New also. Partial Knee Replacement in March

reneee · #1 February 6th, 2010, 07:22 PM

I am 49 years old, female. I had Arthroscopic surgery on Aug. 19, 2009 for Degenerative Medial Meniscus Tear on my left knee. After the surgery my Dr. said that he fixed the tear, but I had a lot of arthritis in my knee, and I was still going to have the pain from that. Xrays showed it was bone on bone.

After prescribing Naproxen for the inflammation, and Glucosamine for 2 months, he never mentioned my having PT after the surgery. I was in a lot of pain after the surgery, it seems that it has just gotten worse since. Late October he gave me a cortisone shot, that worked great for 2 days. There was still pain, but not as bad for 2 days. After that the pain seemed so much worse.

Went back to the dr. in late November, he suggested that I get the Synvisc-One shot. So we got my insurance approval for the shot and I got the Synvisc-One shot December 29th. Dr. said it takes about 1 month for it to start working.

It seems there is never a minute of the day that I am pain free. It hurts to walk, going up and/or down steps. Doing regular chores around the house is becoming harder and harder. I went on January 26th for my check up, Dr. did another xray, they still showed bone on bone and the showed the Synvisc shot hasn't worked at all. He said the only option now is Knee Replacement, the pain wasn't going to get better.

I have tried not to ask for pain medicine, but I finally had to break down and ask for a prescription for pain medicine, he prescribed me 325 mg Percocet to take 1 every 6 -8 hrs as needed. I usually take one midday and one at night before I go to bed. They do help me to get things done around the house that needs to be done, and helps me sleep a little better.

He wants to do the Knee Replacement in March, I am still debating on having. He said if I did not get it, the pain wasn't going to go away, and eventually my leg will start bowing out. It seems that it has all went so fast about doing the Partial replacement. I have talked to others and read about others taking much longer to have the partial replacement.

Does this seem soon on his part to want to do Knee replacement? He said that was my last option to help with the pain since we have tried everything else. I know the pain is so painful, and I don't want to keep going like this. I have 2 little granddaughters one that is 4 years and one is 16 months. I feel like I am being robbed of playing and with them. It is so depressing, I am 49 years old will be 50 in March. I shouldn't feel so old. My body feels 80.

I also have arthritis in my left wrist (I am left handed) I had to quit my job that required me to be on my feet all day, and using my hands. I try to do things around the house to stay busy, but have gained 15 lbs since not working. I am not a big person, but 15 lbs that you are not used to having is a lot. I want things to get back to normal. If this will fix it, I am all for it. I was hurting a lot before my surgery last Aug., and I was expecting it to feel better after having it, but has just gotten worse since then.

God Bless
Renee

brs0660 · #2 February 6th, 2010, 08:48 PM

Renee...Welcome to BoneSmart this is an excellent place to get help and suggestions. Our moderators are Jo (from the UK) and Jamie (Kansas).

The decision to have a knee replacement is really one that only you and your doctor can make together. You have obviously tried the usual steps...PT, cortizone injections, and injections. LIkewise it seems obvious that you have gotten only limited relief from these. It is also obvious from what you wrote that your knee problems is greatly affecting your life and your pleasure.

These were the same issues that I faced as I continued to spiral downward...not being able to do the things I love, not being able to work well etc. I had my Left knee replaced in April of 2009 and I am having my right knee replaced on Tuesday (Feb9). I can tell you that the surgery is a snap, but the recovery is a challenge. The recover is slow and can sometimes be discouraging. I can also tell you that it is the best decision I have made for my well being. I am looking forward to Tuesday and knowing that once I have recovered I will be almost (I still swell sometimes and that makes my knee achy

) pain free for the first time in five years.

There are lots of posts here on BoneSmart that recount the successes and challenges of knee replacement. Good luck in making your decision.

**Josephine** · #3 February 7th, 2010, 10:08 AM

Hi Renee, and welcome to BoneSmart. You've been through a lot and I know you'll find encouragement and information on here. I'll make some comments on your post (which I split up into paragraphs, by the way, to make it easier for people to read).

