Knee Problems & Surgery

[rdparadise]

Well, I've been dealing with a left knee issue now since last June. It started with inflammation of the area below the left knee which actually looked like my leg was clotting.

I had an MRI and they diagnosed mild arthritis and no tears were seen. In the past 7 months, I've had 3 cortisone shots, and a series of 3 synvisc shots to add some lubricant in there. About every 4-6 weeks I find my lower leg swelling due to the irritation from the arthritis.

I have been on and off the bike for several weeks at a time, allowing the swelling to heal.

About two weeks ago, my leg swelled again and I had my third cortisone shot. I'm frustrated because nothing seems to be working. I am now scheduled for surgery on Feb 6 to scope it out and clean it up. The Ortho says if there is only arthritis in there he'll only be able to clean it up and relive some of the pain, but not permanently. If he finds ligament damage he will fix it and that would alleviate the problem going forward.

I've decided to have this done now while it's the winter and my cycling has been curtailed anyway. I'm 50 and in good health otherwise. Recovery is 4-6 weeks.

Any pointers, recommendations going in that I should know about? Any experiences you'd like to share?

Let me know.

Bob

Ps. I forgot to include in my original post that I do have a Baker's cist 12 centimeters long going down the left calf. My ortho says these are usually right behind the kneecap, so it might be something else. This is what was constricting the blood flow back up the leg. The cortisone did eliminate the swelling and improved the circulation.

[Dave]

If they do find some damage that needs repaired, you'll be glad you finally got it done. I've had three scope jobs for torn meniscus. While they're in there, they usually smooth the underside of the kneecap, but in my case there was little cartilage to work with, at least on the left knee. I've always been able to get back on the bike in only 7-14 days, but I never had any ligament damage.

I had quite a bit of swelling after the first surgery on my right knee, and stayed off the bike for nearly two weeks, but the last two times (both on the left knee), I was riding 7 days after the surgery.

Whatever you've got, it's a lot more than minor. Arthritis has destroyed most of the cartilage under my kneecaps, but I've never experienced anything but some stiffness and moderate pain. The kneecaps still don't bother me, but it's only a matter of time. I've never had any type of injections for my knee pain.

I did just get a cortisone injection in my spine. Arthritis has caused bone spurs and pinched nerves around C5 and C6. The injection has helped that problem.

[Ken Robb]

you will probably be told to ice the area after surgery. The old bag of frozen peas technique is good but it's much better to use a device that recirculates ice water from what looks like an Igloo Cooler through a vinyl bladder that is attached to the area by Ace Bandage. It uses a low-voltage pump and keeps the temperature at the wound more uniform. The times I had my knees fixed the surgeon had "loaner". The Doc who did my shoulder didn't so I had to buy one but I thought it was worth it.

[rdparadise]

Bump

Need some advice here, Yo!

Bob

[eddief]

if that is the case, i'd suggest a second or third opinion. not good to have them cutting on you if you don't fully understand what's going on. maybe you do understand and just are not ready to accept.

this aging stuff sucks. i have been scoped once in each knee. wonderful results and hope them and my prostate are in good communication and they all want to live happily ever after. "the knee bone's connected to..."

most of all i wish you good luck.

think the product Ken was speaking of is a company started here in berkeley, but since relocated locally to alameda:

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

or if your knees are really big:

http://www.gamereadyequine.com/

[brians647]

if that is the case, i'd suggest a second or third opinion. not good to have them cutting on you if you don't fully understand what's going on. maybe you do understand and just are not ready to accept.

this aging stuff sucks. i have been scoped once in each knee. wonderful results and hope them and my prostate are in good communication and they all want to live happily ever after. "the knee bone's connected to..."

most of all i wish you good luck.

think the product Ken was speaking of is a company started here in berkeley, but since relocated locally to alameda:

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

or if your knees are really big:

http://www.gamereadyequine.com/

+1 on the other opinions. Also, look into those knee shots of Hyalagan, in the Viscosupplementation treatment.

Actually, ignore that, and go see another doctor!

[BumbleBeeDave]

. . . NOT a doctor, nor do I play one on TV. But I'd be kinda leery of a surgeon who just wants to go in and "scope it out" to see what's going on. Any kind of surgery, no matter how high-tech, is still invasive and should be a last resort. Aren't there tests that can be done with dye to diagnose where a circulatory blockage is without doing surgery? I believe this test is used to locate heart artery blockages. It just doesn't make sense to me to use surgery to diagnose until all non-invasive means have been exhausted.

I'd also be leery of a doc who doesn't address the obvious first. A baker's cyst is just full of synovial fluid. From your description, it's also the only obvious thing that's wrong with your leg now aside from arthritis. The arthritis might cause pain from bone-on-bone contact or lack of cartilage, but I don't understand how that would block circulation. Has this guy even suggested draining the baker's cyst to see if that helps in re-establishing normal blood flow?

