these operations under his belt. Find out what product that doctor uses and research that. I don’t really know what controversies there are in knee replacements so I can’t advise you here. Just don’t go for the latest and greatest. You want something that has a good (and reasonably long) track record.

Expect pain. Talk with your doctors about it beforehand.

5

My unprofessional opinion (well, semi-professional, because calculating the value of operations is part of my job) is the opposite of ethelbert’s. A total knee replacement has a more or less fixed lifespan of 10 years. The earlier you get yours, the greater the likelihood you’ll need another.

6

My Mom’s had both knees replaced. She and my Dad are doing a lot of traveling now that they’re retired, and she opted for the surgery when she realized that they were limiting where they could go based on her ability to walk, climb, etc…

She says it’s the best thing she ever did. Almost never has any pain anymore. Literally two weeks ago they visited the Great Wall of China, and she was able to climb all the way up and back down again without pain.

7

The figure I see most often is that you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years. I take this to mean that you have a pretty good shot at having it last 20 years. My (again, unprofessional) recommendation is that I would rather be as mobile and pain free as possible from 50 to 70 than to have to limp along painfully till I reach 60. I regret waiting as long as I did for my hip. YMMV.

8

My orthopedic surgeon estimated 20 years on a replacement knee.

I’m 54. Three weeks ago I started getting hyaluronic acid shots in my left knee and doing physical therapy. It has helped some (whereas cortisone shots did not.) But if the shots and physical therapy don’t provide significant relief for months, I’m going to insist on knee replacement.

9

Not me, but my husband: Tony was only 41 when he had knee replacement surgery. Yes, his doctor tried to delay it as long as possible, because of his age and the likelihood that there would be complications down the road, requiring more extensive surgery. However, in the 1.5 years before the arthroplasty, Tony had 3 minor surgeries to try to eke a little more use out of the original parts, plus two injections. The pain from damage and arthritis, plus the weight gain that accompanied Tony’s lack of mobility, finally made replacement the only sane alternative - it hindered his job, his daily daily life, everything.

Tony woke up from surgery in less pain than the day before - despite all of the trauma from the surgery itself. By the next day, the physical therapist had him gimping up and down stairs at the hospital. He came home to three weeks of in-home therapy, followed by several more weeks at a PT center. The therapy was brutal - I watched him cry, sweat, vomit, and nearly pass out - but he did it.

Outcome: Tony was back at work within about 2.5 months, working patrol with his K9. He was finally able to train with and work the dogs the way he needed to. Even more importantly, he was able to play with the baby and keep up as she became mobile. He was able to be more mobile himself, and lost 100+ pounds. He would have the surgery again in a heartbeat, because it gave him back his life - personal and professional.

10

That’s happened to me too. I was going to they gym three or four times a week and steadily losing weight until my knee started hurting to much to go. In the last 9 months of doing nothing, I’ve gained 20 pounds.

11

I’ve had two rounds of shots, both cortisone and hyaluronic acid. The latter worked a bit better than the former, but neither of them lasted as long as I thought they would. I also take hyaluronic acid as part of a joint supplement – been doing it for years – and sometimes I wonder if I’d be worse off if I wasn’t taking it.

I’ve heard the same thing re 10-20 years for a knee replacement and the reason for putting it off as long as possible. My mother had no issues with hers, and it was more than 20 years between the operation and when she passed. Ditto my uncle. I have a friend who had a hip replacement done a couple of years ago. She’s in her late 40s and she took up biking afterward. She trains for road races now!

PT did help in the short term, but even though I still do the exercises, I don’t see any remarkable strengthening – I mean, if I faithfully do them, my muscles should be stronger, right? I’m all loosy-goosey and my knee sometimes feels like giving out at random moments, so…? I remember the therapist saying that my job would probably undo all the PT because just the act of standing for hours on end is very hard on the knees whether or not you’re overweight.

Speaking of weight, I’ve managed to lose a few pounds in the last couple of months. I chalk this up more to my ongoing wonky no-thyroid condition than anything else. But yeah, I haven’t been to the gym in a few months because all I can do there is bike and use the upper body Nautilus circuit. I realize these are better than nothing, but still.

12

My friend had a hip replaced in January. She’s 32 and had some kind of infection many years ago that damaged the joint. She just returned to work yesterday and is looking and feeling good. I believe (but am not sure) that she said she got a ceramic hip and it likely won’t need replacement. She did say she wished she had done it sooner and was showing us how she can bend and move- things she has been unable to do for quite some time. She had ‘robot’ surgery. The incision was less than 6 inches long on the front side of the hip (with a couple of punctures in other places). The recovery time was 6 month, although she felt well enough and was cleared to return to work at 5 months.

13

My wife’s knees were very arthritic. She had problems walking more than 50 yards. She had to use the hover-round thing at the grocery store because she couldn’t walk the whole way. She was never on top during sex because it hurt her knees. Due to the lack of ability to move, she gained a lot of weight.