Quote:

Dr. did another xray, they still showed bone on bone and the showed the Synvisc shot hasn't worked at all.

Did your doctor give you to understand that the Synvisc would repair the bone on bone? If he did, then he gravely mislead you. Once it's bone on bone, nothing makes it better. It's like having dental decay - once the tooth's got a hole in it, nothing but a filling with make it better. Same with a joint.

Quote:

I have tried not to ask for pain medicine, but I finally had to break down and ask for a prescription for pain medicine,

You shouldn't - ever - think of getting pain meds as a weakness. You have pain, you need medication in order to have a life. And take it as you are prescribed. You surely are going to have to when you have your knee done anyway.

Quote:

Does this seem soon on his part to want to do Knee replacement?

Not at all. The evidence is there on the xray. Your joint is gone and the only answer is a replacement.

However, I would seriously check out if a partial is really the way to go. Some surgeons who have a preference for partials seem to push for them without considering if they are really appropriate. Thing is that it's not all that common for the arthritis to be confined to just one side of the joint. I urge you to get a second opinion to check this out. You don't want to have a partial now and then find you've got to have it converted to a total in 3-5 years time.

Another thing that might be making you have reservations is your age - well, arthritis has no respect of age! It's no longer the bane of the elderly and we've had a lot of young people on here with arthritic knees, as young as 20 even. And if you have heard any cautionary tales about them not lasting very long, that's not true.

You really need to read around this forum - there's this pre-op forum and a recovery forum, but there's also lots of information in the Library - link up top.

However, the crucial threads for you to read right away are
How to choose a surgeon and a prosthesis
Different kinds of knee replacements surgeries and
implant longevity.
These will give you the basics about getting started on this journey.

After that, come back and ask any questions you have and we'll be pleased to address them.

cindy88fan · #4 February 7th, 2010, 11:53 AM

Renee....Jo is so right on everything she said. Age does not matter. Get a second opinion and go from there. Wishing you the best! Good luck!!!!! I was bone on bone with both knees and having BTKR was the best thing I could have done at the age of 45.

reneee · #5 February 7th, 2010, 02:09 PM

Thanks for all of your replies. I have been lurking a couple of days, before I was able to join. The server or something was down and I couldn't join. So I was thrilled yesterday when I was finally able to join. You all seem so caring.

My dr. never said when he gave me the synvisc that it would fix the bone on bone, he said that there was a chance that it would buy alittle time. I was willing to try anything.

The one question that I have asked him over and over that he hasn't given me a clear answer is: He has said that it is on the medial side. Before I had the surgery last summer, after, and still, the swelling has always been on the lateral side. The pain has always been on the medial side. I really don't understand why the swelling is there. Is this normal?

God Bless
Renee

**Josephine** · #6 February 7th, 2010, 02:34 PM

Well, the gap in the side of your joint is bigger on the lateral side so when there is fluid in the joint (which there almost always is) it bulges there because it can! That's all.

But just because the pain is always on the medial side doesn't necessarily mean the arthritis is only in that part as well. Often we can have arthritis, quite bad arthritis, in other areas as well but are only conscious of the pain in one place.

**Jamie** · #7 February 10th, 2010, 10:59 AM

Welcome to BoneSmart, Renee! I'm glad you found us....we can help you get through this...promise!!

Sometimes all of this can come on rather suddenly. It happened to me that way. I was going along just fine with the normal knee aches when I really overdid something. I went in during one of those times because I had a pain when I twisted my leg a certain way that just wouldn't go away. The MRI show a tear in the meniscus which was "repaired and cleaned up" with an arthroscopic surgery in late March. After surgery, I didn't heal quickly like most people. I had tremendous swelling and pain that was basically ignored by my surgeon. Weeks later when he finally WOULD discuss it with me and ordered another MRI, my knee cartilage was GONE! I was in shock and denial for the rest of the summer and by fall I was walking very painfully with a cane. I forced myself to go to activities, but it was horrible.

