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to TKR or not to TKR

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Hi Sharon,

First of all, cortisone causes insulin resistence, and if you already have that

(type II dibetes or elevated blood sugar) then shots are not a good answer for

you. If you are already controlling your blood sugar with insulin or other meds

you will have to take more for the period of time the cortisone shot is active -

possibly up to 30 days.

It sounds like you may have what I had - the cartilage between my big leg bones

was " OK " , or it looked like there was some there on the Xray, but there was no

cartilage on the underside of my kneecap or on the head of the femur where the

kneecap has a groove it is supposed to glide on top of. My knees are misaligned

a bit, so the kneecap was never in the groove, and maybe due to that and 20

years of stairmaster and skiing, I ended up with severe arthritis and no

cartilage in the anterior compartment of my knees - which was discovered when I

had arthroscopic surgery on one knee a few years ago.

The pain and disability got much worse over the last 2 years, possibly due to 5

autoimmune diseases I have (and I am on prednisone) and I went to see a surgeon

who does only knees, Dr. Coon. At first he said " clearly you do not need TKR,

there is some cartilage between your leg bones. But you have no cartilage under

your kneecap, so the surgery I would recommend is " patello-femoral

arthroplasty " .

But then he took a look at my medical situation and decided TKR might be best

since it looked like the destruction was happening pretty fast and he didn't

want to do the patello-femoral arthroplasty and THEN have to do a TKR in a few

years. I researched it and then I got some more opinions and they said " do the

TKR and get it over with " . I went back to the surgeon and asked him about

patello-femoral arthroplasty. He admitted he only did about 6 of them a year

and that half of them failed and had to have TKR anyway. He said he mostly did

it for younger people who didn't want TKR and thought they were going to have an

easier time just fixing the kneecap. But he said the recovery is pretty much

the same.

I don't know how this compares with the surgery you are contemplating, but it is

very important to find out how many have been done, how many failed, and how

many had to have revisions or TKR. You have this data for one doc, but I would

get it for all the docs performing this resurfacing to get an idea how long it

has been done and what the overall stats for it are.

As for " getting better health " before doing surgery, that is important, but in

truth, can you really get better health when you can't walk without pain? That

was my dillemma. I had TKR on Oct 8 and am very glad I got it over with. Even

though the new knee works better than my old knee, I still have some pain from

the surgery, but I think at 6 months that will be over. In a year, I will have

TKR on the other knee.

These are very hard decisions and no two people are alike - but mobility is

primary to good health.

--

Callahan Goodman

Quidquid latine dictum sit altum videtur

Sharon wrote:

as you know I was going to have surgery after the first of the year to get knee

replacements. Well I went to a dr on Friday for a second opinion to try and get

something else not as drastic there is a video on the link to watch if you want

to.

http://www.conformis.com/Patients/ConforMIS-Patient-Specific-Implants/iTotal-Tri\

compartmental-Knee-Resurfacing-Device

they took x-rays and said it will take the mri to make sure because I my knee

cap is in bad shape it has a spur growing out of it but he has done 30 of these

surgery and had to redo 7 to total knee replacement.

He is concerned about my health and doing a replacement right now. So I will

have the mri just to make sure if I can't or can't do the easy one (conformis).

So before I knew what was going on he shot both my knees up and said it would

give me almost immediate relief. Well it did my knees are just sore from the

shot. I said how often can i have those he said as I need them but because of

the blood sugar's I need to watch it and sure enough yesterday blood sugar was

210 but this morning they were back down to 129 which is still a little high.

Hubby likes this dr better and so do i so I think we are going to stick with him

and not do the worse right now. See how long these shots last he said it would

depend on what I do. I said well that's the point I want to be able to do

something not just sit. So it's going to be a wait and see again. I will call

and cancel the surgery for now. He just thinks I should get better health first

and that they make the knees better and better each year

so if I could wait a year or so if I can't have the conformis.

Sharon LeVine

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>

> As for " getting better health " before doing surgery, that is

important, but in truth, can you really get better health when you

can't walk without pain? That was my dillemma. I had TKR on Oct 8

and am very glad I got it over with. Even though the new knee works

better than my old knee, I still have some pain from the surgery, but

I think at 6 months that will be over. In a year, I will have TKR on

the other knee.

--------------------

One of the surgeons I talked with said that he did quite a few TKR

surgeries on overweight patients prior to their getting a gastric

bypass or similar weight loss surgery. He said this was at the request

of the other surgeons, who tell him that the gastric bypass success

rate depends on their patients being able to walk and exercise.

I know that in my case, about the only exercises I could do prior to

TKR were upper body, like kayaking. I was not able to get my legs

involved, and therefore most of my metabolism potential was not being

used. TKR changed that. I actually LIKE to walk now, where before,

about I could do was cringe at the thought of walking.

FWIW

Bill in Minneapolis

BTKR a little over a year ago.

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Hi Bill ,

    I had a knee replacement done seven years ago it works  find I just have

pain with my Hip replacement because of bad scar tissues and bursitis I had that

replace 8 years ago both on right side:-( Well I wish you and everyone in this

group a Merry Christmas :-)

                    Susie

From: Bill <wwblues2@...>

Subject: Re: to TKR or not to TKR

Joint Replacement

Date: Tuesday, December 23, 2008, 11:54 AM

>

> As for " getting better health " before doing surgery, that is

important, but in truth, can you really get better health when you

can't walk without pain? That was my dillemma. I had TKR on Oct 8

and am very glad I got it over with. Even though the new knee works

better than my old knee, I still have some pain from the surgery, but

I think at 6 months that will be over. In a year, I will have TKR on

the other knee.

------------ --------

One of the surgeons I talked with said that he did quite a few TKR

surgeries on overweight patients prior to their getting a gastric

bypass or similar weight loss surgery. He said this was at the request

of the other surgeons, who tell him that the gastric bypass success

rate depends on their patients being able to walk and exercise.

I know that in my case, about the only exercises I could do prior to

TKR were upper body, like kayaking. I was not able to get my legs

involved, and therefore most of my metabolism potential was not being

used. TKR changed that. I actually LIKE to walk now, where before,

about I could do was cringe at the thought of walking.

FWIW

Bill in Minneapolis

BTKR a little over a year ago.

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