She was 36 when she got her left knee replaced.

She’s 39 now and has lost over 100 pounds. Her quality of life is much better and she is a much happier person than in the years leading up to her knee replacement.

Her left knee was so bad, you could hear it grind as she walked across the room. She’s over 6 feet tall and got to that height by the time she was 14. Her knees grew wrong and throughout middle school and high school, she constantly dis-locating her knees - the left much more often than the right. She’s had numerous knee surgeries over the years as well as more arthroscopic surgeries to help.

Her doctor told her that her new knee should last up to 20 years. Then they might be able to do one more replacement after that. Like many of the posters above, she figured it would be better to stuck in a wheel chair in 40 years than now (assuming that a) she is still alive in 40 years and b) medical science hasn’t discovered something better by then).

They had talked about replacing her right knee 10 years after her left knee to kinda stagger the surgeries out, but she is doing so much better, that it might not be an issue for much longer than that. Her right knee was taking over a lot of the load from the left knee and is now much better.

The recovery wasn’t that bad, but she was rather flexible before the surgery. She had 90 degree movement within a month after the surgery and she never really cried nor threw up.

Prior to the surgery, she was taking a lot of vicodin to deal with the pain and built her tolerance up. The vicodin they gave her afterward did nothing so they had to put her on a stronger pain killer, neurotin, that she got addicted to. But we were able to ween her off of that once we realized the issue.

Now she can do everything in that list from the beginning of this post. But she if very careful with it so it will last as long as possible. She doesn’t run or do any type of high impact activity. She refuses to walk over ice without holding onto me. No rollerskating or skiing. But she has been steadily losing weight and actually allowing people to take pictures of her now. We’re keeping the cane and walker just in case, but she’s much happier now.

14

I have been fighting getting my knees replaced since 15 years ago. Next week I give up and am having the right one done on the 13th. However my wife who had shown no previous problems, was told she might need something done in ten years. She actually had both replaced in a bit less than a year because her knees went to hell in that little of time. I’ve held on 5 years after she had hers done. Obviously, YMMV. She was 53 then.

15

I have two friends with recent knee replacements, both 50 year old men.

The first had both knees done at the same time (he was an active duty Marine; they’re crazy like that). Followed doctor and PT orders to a T (which shocked the hell out of all of us), and was walking normally within a few weeks, and was able to pass his physical fitness test a few months later. Says it was the best thing he’s ever done.

The second had an accident that did significant damage to one knee, on top of previously-existing damage that resulted from being a retired Marine who had let himself get a little rotund after he got out. :smiley: The operation was a little trickier, and his recovery a little longer, but within 3-4 weeks he was walking unassisted and 6 months to the day later he was skiing. His PT folks had to actually make up exercises for him because he recovered so quickly, but still needed the structure of PT until everything was healed.

With the right surgeon and physical therapist, it’s really worth it. The PT is no joke, though, so prepare yourself for that.

16

After three hyaluronic acid shots in my left knee, my doctor notified me yesterday that my medical insurance has declared hyaluronic acid “experimental” and will no longer cover them.

17

I have two friends who’ve had both knees done. Both were in the same age group (early 50s, OK one may have been in her late 40s).

In the case of the first friend, she was kicking herself for not having it done sooner. Or as I joked “or you would be if you could!”. Yes, she still has some lingering issues, but nowhere NEAR the daily constant pain she was in before. She had the second one done about 6 months after the first.

And:

bwuh??? This is HARDLY an experimental treatment. OK, maybe in OTHER joints, but it’s fairly standard care for knee issues. I did the series myself 4 years back when, for reasons that still mystify me, one of my knees started to hurt like HELL for months on end (and of course the ortho insisted I try PT, which as in the past made it all much worse).

If I were to get back to that level of pain, I’d sure as hell try the injections first. One annoying thing though is that the injections have to be paid for by your drug coverage. Yeah, I had to order the stuff from our online pharmacy and ship it to the ortho, and the online pharmacy screwed that up royally. Took several months to get that straightened out.

18

Its safety isn’t in question. Its efficacy is, however.

19

Your post helped me figure something out about my insurance that a couple phone calls confirmed. My medical insurance (State of Kansas Blue Cross) will no longer pay for hyaluronic acid shots directly. My surgeon says the reason is because it’s efficiency is called into question. Three shots has done me a great deal of good.

My prescription insurance (Caremark) will pay for hyaluronic acid under other brand names than I was getting (Euflexxa). I just have to get a prescription from my surgeon, go to CVS and get it filled, and take it to my surgeon. I don’t know why my surgeon didn’t understand this.

20

Probably because his practice accepts 4,000 insurance plans and even his billing staff don’t know all of them. It’s not him, it’s The System.