Also, is this doc aware of what specific activities--in this case cycling--are causing you pain? I agree with the others who suggest getting a second opinion from a doc who has no connection whatsoever to this guy and doesn't know about his diagnosis. I've been through the "second opinion" thing. If these guys know each other they tend to support each other.

BBD

[rdparadise]

Guys:

I've had the knee drained once and the cortisone has completely reduced the swelling. The Doc after this latest cortisone shot thinks everything looked good, and wanted to keep an eye on it. I've been through watching my knee over the past six months trying everything non-invasive to no avail.

I actually want the surgery now to clean up the knee and hopefully eliminate the irritation that's causing the swelling. I trust the doctor and he has a booming practice from what I can see. He is in surgery two days a week fixing many of his patients so I'm confident he'll do the same for me.

My knee does feel unstable and I'm looking forward to the scope to fix my issues and put this episode behind me. I want to have a good upcoming cycling season, one not inhibited by the arthritis.

I'll look into that icing device. That sounds like a winner.

Bob

[BumbleBeeDave]

. . . before you do anything surgery-wise. Just because the surgeon has a "booming practice" doesn't mean the surgery is necessary or appropriate. I recognize that may sound overly cynical, but a conservative, cautious approach by you as the patient at this early stage, advicating for your needs, could pay some great dividends later. so it may take a couple of extra weeks to get the second opinion--isn't your long-term health and ability to do the physical things you love worth it?

Here are a couple of links I found to unnecessary surgeries . . . Note that knee arthroscopy is right up there on the list . . .

BBD

http://www.associatedcontent.com/article/301359/unnecessary_surgery_the_four_most_common.html

http://books.google.com/books?id=AuQqaUmLhLEC&pg=RA1-PA56&lpg=RA1-PA56&dq=unnecessary+knee+operations&source=web&ots=0fuk5QCBYk&sig=cqzdeH5_ktbW0rmeFa6Y0HKz4aM#PRA1-PA54,M1

http://www.hachettebookgroupusa.com/books/9/0446678198/index.html

[Kane]

Why not go see a good A.R.T. pt or chiro. Most of the pain in the knee comes from muscle imbalances, pronating foot, superficial fascia irritation etc.

Do a trial of conservative care for a couple of months. Deep tissue work, stretch the quad, calf and hamstring, skin rolling, strengthen the quad etc, etc.

Many is the time that a few visits turned the course of the knee problem around, once these external factors were taken care of. Essentially the knee is a hinge joint that is affected by the stresses place across the hinge.

Clinical trials on arthroscopy show that several years later there is no difference between the ones that got snipped and the ones that didn't. 2002, J. Bruce Moseley, New England Journal of Medicine. Bucket handle tears with lots of swelling show the greatest improvement after the snip.

Good Luck.

Kane

[rdparadise]

Guys:

Thanks for all of the feedback guys. I did look at the recommended links and appreciate the advice.

I've taken the conservative approach since last June in an effort for forego surgery. What I've experienced is a reoccurence of the swelling and discomfort every 6-8 weeks. I've been doing bikram yoga now once a week for the past 8 weeks expecting this to help and it has, however, it has not eliminated the swelling or pain.

I actually think this last period of swelling was due to an aggravation that occured while doing the yoga at the beginnning of January. I am still doing the yoga and will continue post operation once my knee strength has improved.

The last time I saw the doctor after this latest cortisone shot, he wanted to watch it for a few more weeks. I didn't because, I've been through "watching it." I want some relief that won't impact my cycling season.

I'll let you know how it turns out.

Bob

[BumbleBeeDave]

Good luck! I hope that whatever course you pick, it works out well and you're ready when the spring is ready!

BBD

[JohnS]

I take it this is rheumatoid arthritis. I have osteoarthritis in my shoulders and I've never had any swelling. I've also never had cortisone.

[rdparadise]

Guys:

Well, I had my knee surgically repaired last Wednesday. The ortho found and fixed a small miniscus tear and a lot of crap in there that was causing the swelling. I was putting weight on it immediately following the surgery and as of today I am walking with only a slight limp.

I'm going back to the ortho today to remove the ace bandage and dressing, look at the pictures and determine a path for rehabilitation. I'm hoping to be back on the bike within a week. Riding carefully and rebuilding the strength. :banana:

Thanks again for all of your feedback. The knee already feels 100% better than pre-surgery.

Regards,

Bob

[Volant]

That's great news!! I hope your recovery continues to go well.

[Ahneida Ride]

Take it easy !!!! Things take time to heal...

My Best ....