Quoted from reynolds531:
I have given the anesthesia for many, many total knee arthroplasties. The age spectrum goes from forty to ninety. The younger patients tend to be individuals with prior knee injuries and subsequent surgeris that have led to severe osteoarthritis. The key question to ask yourself is are you at the point were the pain is totally impeding your lifestyle? If you are unable to perform your ADAs (activities of daily living) it may be time to consider a TKA.
Your surgeons telling you to wait as long as you can are giving you good information. They do have a finite lifespan and a TKA revision is not an easy procedure that has a whole list of problems.
Consider the "easy" stuff: lose as much weight as you can (it is amazing how this can work), get yourself on a bicycle (stationary or moving) and build up those quads as much as you can, maximize your medical therapy (non-steroidals, tylenol, the occasional narcotic if it helps). I mention cycling as it provides an excellent exercise that does not involve knee weight bearing.
At some point you will know when it is time for the surgery. Yes, it is not risk free and no doubt you are aware of the complications. That said, it is one of the most rewarding orthopedic procedures for patient satisfaction. These days it should not be hard to find an excellent lower extremity/total joint orthopod. It is it's own sub-specialty.
Expect a year of your life will be given over to rehab. Rehab (early, continuous and often) is the best determinant of success.
If you do decide for the operation make sure that they perform a spinal anesthetic. It lowers blood loss, decreases the incidence of a blood clot and often leads to less post-operative pain. I would also suggest that you look into an aggressive multimodal pain therapy approach. Your surgeon may or may not be a fan of peripheral nerve blocks. In the right hands they will certainly diminish the very acute postop pain. Knees and shoulders are the worst for pain.
Good luck and keep us posted.
Thank you VERY much for this information brother!
Yes, I’m bone on bone. Yes, I’ve had 3 prior surgeries to repair all my torn ligaments, meniscus and shattered tibia (12 huge screws) The second surgery was a “clean-up” and the third was to remove the screws that held my tibia together.
Fast-forward 16 years and here we are. I saw MANY doctors (X-rays, MRI’s) during those 16 years to see if anything could be done to get better range of motion and they all said no way. But neither of them gave me or suggested a gel shot or anything to help “prolong”, if you will, the life of my knee.
Now I wonder: Had I gotten some gel shots, or perhaps some PRP done during those 16 years would I be better off today? Perhaps with a less aggressive OA? Just to think that I could have had some of these treatments makes me really angry at those Doctors.
I’m no stranger to aggressive therapy. I did 1 year of therapy non-stop during those 3 surgeries. Was out of work for a whole year too!
I just started to eat a bit less in an effort to lose 20 pounds or so. I’m not fat at 6’ 3” and 220 but losing some weight would help a lot no doubt. I work out on a regular basis and use the stationary bike and do leg raises and squats on the machine. This makes me feel a lot better.
I’m currently able to walk with some moderate pain. I use a brace that helps a lot. It supports my knee tremendously! One real issue I have is when I sit and bend my knee past a certain point. It lock into positions and the only way for me to get up is to first “unlock it” by using my other leg to push it and get it straight. Once I do that I’m OK if I limit my walking to some degree.
Thanks so much for the spinal anesthetic pointer. I’ll ask the Doc about that. Thanks!