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Tuesday, May 21, 2013
Why are they making me wait until I am older?
Hi, I am a 40 year old female that was injured in 2007 when a 1500 lb cow slammed a gate into me, injuring my right knee. After months of formal therapy, and a surgery that included debriment of the kneecap and lateral release. Which the dr`s comment was my underside of the kneecap was a mess with Grade 3 Chondromalacia. This surgery was unsuccessful at reliving my pain. We tried supplement injects with no success. My next option as explained by my dr. was to wait until the whole knee goes totally bad and have a knee replacement. I have followed their instructions by changing my lifestyle and activities. Why won`t they fix the knee now instead waiting until I am totally disabled. Before the accident, I played basketball 4 days a week, walked 3 miles a day, yoga twice a week, and I ride horses competitively. Now I bicycle 3x a week and ride. Help!
As you may know, knee replacements typically need to be replaced after 10-15 years, depending on activity level and body weight, among other factors. Replacing the replacement, or "revision arthroplasty", is a more technically demanding surgery with a less predictably favorable outcome compared to the initial knee replacement. All other "less aggressive" treatment options are typically tried before proceeding with a knee replacement, particularly at your age. If your surgeon has nothing else to recommend at this time, you may want to consider getting a second opinion, to be sure all non-surgical treatment options have been given an adequate trial, which would include, among others:
- oral (and topical) anti-inflammatory medications
- oral (and topical) pain-relieving medications
- knee injections using several different steroids or "viscosupplements" - since one may work better than another
- "anti-seizure" medications (which may raise your pain threshhold)
- "anti-depressant" medications (which may also raise your pain threshold)
- various different types of knee sleeve/brace design
- a TNS (transcutaneous electrical nerve stimulation) unit trial
- Glucosamine/Chondroitin, SAM-e, and a number of other "nutritional supplements"
- in addition to strengthening the bad side, if your attempts at doing this have been limited by pain, intensive strengthening exercises on your good side can "cross-over" to benefit your bad side.
If all nonsurgical treatments have been exhausted, and if your functional level continues to deteriorate, a knee replacement certainly can be performed at your age (they are sometimes performed in children with arthritis), but such high impact activities as playing basketball are usually advised against following a knee replacement, to prolong its longevity.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University