My pivitol moment came in September when (still in denial at needing a knee replacement at my tender age of 59) hubby and I went to an art festival in a local park. They had shuttle busses we rode from the parking area. I took my cane so I could walk all around. I made it a couple of hours, but then hurt pretty bad. As we were boarding the bus, EVERYBODY stood back and motioned for me, the poor old cripple, to board first. That was IT!!! I knew I had to do something to get my life back.

I researched and got a NEW and BETTER surgeon. We tried Supartz shots to get me through the holidays. I didn't want to be recovering during Christmas. And by March of the next year, I was on my way to recovery. In fact, once I had the knee replaced, I realized how bad it had been all along....it just didn't register pain for some reason. When I stood on my new knee joint the day following surgery, it was so strong and stable....I was amazed and knew instantly I had made the right decision.

I have never, ever looked back!

Unfortunately, I didn't find BoneSmart until just AFTER my TKR. I wish I had known about Jo and all the folks here from the beginning.

CG'sknees · #8 February 10th, 2010, 07:50 PM

Hi Renee, and welcome to the group!

Your story sounds a bit like mine. I had what was described to me as "mild" arthritis for years, damaged my right knee while foolishly climbing up 380 steps up the side of a hill in San Francisco in Oct 2007, ended up in ER where the doctor who looked at my x-rays said I had the knees of a 96 year old!. I was referred to an OS by my PCP, and had arthroscopic surgey in Nov 2007. The OS was very adamant that I was too young for knee replacement, and assured me that I would get better. HA!!! What a jerk he was.

I found out AFTER the surgery that this OS didn't even do replacements, so of course he was discouraging of them. He also suggested synvisc, cortisone, PT, etc. I was miserable for months...and let my PCP have it one day about how let down I felt. She felt so bad that she was now going to refer me to the "gold standard" OS in Los Angeles for a consultation. OS2 took one look at my x-rays and said I was absolutely ready for replacement. He showed me the bone on bone, the spurs (one off the top of my kneecap looked like a unicorn horn!), and said that for OS1 to have done what he did to my knee was "criminal". I had found my knee savior!!

I had RTKA in November 2008, had fabulous results, and went back for LTKA just last month (1/8/2010). Things are getting better each day, although it's true that the recovery is something you have to be patient about.

I urge you to get a second opinion, and to do some research about the best surgeon in your area. Really the OS you pick is the most important decision you will make, in my opinion. And once you get past the recovery period and get to the point where your knees are not the ONLY thing on your mind, you will be so grateful that you made this decision.

Having two grandchildren of my own, I know how it is to feel that you can't be more involved with their activities. Why wait any longer for that day???

All the best to you.

reneee · #9 February 10th, 2010, 09:01 PM

Thanks for the welcome. I have thought about getting a 2nd opinion, but unfortunately where we live there are only 2 ortho. drs. I know that stinks. We live in very rural Georgia. While I could probaly go to another town, I don't know how our already suck health insurance would work. We have never actually ever used our insurance, but this past year we found out just how much it did stink. It used to be pretty good, (but we never had to use it then) With the economy the way it is, my husbands employer in the last couple years, had our insurance coverage change. We actually did not know how our insurance was until last year, when I had my surgery for the torn Meniscus, my husband last year had alot of medical bills also, and now he is on the CPAP for his sleep disorder. We are now at $1,000 ded. per person pays 70%, and get this, with the cost of healthcare we only have $35,000 coverage for each of us. Since July - Dec. I had been to my Ortho. Dr like 10 times. My GP is the one I first went to, and he ordered the 1st xrays & the MRI. The last I think 4 visits of 2009, I had exceeded dr. visits for insurance to pay. Since the surgery he has done xrays on 3 different occasions, the cortizone shot. The visits ranges from $120 - $200. Then the last of Dec. I had the Synvisc-One shot, I haven't seen the bill on that yet, but from what they told me with the visit and the shot it would be around $1000.

