My left knee - OS verdict
lottiefox
Member Posts: 64
Hi all,
I had an MRI on my left knee a couple of weeks ago that showed early OA changes under the patella and an osteochodral lesion in the medial femoral condyle. I've been having knee pain (anetrior and medial) on and off for months and over the past few weeks its been constant, with swelling, discomfort etc etc. Naproxen helped the swelling a bit, Tramadol took the pain away but made me feel extremely unwell so I'm back paracetemol and ibuprofen and stuff to keep the pain at bay.
Saw an OS today (someone recommended by a friend who had knee surgery) and his verdict has shaken me. I was hoping perhaps for a suggestion of injections to calm things down, possibly a scope to "tidy things up" but he seemed to think my knee was beyond that - at the age of 40.
His suggestions:
1. I have a bad bunion on the left foot (and a small one on the right) thats been there since I was a teenager. He says this needs correcting before there is any point sorting anything out on my knee. OK, I understand the link between feet, knees, hips etc - I'm a (was) a fitness instructor so the whole kinetic chain and biomechanics was part of my training.
2. The lesion on the femur needs cartilage grafting onto it by removing cartilage from a non weight bearing bit of the femur and grafting it in to the gap.
3. The cartilage behind the cartilage is "gone". I'm not sure if he means gone completely or just wearing out in a certain area (I was a bit shell shocked by the time we got to this part of my knee) and needs grafting - this would be done by harvesting some cartilage, growing it in a lab, and then sticking it back under the kneecap. This is open surgery not arthroscopic.
Expected recovery/rehab = 12-18 months. Success rate = 80% (I'm sceptical about this as surgeons always are optimistic to me!)
So, he seems to be telling me major surgery to deal with whats been described as "early OA changes". I am gob smacked. I don't know what to do - whether to leave things alone and just keep managing the pain/restrictions but with the real risk they'll get much worse or go through what is major surgery on the hope the grafts take and I get back more mobility and ability to do sports etc. I am used to being really active (walking, biking, gym, dancing etc) and I'd love to get back to where I was only 8 months ago. But at what risk? Do I go through all the grafting etc and it might fail or it might not last and I am still looking at replacement? He seemed so dimissive in many ways - get the bunion removed, we'll grow some cartilage, stick it in and bobs your uncle. He was quite surprised that I was somewhat upset by the end of the 30 minutes! Perhaps he isn't the OS for me whatever I decide! :?
Sorry to moan, any thoughts welcome or even just a cyber hug. OH has bought me Cosmo and some chocolate in a bid to make me smile.
I had an MRI on my left knee a couple of weeks ago that showed early OA changes under the patella and an osteochodral lesion in the medial femoral condyle. I've been having knee pain (anetrior and medial) on and off for months and over the past few weeks its been constant, with swelling, discomfort etc etc. Naproxen helped the swelling a bit, Tramadol took the pain away but made me feel extremely unwell so I'm back paracetemol and ibuprofen and stuff to keep the pain at bay.
Saw an OS today (someone recommended by a friend who had knee surgery) and his verdict has shaken me. I was hoping perhaps for a suggestion of injections to calm things down, possibly a scope to "tidy things up" but he seemed to think my knee was beyond that - at the age of 40.
His suggestions:
1. I have a bad bunion on the left foot (and a small one on the right) thats been there since I was a teenager. He says this needs correcting before there is any point sorting anything out on my knee. OK, I understand the link between feet, knees, hips etc - I'm a (was) a fitness instructor so the whole kinetic chain and biomechanics was part of my training.
2. The lesion on the femur needs cartilage grafting onto it by removing cartilage from a non weight bearing bit of the femur and grafting it in to the gap.
3. The cartilage behind the cartilage is "gone". I'm not sure if he means gone completely or just wearing out in a certain area (I was a bit shell shocked by the time we got to this part of my knee) and needs grafting - this would be done by harvesting some cartilage, growing it in a lab, and then sticking it back under the kneecap. This is open surgery not arthroscopic.
