Tuesday, May 14, 2013

Why I'm Not Getting a Knee Replacement-For Now

Forewarned everyone, this is a long missive, but I felt it needed to be a single post. Also, it would seem it is time to play with my blog lay out again. Bear with me and feel free to share your thoughts!

As most of the readers of this blog know, I have had arthritis in my knees for years. Right before Christmas of 2005, I fell from a height on a stairway onto German cobblestones. The damage to my knee was extensive although it was not broken. At that time I had an MRI and the same physician who assured me the knee was not broken added "but of course you know you have no more cartilage in your left knee."  Until then, I knew I had arthritis but not at what level.

The possible causes of my arthritis are numerous.  In another life, when I served in the active military, I ran in combat boots on cement. Every day, as part of my physical training.   I have a history of arthritis and bursitis in my family. Finally, of course, I was over my optimum weight for some time.

Today my new primary physician gave me referrals to an orthopedist and I will be making an appointment. I was fortunate to have a really good ortho in Dallas, who was open minded and discussed all the alternatives. He was not "cut happy" and encouraged me to do my own research (which I did) and come to my own conclusions. During this time I read quite a few books, looked at online research and discussed the situation with my doctor. The end result is that I decided not to have surgery. Instead I have used a combination of therapies to lower my pain and increase my mobility. First though, its only fair to look at why I decided not to go "under the knife"

According to my research, many patients still experience pain and discomfort after the procedure. My purpose would be to eliminate discomfort. If that's not going the end result, then I need to reconsider. A study in 2010 said that only 48 percent of patients were pain free after surgery. I do understand advances are being made yearly. 52 percent of those patients assumed after surgery that they could have unlimited activity but only about 20 percent actually did.  Another study done at the same time shows that after five years only 63 % were experiencing less pain after surgery.  This same study shows that sports and recreation abilities function was only twenty five percent better. My purpose in having surgery would first be to eliminate pain in the long run, and second to improve daily activities. At this point the statistics are not firm enough for me to take that step. Note: this is not a term paper, but for those interested, I will email the name of the studies if asked

To add to the above, surgery and hospitalization have, of course, their own risk. Not being an alarmist, just looking at the facts. General anesthesia increases complication risk. Hospitalization increases your risk of infection exponentially.  While these are not major contributors to my decision, they affect my choice outcome.

I am still not at an optimum weight, although I have lost a great deal.  I am still losing weight but will probably never be as I was at thirty. This is fine for me. I am a voluptuous woman who can increase her health level without being thin.  While further weight might lower my risk and made the surgery more optimum, my weight is about third or fourth in my decision hierarchy.

 I don't only have arthritis in my knees. I have osteoarthritis in my shoulders already due to family history/. I need to look at therapies that will take care of my aches wherever they are, not just in my knees.

 Last but surely not least, the above mentioned fall causes me external pain, and would not be erased by surgery. My external knee is so damaged and sensitive that I only wear knits or silky pants on the bottom-rarely even a well washed jean.

Now, to lower my pain and increase my mobility, I have looked at many alternatives. Some I ruled out, some I kept. I'll say here that some of my therapy includes foods and supplements-along with medical alternatives:


  • In have synvisc injections into my knees at regular intervals. Officially, the jury is out on this one, with many saying that this liquid makes no difference at all. I have noticed a huge difference in my pain level. I suppose this could be all in my mind, but it's doubtful. My experience with these injections is that after a few weeks my mobility increases dramatically. It is supposed to help with inflammation and encourage the body to provide it's own joint lubricant (layman's terms here).  My experience is that they do have to be repeated every so often.
  • I take a glucosamine/condroitin supplement for inflammation. While I am unsure whether it helps rebuild anything, I know in terms of pain when I have not been taking the supplement.
  • After much research, I have added to my diet many "anti inflammatory foods" in food portion or pill portion. I use these on a regular basis, trying to eat the foods multiple times a week even if I have to shop off season. These include green tea (in pill form as I am not big on tea), wild caught salmon (every week to ten days), blueberries, broccoli, and virgin olive oil. Sweet potatoes are also anti inflammatory but I dislike them-I do however eat pumpkin all the time as I believe it is it's own food group. I have been much less adept at limiting inflammatory foods from my diet. I know full well that milk is an inflammatory and yet I have a glass of skim at bedtimes most night. While I have lost weight and am on a diet, white sugar is still a part of my life.  I am for eating meat not fed with corn, but organic is not always available or affordable.
  • I walk as little as possible. Relax, this doesn't mean a scooter or even a wheel chair. It does mean that I walk when I am going somewhere, or when I am traveling and sightseeing. I do not do weight bearing exercise, ever, no matter what. I occasionally use a recumbent bike, I have a forty five minute seated aerobic video, and I do water aerobics. You do need to use it rather than loose it, but not abuse it at the same time. I try to do a regular series of knee motions in bed, as well as knee massage.  Briefly, bent knee walking increases pain and can injure the knee further. My exercises (not aerobic and relaxing) increase my range of motion, as well as straighten the knee. I also do these AFTER water aerobics in the warm pool at my rec center.
  • I baby myself when I walk. What does this mean? I walk slowly enough that I am walking knee/toe rather than flat footed to avoid the pain. Walking otherwise increases the likelihood of thigh pain and heel spurs. I have a brace if I really need it and avoid climbing stairs when possible. I will s take the long path around if there is no ramp. Finally, I wear really, really good shoes (Clark's mostly) that are extremely stylish and yet have really good support. 
  • At this point,  I have never taken a prescription for arthritis, even with bone on bone issues. I take aspirin, use a heating pad or cold pad as needed, and sleep with a tiny pillow under my knee as necessary.
Lest all this sound like my life is hindered in some way, let me be clear. I am not a high energy hiker or biker. If I were, I might, might mind you, make a another decision. Nevertheless I have a normal life. This includes traveling and walking around Santa Fe, Boston and other towns. It includes swimming regularly, volunteering, going out, and doing almost anything other retirees do that is not high energy athletics. I don't spend  time catering to my arthritis, I do sensible things that are part of a daily or weekly routine, most of which are healthy anyway.