So how would I go about getting a 2nd opinion?

Would another dr. have to do all the xrays/MRI again? Sorry to sound so dense, but we have always been I guess somewhat healthy and never had a reason to go to the dr. I mean at different times in the last fews years, just minor. Another thing, if for some reason, another dr. said I actually need a total knee replacement, I have heard they are around $30,000, I have no idea. I also have Arthritis in my left wrist, he said he would shoot it with cortizone when he does my knee surgery. For the past 26 years I have had carpal tunnel, for years I have hurt with it. But last year when my knee started giving me fits, my wrist decided to try to out do the pain. I know this was stupid of me for not getting something done earlier with the carpal tunnel. We have 4 children, now they are grown, but with raising 4 kids, then, the kids was 1st as far as their needs. Putting 3 in college. Well, need I say more, they broke me. I am still paying college loans. I had to quit my job after I had my knee surgery last summer, I have always worked in retail, I had a butt of a boss. Sorry about rambling on, I just don't know what steps I need to do. I guess I needed to vent.

God Bless
Renee

**Josephine** · #10 February 11th, 2010, 02:26 AM

No worries, Renee. That's exactly what we're here for. Your situation regarding insurance sounds awful! And being a Brit, not a lot I can say.

I don't see why another doctor should need to do scans and xrays again provided you can get hold of the originals and take them with you.

You can look for some knee surgeons using the search feature here. Then, when you have compiled a list of possibilities, phone them and make sure the surgeon does specialise in knee surgery and make an appointment.

But, as Jamie said, do make sure he is not connected with your original surgeon else he will probably not give you a totally unbiased opinion.

**Jamie** · #11 February 11th, 2010, 09:36 AM

Renee, so sorry about your limited insurance. But at least you have SOME benefits. If you don't have a written copy of the benefits, call the company and request that they send you one. You'll be in a better position to know what is ahead in terms of cash out of pocket if you have that and can go over it.

Then go to your current surgeon (and possibly the facility that did any xrays and MRIs if it is separate from your doctor) and request copies of all the films and written reports. You may have to pay a nominal charge for them to make copies, but you can get them. You will need to take these to any new doctor you decide to see. You do NOT have to start all over from square one.

The cost of a partial or full knee replacement can vary quite a bit, but I'm thinking my TKR was around $30,000 counting everything. BUT......insurance and hospital billing in the USA is a complex process. What the surgery and other associated expenses "costs" is usually NOT what it seems. Insurance companies negotiate lower costs with the hospitals and doctors. Amounts are written off. So what is finally paid may be much lower than what is stated as the "cost" of surgery.

I would imagine that a PKR might be very close to the cost of a full TKR....so I doubt if you would save anything by trying to go that route first. If you had to later go back and get a full TKR, you would be dealing with the costs all over again. While I'm not saying you definitely should get a TKR, I am saying that, given your insurance situation, it may be something you want to consider when making your decision.

Even if you have to travel to a larger city to see a different doctor, I would recommend you do it. You need this additional information plus it frankly doesn't sound like the doctor you're seeing is a knee specialist (meaning he does only knees and performs hundreds of knee replacements each year). You want someone operating who has this type of experience and skill.

For any of the procedures that you require in a given year, you do have the option of paying for them yourselves. While that may sound scary and expensive, it is normally possible to negotiate the costs down with your care provider. So that also may be something to consider when weighing your options.

You mentioned a benefit limit of $35,000 per person with your insurance.....is that a lifetime benefit or annual benefit? If it is annual, it will usually reset in January of each year so sometimes you can time your procedures to take maximum advantage of the insurance cycles.

Also, it is important to know if you have the type of policy that requires you to go to specific doctors in a network (HMO) or if you can see any physician you choose (PPO). The documents you receive from the insurance company will tell you that. Even with a PPO policy, the insurance company will have doctors who are "in network" and therefore less expensive than doctors who are "out of network." This is also something to consider when choosing who to see for that second opinion.

