Wednesday, March 05, 2008

Arthritis And Total Knee Replacement....Part I

I want to say this is my personal experience only. It is not intended as medical advise (I'm not a physician). Nor do I intend this to discourage or encourage anyone's decision about the possibility of having knee replacement surgery. This surgery is an individual experience. Since we are all extremely unique, we can all expect different outcomes, recovery times, post-op complications and the list could go on and on.. I do hope that by telling this, that anyone who happens to stumble in here, might leave with a little insight, and be a bit more informed as to what type questions they need to ask their Physicians.

Arthritis began to effect my life more than 25 years ago, when I was still in my 20s. By age 28, for the first time, a Dr. described my knee pains and stiffness as being arthritis. I wasn't sure what to think about it at the time. My mother had terrible arthritis. I had watched her lose more and more of her mobility and her lust for life over the years. I decided to put this diagnosis out of my mind for as long as possible. There is something to be said concerning mind over matter.I had children to raise. I also had a home, a husband and a full-time job. What did he mean "Start taking it a little easy on your legs?" When you are 28 yrs. old there is no such thing.

I would get up in the morning, and stand in a hot shower, trying to loosen my knees and keep the stiffness away. I would also take 1 or 2 aspirins before going to work. It all seemed to help, I managed to get everything done. At night I would watch TV or play with my son and not even realize, for a long time, that while I would be doing these things I would also be rubbing my knees. It was like my subconscience was willing them to stop aching, while my conscience mind wasn't even aware they were.. It was a long time before people finally brought it to my attention that I was doing this...I totally would not deal with arthritis.

As things progressed, it became harder to ignore. I had to start taking something different than just aspirins for it in my early to mid 30s. For a time I tried different NSAIDS with varying degree of success.

When I was 37 years old, I stood up from the sofa one morning and could not walk. It was extremely painful to even move my left knee at all. I could not bend it and could only manage (after a while) to take little baby steps. I didn't know for sure if this was my arthritis or something different. What in the world would I do now? I had to go to work, and, stand for many hours once I got there. Impossible!

I phoned my PCP who in turn phoned an orthopedic surgeon. I was in luck and he could see me the next day. This was in early (Jan) 1991. They did not do MRIs on knees at that time. He pushed, pulled, tried to bend and did all sorts of things with my knee. It was swollen, red and HOTTTTTT! Amazingly the x-rays basically showed nothing! OK, what to do now? He explained that he believed I probably had torn some cartilage (How, just by standing up?) and wanted to do arthoscopic surgery to repair it and get an inside view of what was going on. For me this was a moment of relief...NO ARTHRITIS on the x-rays! Did that mean I probably didn't have it? Why did I have all these pains in both knees if it wasn't arthritis? Could it be possible I have this torn cartilage in both knees, for whatever reason, and no arthritis?

As you can tell, I really didn't understand this illness at all at this time? I had been treating it for more than 10 years but had so profoundly ignored it as to not make myself knowledgeable on my own illness. Anyway, lets have this surgery and fix this cartilage and forget about arthritis...WOOOPEEEEE!

Day of surgery: Feb. 11th. 1991....We arrive to OP surgery where I am prepped and given instructions on how to use crutches.. OS arrives and talks with me for a few minutes. Tells me this will be a short surgery and informs my family I will be back in room within an hour and an hour later I can go home...I wake up and realize it is now about 3 hours since I had this discussion with the OS. My family is all trying to tell me all at once what he had said.. Anyway, because they were all talking at once and I was still in the, not to bright stage of post-surgery, none of it was making any sense...But, lo, my OS is still in the hall and he comes into my room...He walks up to my bed and says...."My dear, arthritis has completely destroyed your knee." I thought...." Well, isn't he charming".....

He proceeded to tell me how he had scraped (making a fist with his hand) this much arthritis from one of the bones. He said alot of other stuff which really didn't phase me, "arthritis destroyed your knee" were the only words I had heard, he lost me after that. He then got my attention again but telling me "Your going to be in a wheelchair, I'm not sure when that will happen, 6 months, 6 years, etc...but it will happen." He tells me I need to have total knee replacement but I am too young so we will just continue treating it symptomatically and increase my NSAIDS and sail along for awhile. .I was wondering....."How could a wheelchair be preferable to TKR?".... He also did not want me to take any PT following this surgery. He felt it might make the situation worse and he wanted me to progress at my own pace...

I had a job that I had to get back to. I was home for 4 weeks and had begun taking feldene. I then returned to work and standing for up to 12-14 hrs. on many days. My knee did not like that. It hurt all the way down my leg and was making it impossible to ignore. Not only that but as luck would have it, my R knee picked just this time to become more painful than ever before. Maybe because I was putting more pressure on it since having the left knee surgery? I also had gained weight when I had my babies. After this diagnosis, I joined weight watchers and lost down to 118lbs from close to 200lbs. I have managed to stay in the 135 range for all those years since then. It is a battle I have fought all my life.

I returned to my surgeon and explained that the pains seemed to be getting worse. He put me on steroids (medrol pack) for a while. ....Sweet Jesus, it worked. ....The pains started easing up and work wasn't so bad again. However, when I returned to my surgeon he suggested we now schedule the same surgery for the R knee.... Oh no, I wasn't ready to have that surgery on the right knee and be laid up again for 4 weeks and not be able to take proper care of my family. I left his office that day and never returned for almost 14 years.

**Surgical report of arthoscopic surgery dated Feb 11th. 1991**

"Preoperative diagnosis: Internal derangement of theleft knee

Postoperative diagnosis: Advanced osteoarthritis, medial andlateral femerol condyles and the
lateral tibial plateau.

Operation:Diagnosticand operative arthroscopy with
debridement of the osteo-cartilagenous fragments in both compartments.

The lateral compartment had severe osteoarthritic changes. There was an area of at
least5cm. x 6cm. on the mainweight bearing portion of the lateral
femoralcompartment that was a crater, free of its cartilagenous tissue with the crater down to the subchondral bone.The opposing surface of the lateral tibial
plateau appeared to be relatively within normal limits, but more medially from
this somewhat lateral area on thefemur, the lateral tibial plateau also had an area, about a dime size area, of the loss of all articular caritlage. These areas were all smoothed and debrided.

Osteocartilagenous fragments we removed with the shaver and suction in the medial compartment, there was an area about 3 x 3 cm.
on the main weight bearing surface where there is much fissuring and fracturing of the articular cartliage on that condyle. this was also smoothed and removed back to a good firm tissue.

An abrasion chondroplasty was not felt wise."

Part II will follow. This was only the beginning.

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