A little help please, I have a bad knee

[CuseFaninVT]

And lots of good advice here to put together your lust of questions.

OttoinGrotto - what do you think of this band name?

 

[NineOneSeven]

One of the most misleading things you can hear after an injury is that the x ray is negative, because it’s a false sense of security moment for the uninformed. Yeah you don’t have any fractures, but you completely tore your anterior talofibular ligament. Here’s a dumb brace to slide on that doesn’t do anything. It’s just a sprain you’ll be back soon. Just a little RICE.

*speaks from first hand experience, he wasn’t back soon*

 

[GooseMutt]

In my experience, orthopedic surgeons often leave out details. I don't know how many patients I've had that were surprised their knee initially hurt so much after their surgery because the surgeon just told them they'd fix them up and they'd be good as new. That's why if I have any patients that are looking at having one, I try to spell out what I typically see post op.

Mine was surprisingly good but I really did the rehab diligently

 

[CuseTroop]

Okay, I want to thank each and every person for their help with my knee. I can't tell you how thankful I am for it. It has now been 5 days since my gel injection. And my knee is starting to feel better. Not perfect, by any means. But I can walk for a bit without my knee buckling. And that ain't bad. Hopefully, it will continue to improve. What I hope is that I can get at least 6 months and give me time to get accustomed to the idea of a tkr. Cuseregular really seemed to hit my problem on the head. You know, if my orthro would have said this is going to hurt and your knee may buckle for a couple of weeks, instead of just saying this may take a couple of weeks to work. If it does work. I would have been better prepared for the last 5 days. Once again, thanks to one and all.

If ya make it over to my neck of the woods let me know. We’ll see if large amounts of vodka heals knee injuries

 

[CuseLegacy]

All right dash here’s another take on the issue. 30 years teaching orthopedics, treating knee injuries for same working with lots of ortho guys, etc, here are the things I’ve gleaned and learned professionally. Also well versed with said topic(s) from my own hs/college football injuries to both knees.

The basics. X-rays are almost useless except as a preliminary baseline. What other technology from 100 years ago are we still using! Can’t tell if you have had an MRI in the thread. If not GET ONE before you do anything major or surgical. It’s the only way to tell with any decent certainty what’s going on.

True that even it misses things but it’s currently the best non invasive technology we have. In back care (my sphere as you know) many times patients will have false negatives that the severity of say a disc herniation is only seen with open surgery. In the case of this specifically it’s often because they get their MRIs done first thing in the morning and not at the end of the day after days worth of activity worsening the disc condition.

Same can happen here with knees. But also same can happen in reverse. Meaning many studies have been done on asymptomatic pain free patients who have had MRIs done and over 50 to 60% of them have disc herniation’s and don’t even know about it.

Same for knees. Many many have arthritis and don’t even know about it until you hit the proverbial last straw to allow symptoms to begin, like with a toothache, it sounds like what you’ve experienced.

Point of mentioning it like that is that you’ve likely lived with a large degree of any arthritic damage you have present for a long long time and now there’s a very good chance you will can continue to live for a while after this before needing a TKR.

A large part of any pain syndrome, including knees, is the potentially short term inflammatory tissue reaction that occurs. It’s often why we’ll find a patient well into their arthritis by imaging with no previous symptoms of significance. Take care of this inflammation if it is indeed short term and you can alleviate a lot of issues.

Ice for acute pain like you’re in now, this is going to be a long-term deal either often on or chronically so invest in those soft malleable commercial ice packs with Dr. types and therapists are using our offices. So ice for pain warm moist heat for achy stiffness.

Something happened either micro trauma or macro trauma that caused the inflammatory response (kind of like your reaction to the shot, which should improve by the way dramatically very soon unless there is an infection present).

Or it could be that you’ve reached the beginning of the end of the knee truly needing a tkr. So that said when it’s time it’s time, and as we always say to patients you will know when it’s truly time.

But your instincts are good to try and put it off if you’re otherwise healthy. when that time comes you have to be good with giving up normal kneeling and any vigorous sport, for a life of golfing, walking and maybe some doubles tennis.

If the pain is intolerable the relief with surgery and all the rehab will have been worth it.

Some generalities: location location location. Sounds like medial compartment for you vs patello-femoral (knee cap) and that’s more of an indication for surgical intervention if truly advanced and painful long term.

But there has been too many times to count where patients have these problems simultaneously and the patella issues end up being the main driver of the pain symptoms. As noted somewhere here this is known as a "Chondromalacia Patella"

So find this out, get some pt if so to include ultrasound, heat, ART, joint mobilizations, use the various strap braces available, use the Voltaren advised, try a level 5 cbd lotion/cream and use otc nsaids as needed (but not long term - any nsaid - because while they can help with the short term pain they can and do actually make the condition of arthritis worse long-term, Believe it or not). This last paragraph of advice holds true for all orthopedic concerns.

Ok now if this is all done and still you’re hurting (sounds like you skipped right to this, but you can always go back), so then the next course of Rx post conservative therapies is the injections.

If one maybe two Cortizone shots do not work long-term than any further can cause further damage in many ways (especially seen upon surgeries), so then you get to where you are now with the various lubricant/hyluranic shots like synovisc and the other ones listed in this thread. Give these time, unlike a quick acting drug they take longer to reach peak efficacy.

Relatively new to the treatment paradigm is the PRP (platelet rich plasma) others have mentioned. If caught in the mild to moderate stage is the seems to have dramatically positive potential. I would certainly try it before submitting to a life-changing TKR.

Finally for you and everybody else do not underestimate the potential of the supplement route for prevention, protection and treatment of any osteoarthritis issue.