Expected recovery/rehab = 12-18 months. Success rate = 80% (I'm sceptical about this as surgeons always are optimistic to me!)
So, he seems to be telling me major surgery to deal with whats been described as "early OA changes". I am gob smacked. I don't know what to do - whether to leave things alone and just keep managing the pain/restrictions but with the real risk they'll get much worse or go through what is major surgery on the hope the grafts take and I get back more mobility and ability to do sports etc. I am used to being really active (walking, biking, gym, dancing etc) and I'd love to get back to where I was only 8 months ago. But at what risk? Do I go through all the grafting etc and it might fail or it might not last and I am still looking at replacement? He seemed so dimissive in many ways - get the bunion removed, we'll grow some cartilage, stick it in and bobs your uncle. He was quite surprised that I was somewhat upset by the end of the 30 minutes! Perhaps he isn't the OS for me whatever I decide! :?
Sorry to moan, any thoughts welcome or even just a cyber hug. OH has bought me Cosmo and some chocolate in a bid to make me smile.
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Comments
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Hi
Sorry about that.
I have problems with my left knee. I get terrible pinching in the lower outside quadrant and lately been getting a sharp tightness on the inside too.
I had keyhole to clean in up and to investigate what ws going on i there and they basically found that my cartlidge had a split through it and the patella had basically been worn down which is what is causing me problems. I would always get pain if I tried running (can no longer do anyway because of my back and hip) then in the morning after exercise I wouldnt be able to bend it for ages.
Since I found this out I havent run at all and feel extremely frustrated because I am currently unable to exercsie at all.
They told me I would need my knee cap replacing at some point but they wouldnt consider it at the moment because of my age (29).
I am making do with synvisc njection which wore off after about 5 weeks.
To answer your querie. Personally, I would have the op now if they offered it to me. I am currently unable to lead the life I want to and it makes me extrememyl unhappy. If it was me I would see if as a win win situation. If there is a slight chance it could improve your life then do, if it doesnt work then you are back to square one.
Personally I would bite the surgeons hand off. Why wait until you are older to get your life back??0 -
Sorry to see this lottie
It must have been very scary and no wonder you are in shock. The OS has given you so much to think about. Take some time to think about what he has said there is no rush to make decisions. You lost me on the medical stuff so I do sympathise with your dilemma and confusion, but I am sending buckets of hugs and hoping you feel a bit brighter tomorrow.
take care
Chris0 -
HI,
sorry to hear that the news was not as positive as you hoped for.
You could always ask for a second opinion ...... a lot of people would given the seriousness of the op you describe.
Also have you thought of ringing the helplines on Monday for a chat? I am sure they could give you advice on how to make a decision when you have all the info you need.
If you have a good relationship with your GP you could also think of going in for a chat.
good luck & hugs to you ((((((((()))))))))) ((((((((((())))))))))))))0 -
Wow, that is a heck of a lot to take in, Lottie. Gulp. Gulp. :shock: :shock: Is an OS an orthopaedic surgeon? I am surprised that he is talking about your bunion as well. I too have had one since my late teens and had a Total Knee Replacement 2 years ago. I am having another TKR on the leg with the bunion in January but there was never any mention about an op on my bunion first!! I did enquire about it once a long time ago to a surgeon and he dismissed it.It has never given me any jip really, just looks horrid and makes it difficult to get shoes as I have a wide foot anyway. That in itself can be an op that takes a long time to get over. Surgeons often do not have a good bedside manner but are excellent at their work. If you don't feel you can put your trust in him, then don't. You have to have that, in my view anyway. I presume this OS is good at bunion ops as well as knee ops. It may be worth asking him how many bunion ops he has performed and his success rate.......
May I ask if this was a private or NHS referral?
I would get a second opinion, without a doubt. I can well see why you are "in shock". I would have been too.
Luv
Elna xThe happiest people don't have the best of everything. They just make the best of everything.