I know this sounds like a lot of things to deal with.....especially when you are hurting. But take it one step at a time and you can get through it. This upcoming surgery is VERY important to your wellbeing for the rest of your life and you want to get it right.

Please post again with any questions or concerns. There are plenty of people here who can help you through the whole process.

reneee · #12 February 11th, 2010, 11:55 AM

Hi Josephine & Jamie for commenting again and your advice. I do feel like I am being pulled this way and that way. While my ortho. Dr says I need the partial knee and planning on next month. Its like I see some relief finally, then I think if he is wrong and I needed the Total, I am right back where I am now or worse. Its affecting me mentally

.
My insurance has a $35,000 per year limit per person - just a couple of years ago, it was much better, but my husband's employer (privately owned business ) and our insurance is a "Employer owned insurance" due to the economy dropped our better coverage for this. Still, I am thankful, at least it is better than nothing. And yes, we do have to stay in our network. If we had our choice, I would go to Alabama, 6 hrs. from here, where my sister n law works for a Orthopeodic Group. And not sure if the other Ortho Dr. here is affiliated with the one I am seeing. They are not in the same office. I do know however, a friend of mine was in a car accident in Dec. and banged up her leg, and needed surgery, My dr. is the one she had seen & she and her husband did not like him, so they had the other Ortho. dr in the this town for a 2nd opinion, and he said he did not totally agree with him, but he could not take her, as she was the other dr's (My dr) patient. I hope I didn't bore you.

Thanks and God Bless
Renee

**Jamie** · #13 February 11th, 2010, 12:16 PM

Renee, never a bore!!! The situation you described is what happens when doctors know each other and have some of that "good old boy network" thing going. From what you describe, you really DO need that second (VERY independent) opinion. Take the plunge and see someone in your sister-in-law's practice. If you give me the name of the practice in Alabama, I'll take a look and see if I can tell which doctor might be the best for you to consult with.

I'm glad to hear that your $35,000 benefit is annual and that you have complete choice of doctors. This is good and it means you have a policy you can work with to get your knee repaired.

Caroline109 · #14 February 19th, 2010, 01:31 PM

Renee, I had Supartz injections (like Synvisc) as a last ditch effort to avoid having a PKR. DIdn't do a thing except cost money and 5 FRiday afternoons in a row!

My PKR hospital bill was $32,500 (which included the implant). It didn't include the surgeon or the anesthesiologist charges. Lucky for me, having had a similar surgery as you did earlier in the year, I had nearly reached my deductible, all but $44, so I didn't pay anything after that last $44. Nothing for PT either, thankfully, which was probably at least $200 a session (I know the price went up while I was in the middle of it because PT changed management who upped the price). I live in an expensive part of the US, FAirfield County, CT (although I don't live in one of the very rich towns), 60 miles from NYC. Prices elsewhere are probably less. And, my husband is actually an employee of our health insurance company (he's a techie) so we have very good insurance.

Similar Threads
Thread	Thread Starter	Community Topics:	Replies	Date
Weight and Partial Knee Replacement	Joni	Knee Replacement Pre-Op Area	53	February 19th, 2010 04:49 PM
Two knee scopes now knee replacement soon	ropesandspurs	Knee Replacement Pre-Op Area	1	November 20th, 2008 03:20 PM
Uni Knee Surgery - Advice please	dacw	Knee Replacement Pre-Op Area	6	November 15th, 2008 07:24 AM
Partial Knee Replacement Options	tngrub	Knee Replacement Pre-Op Area	14	May 30th, 2008 12:15 PM
Partial Knee replacement versus total?	rhino	Knee Replacement Pre-Op Area	3	October 20th, 2007 05:27 AM

The Following User Says Thank You to Josephine For This Useful Post:
reneee (February 11th, 2010)

Is BoneSmart® Helpful To You?