Everyone has to make their own choices when it comes to physical well being. In this particular  case, I've chosen less radical alternatives to a chronic condition.  This works for me, it may not work for you.  What has your experience been, be it lupus or arthritis or any other condition?  Feel free to share.

Finally (and off topic) two of my fellow bloggers have new retirement books available on Amazon. I've begun reading and hope to share my opinion soon. I have wonderful expectations!

17 comments:

  1. I feel for your situation. My best friend has osteoarthrithis, has had both knees and hips replaced and she just turned 60. Like you she resisted the surgeries, but finally relented. I think she is pleased that she had them done. I know she is thrilled she can wear normal shoes for the first time in probably 10 years. With that said, it wasn't an easy decision or process on any of them. Each of us has to weigh our options, make the best decision at the time, knowing we can change our minds. Good luck

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  2. Thanks, Cathy. Fortunately I can wear normal shoes, and fashionable ones....they just need good support and I will never wear heels again, lol.

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  3. This must be a difficult decision to make and you clearly have researched your options. I wish you well on your weight loss journey as I can only imagine that will help reduce the stress and pain on your knee. That being said, the two women I know who finally had knee replacement really wish they had done it sooner. One had to lose weight before the surgery was approved but she did that by swimming laps along with dieting.

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  4. WAs any of your knee pain documented while you were active duty? Any?
    You might want to go to the VA and have it evaluated.
    I know you have pretty good health insurances- but it would not be bad to have a back up for prescriptions....

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    1. Oh no, this was not documented until well after my six month of army service. And of course since then the army has recognized the damage and pt is now done in pt outfits, with tennis shoes for the most part. there are still forced marches, but not as a regular physical exercise day by day for most folks.

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  5. I think you are one smart lady! As a (retired) Nurse I have seen the good the bad and the ugly, and your decision making process is a great example of what people should do before agreeing to major surgeries and procedures!! Kudos to yoU!!Especially during this week when crazy celebrities are having their breasts removed and being held up as role models for the rest of us. NOT!!!! don't get me started on my opinion of THAT debacle!!!!!

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  6. Thanks Madeline. My decisions are a work in progress as always.

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  7. Barb I'm a VAsocoal worker, if you received treatment for pain in your knees at any time during your active duty you may want to look into applying for service connected status

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  8. Hi Terry.....no the difficulties started some time after my discharge .

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  9. I fought having my first knee replacement for a number of years and finally caved in 2008. I would have so much pain lying in bed at night that I'd be in tears. The replacement is not perfect and nothing like the knee I had as a young woman but still it is much, much better than the pain I had before. At some point here I need to decide whether I will do the other one or not but most likely I will.

    My husband is 9 days out from his knee replacement and unusual in that he is feeling little pain and getting around quite well within the house and back garden with just a cane.

    Good luck to you, Barb.

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  10. It seems as though a knee replacement operation (or two) is SOP for many of us. Like you I know of friends who had it done and are in no better shape than before. Of course, the opposite outcome is also true.

    I appreciate you laying out both your thought process and your approach to some level of healing on your own. If I am ever in that situation I hope I am as thorough as you in looking at all my choices. I am a bit of a baby with pain and extensive PT.

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    1. Yes, there is surely anecdotal evidence on either side. I fully admit i have a real low tolerance for pain..

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  11. Barb, I have reading your blog for some time and have never commented, but I want to tell you about the great stretching DVD that my dau and I use. We have been doing these stretches for several yrs and they really help. I am not a small woman and even I can do them. They even help after we have worked in the yard and have sore muscles. They help the pain go away sooner. It might help you with your pain. I have osteoporosis in my back and these help that. Plus I have a Problem knee, too. Here it is--http://www.amazon.com/gp/product/B002ZEZ7L6/ref=s9_simh_se_p74_d0_i1?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=auto-no-results-center-1&pf_rd_r=BFE0B42C773444728B1F&pf_rd_t=301&pf_rd_p=1263465782&pf_rd_i=jacque%20and%20dorthee%20gualtier

    Hope it helps! Ann M

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    1. I will certainly check this out, thanks SD o much!Welcome and thanks for commenting.

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  12. Good for you making well informed decisions. More people should follow your example.

    God bless.

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  13. Hi,

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  14. There are several medical conditions that may lead to the need of knee replacement surgery, and arthritis is the most common among them. Genetics, developmental abnormalities, some form of injury and obesity are the other contributing factors.I find this website for Knee Pain Shoes.

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