If you can lay down at night knowing in your heart that you made someone's day just a little bit better, you know you had a good day.0 -
sorry its all a bit much to take in but if you are not sure get a bit more advise if possible ,but what i can help with is a big big cyber hug ,{{{{{{{{{{{{{{{{{{{{{{{{hug}}}}}}}}}}}}}}}}}}}}}}}I know i am a lady ,all life is a journey xx MAY xx0
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Hi
I have OA in both knees and can understand your discomfort and concern. Not sure what to suggest for you. Have you spoken to your GP. MY knees are totally shot and I need 2 total knee replacements. The first surgery will be soon I hope.
Things have been left so long by our gracious NHS that I'm now going to have to use a wheelchair when I'm out alternating between walking sticks and crutches for short distances and in the house.
I'm 53 and they've been saying I'm too young for the past few years! However now that my mobility is seriously deteriorated they will now do surgery.
We are all different and these are big decisions that you should discuss with your GP. I'm on co-dydramol x 8 a day; 3 amitryptilines at night and 3 diclofenacs a day to control the swelling/pain. However, some days even the meds don't work!
I do hope you find the answers you're looking for.
In the meantime take care.
Sharmaine0 -
Lottie hello,
I hope you are feeling a little less shell shocked this morning.
I wanted to say that I feel Elna has touched on something that had occurred to me too. Was your appointment - and possibly any surgery - arranged privately? I`m afraid that, in my experience, if you are paying, then some surgeons tend to be a bit "scalpel happy".
Again, as Elna said, unless you have total trust in your surgeon, do not go there! I had a TKR in 2007, with quite amazing results, due almost entirely, to a great surgeon........Ange.0 -
Hi again, Lottie!
I wrote my last message in the early hours but having had another think about your posting, if it was me, alarm bells would ring a little because, quite honestly, if I was having a bunion operation, I would wish to put my trust in a surgeon that deals with feet, all the time. If I am having a knee operated on, I would likewise, wish to have a surgeon perform the operation that has a keen interest in knees only. A surgeon that dabbles with feet, knees and perhaps hips too, would scare me.
I would strongly recommend a second opinion. What have you to lose?
Love
Elna xThe happiest people don't have the best of everything. They just make the best of everything.
If you can lay down at night knowing in your heart that you made someone's day just a little bit better, you know you had a good day.0 -
Thank you all so much for the support and comments. This place really is amazing. The helpline is a great suggestion, thank you. And it helps SO much just reading that other people understand, I can only give you all a big hug in return.
The OS was a private consultation - someone who worked on a friend's knees after they had serious football damage and who does the local prem footballers etc. I don't think he was suggesting he did the bunion op, but he didn't suggest anyone else who could help either and seemed a bit surprised I was shocked at the thought of 3 separate surgeries. To be honest it was almost like a chiding "well, you've got shocking bunions as well so they should be sorted or else there's no point sorting the knee out" that he threw in at the end of the consultation.
I've got SO many questions that have come to mind now I've slept on it and thought about it. I'm not sure I want this bloke near my knees anyway as if there were problems I am not sure he'd have empathy.
I am going to get a 2nd opinion on the 15th December in London. I know this chap yesterday was probably going for the gold standard option - save the knee as best he could with the best chance of return to my previous fitness/active life - he went thru other options such as a wash out, microfracture etc but said they'd only possibly help in short term and this grafting was the best solution. If they carry on degenerating then grafting isn't an option as I understand it.
Anyway, I fel better today. Still shell shocked and ready to cry at the drop of a hat but OH is taking me out for lunch and to the seaside, and the sun is shining. Its a long road ahead I know. Will write more later.
thanks again,
Lottie xxx0 -
Aw bless, Lottie! You have a lovely day out at the seaside with lunch thrown in, with your brill OH.
Love
Elna xThe happiest people don't have the best of everything. They just make the best of everything.
