Thursday, December 12, 2013
I am a 30yr old lady with significant grade 3 chrondromalacia of the femoral sulcus in my right knee and have lost 50% of the cartledge. I`ve already had an arthroscopy with a debriment and wash out, which wasn`t successful. I`m currently awaiting tests on my left knee as I`m getting the same symptoms. I have a walking stick to use and countless medication to take, which doesn`t really help. To what degree would I need to be before I could have a knee replacement, as I keep getting told that I am too young.
Knee replacements can be performed at pediatric ages, so it's certainly technically possible for a knee replacement to be performed in a 30 year old. However, as you probably already know, a knee replacement will not last indefinitely... implant longevity is typically quoted to be around 15 years, depending on the patient's body weight and activity level, among other variables. Knee replacement is an irreversible treatment option which is usually delayed for as long as possible, unless function and symptoms are worsening despite a comprehensive trial of all available nonsurgical treatment interventions.
The better your right knee feels, the less you'll be favoring it and placing a disproportionately greater load on your left knee, and vice versa, so anything which ends up helping one knee may help the other, both directly and indirectly.
As you've experienced with your right knee, debridement and "washing out" procedures for knee arthritis don't necessarily improve symptoms/function, so if the tests you're currently undergoing for your left knee symptoms reveal degenerative changes in your left knee and left knee surgery is advised, consider getting a second opinion.
Also, if your current physician has nothing else to recommend and your levels of pain/function are not acceptable, getting a second opinion - from a nonsurgical physician musculoskeletal specialist - would be appropriate, to determine if all appropriate nonsurgical interventions have been given an adequate trial, including:
- trial use of various designs of knee bracing;
- physical therapy, including pain-relieving treatments and maximizing strength and flexibility not only of thigh muscles, but also "core" (including hip) and ankle muscles;
- a "cross-training" exercise program to maximize stamina/fitness without aggravating your knee symptoms in the process;
- knee injections (various different steroids and/or "viscosupplements" - with it not being uncommon for one "injectate" to work better than another);
- optimal doses of medications from more than one category (more than one medication from each medication category often needs to be tried), including oral nonsteroidal anti-inflammatories (NSAIDs), oral non-NSAID pain relievers, topical anti-inflammatory and non-antiinflammatory medications, "anti-depressants" and/or "anti-seizure" medications - either/both of which can act to "raise the pain threshold" to improve pain/sleep disturbance, and such "supplements" as Glucosamine;
- appropriate footwear, including appropriate arch support and cushioning;
- considering at least temporary use of two canes, or one or two crutches, until symptoms have sufficiently lessened to then wean yourself from such hand-held gait aids; and
- body weight reduction, if applicable.
I hope this information is helpful.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University