If you can lay down at night knowing in your heart that you made someone's day just a little bit better, you know you had a good day.0 -
Hi, I would definatly have a second opinion - the surgeon seems to be suggesting massive ops at a very early stage in your treatment, without trying anything else, such as steroid injections etc.
I'm no medic, but I do have oA in quite a few joints including my hips. Surgery has been ruled out at the moment for the OA, as its not severe enough and I'm only 54, which increases the risk of needing replacment of the replaced joint.
For you, at your age, I can see that issues of quality of life and enjoyment of exercise etc are going to be very important, but a second opinion would certainly be a good idea, so that you can talk it over and see just what the options are. I wish you well in your decision making, but if unsure, say no at the moment, it can be done later if necessery. As for the bunions, I have 1 big one and one small one and as long as I'm careful with buying shoes that don't rub, I'm fine! Love Sue0 -
Hi Lottie,
Glad you are going for a second opinion and really hope you had a good time today? Cris xx0 -
Thank you everyone for listening and helping - this week's task amongst the real-life work I need to get done is researching everything I can on the cartilage graft surgery, outcomes, predictors for success/failure, co-exiting conditions e.g. bunions and so on. I want to be prepared when I see the 2nd opinion. I'm quite shocked that some of the articles I've read so far seem to indicate that even extensive grafting isn't yet linked to a definite reduction or even delay in OA symptoms worsening or setting in. I need to have better odds than it "might help with getting about and some pain reduction but you'll still have/get OA getting worse" for major open knee surgery and 12-18 months rehab!!! :shock:
I had a lovely day out. Heated seats are SUCH a bonus in the winter and OH got me a huge Sunday carvery and we got some very chilly fresh air at the top of the River Severne. Living in Bucks means we aren't really near any sea, so this was the best option for a shortish drive. OH has been just brilliant this weekend, makes you wonder what you'd without them.....even when they do drop undies on the floor and never empty the dishwasher!!!
Thanks again all xxxx0 -
Hello again folks,
I saw the 2nd opinion OS today, he was a far nicer bloke with a much better and reasoned bedside manner. Unfortunately he agreed with OS Number 1 that there was pretty extensive damage to both the patella and in the medial compartment. His recommendation is an arthroscopy to "tidy" behind the patella and to microfracture the femoral lesion - but this is a buying time operation with no guarantee of success or long term improvement and he has mentioned the need for us to be considering "more significant" surgery in the future. Great....I'm pretty undecided what to do. :?
One thing he asked was whether I had any other symptoms in other joints, and at the time I replied No as primarily its the left knee that is the issue and thats the one I had MRIs for etc. However, over the past 24-48 hours my other knee has been getting progressively worse - swollen, painful, stiff, a bit red. I spent 15 mins on the exercise bike yesterday and thats sent it into freefall. Just like knee number one went when it first got so painful. The pain in knee one has actually abated a bit over the past week or so, but now number 2 is taking over and seems to be worsening by the hour. Bizarrely I've also got pains and aches down my legs and around the knee joint line, almost like bone pain, and now two sore ankles. These may of course just be as a result of the one knee throwing me off balance etc when I walk. But last week I had 3 days of a really sore lower back, I've lost about 5 pounds in weight despite having to severely curtail my usual hectic exercise regime, am waking up at night soaked in sweat on many occassions and generally feel more tired (but I'm worried about the OA, and that could easily be affecting sleep/eating etc). I've also had an achy left shoulder two mornings but assumed I'd slept strangely. I was also tested positive for anaemia back in May but thought nothing of it as I had just got married and the GP thought it was just stress and I'd been through a bad bout of heartburn and stomach problems (all fine on endoscopy and put down to wedding stress). I've not been tested for anaemia since. Does any of this warrant a check up for RA? I really hadn't considered this until today, prompted by the OS's question and the strange range of symptoms that seem to be happening. I thought RA started in hands and/or feet and those are fine....
Any help gratefully recieved.
Thanks all
Lottie xxx0
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