Toga listed one that I am not even aware of, but I think there can be no question anymore about the validity and usefulness of the various supplements out there to protect our knees hips and other joints.

For example myself, I am almost 60 had a lifelong history of high-level sport, Multiple knee hip ankle and shoulder injuries of various types, and I think the supplements I’m about to list have been tremendously helpful for me so far avoiding the fate of all of my friends, family, and patients who have had so many problems surgeries and ultimately replacements with their joints.

For 30 years now i’ve been taking fish oil, MSM, glucosamine sulfate, chondroitin sulfate, cytyl myrostoleate, hyaluronic acid all for their joint/cartilage protective and healing properties and turmeric/curcumin, quercetin, bosewellia, etc. for their natural anti-inflammatory properties. Wouldn't do the collegen listed elsewhere though, molecularly, it's too large a compound to effectively get in the areas needed to be effective.

Just recently sent myself for a whole bunch of x-rays because I thought I was starting to get some old man significant arthritis issues (turns out it was other softer tissue issues and not DJD - degenerative joint disease).

My dr pcp looks at me like some lab rat when he sees me as an overweight now older person but whose X-rays remain pretty clean, still off any meds and whose blood numbers shouldn’t be as good as they are.

As for somebody my age, with my sports and medical history, I should have a lot more arthritis than I do, which as it turns out is almost none. Similarly for the patients that have been on this stuff, same results. It’s never too late to start and get benefit from these things despite what others may tell you.

Good luck bud.

I still remember when my mother's doctor pooh poohed the benefits of Glucosamine and Chondroitin. Now it's a recommended supplement.
We take Flaxseed Oil instead of Fish Oil. Similar benefits.
I was happy to see Voltaren Gel become an OTC product. My mother was given samples of the gel back when it required a prescription. It works.

 

[texascpa]

the x-ray showed a gap and my Orthro drained my knee (there was a lot of fluid) and gave me a cortisone shot. The shot didn't work. Not for nothing, but he gave me the shot in the knee and it really seems that the pain is on the other side of the knee. Anyway, on Friday, I had a gel injection. he said that it might take two weeks until we know if it worked. Well, yesterday, my knee felt great. But today, it is worse yet, Anyone evr have the gel shot before? And I think if surgery is next (I sure hope not) I may ask for a different dr. Thoughts?

I had Orthovisc shots in my knees for about 10 years. They started out lasting about 2 years, each knee, but my left gradually got worse. I had to finally have my left knee replaced last November. After-surgery recovery didn't go great as I had an infection in my leg and couldn't get my knee to bend further than 80 degrees. Eventually, I had to get a "manipulation" done in December. Basically, go back in and have my knee forcefully bent. All is good now. My right knee is still doing well under the shots. Eventually, just as you will, I'll have to get that one replaced too. I'm 51, btw.

 

[TexanMark]

If it ever comes to this, total knee replacement worked very well for me. With almost 50 years of basketball on hardtop courts, tennis, skiing and baseball injuries, I was dragging my left leg and was in constant pain. After replacement (and 3 months of physical therapy), I walk normally and have had no pain since.

And a cool scar!

P.S. I love when Cuseregular talks the talk...so much learning for me.

 

[kcsu]

Your knee should enter the portal Dash. Pick NYU, Vandy, Any Ivy but Penn for sure, Stanford and your knee will thank you. Glad your on the mend!

 

[OttoinGrotto]

OttoinGrotto - what do you think of this band name?

I like it.

 

[OttoinGrotto]

All right dash here’s another take on the issue. 30 years teaching orthopedics, treating knee injuries for same working with lots of ortho guys, etc, here are the things I’ve gleaned and learned professionally. Also well versed with said topic(s) from my own hs/college football injuries to both knees.

The basics. X-rays are almost useless except as a preliminary baseline. What other technology from 100 years ago are we still using! Can’t tell if you have had an MRI in the thread. If not GET ONE before you do anything major or surgical. It’s the only way to tell with any decent certainty what’s going on.

True that even it misses things but it’s currently the best non invasive technology we have. In back care (my sphere as you know) many times patients will have false negatives that the severity of say a disc herniation is only seen with open surgery. In the case of this specifically it’s often because they get their MRIs done first thing in the morning and not at the end of the day after days worth of activity worsening the disc condition.

Same can happen here with knees. But also same can happen in reverse. Meaning many studies have been done on asymptomatic pain free patients who have had MRIs done and over 50 to 60% of them have disc herniation’s and don’t even know about it.

Same for knees. Many many have arthritis and don’t even know about it until you hit the proverbial last straw to allow symptoms to begin, like with a toothache, it sounds like what you’ve experienced.

Point of mentioning it like that is that you’ve likely lived with a large degree of any arthritic damage you have present for a long long time and now there’s a very good chance you will can continue to live for a while after this before needing a TKR.

A large part of any pain syndrome, including knees, is the potentially short term inflammatory tissue reaction that occurs. It’s often why we’ll find a patient well into their arthritis by imaging with no previous symptoms of significance. Take care of this inflammation if it is indeed short term and you can alleviate a lot of issues.

Ice for acute pain like you’re in now, this is going to be a long-term deal either often on or chronically so invest in those soft malleable commercial ice packs with Dr. types and therapists are using our offices. So ice for pain warm moist heat for achy stiffness.

Something happened either micro trauma or macro trauma that caused the inflammatory response (kind of like your reaction to the shot, which should improve by the way dramatically very soon unless there is an infection present).

Or it could be that you’ve reached the beginning of the end of the knee truly needing a tkr. So that said when it’s time it’s time, and as we always say to patients you will know when it’s truly time.

But your instincts are good to try and put it off if you’re otherwise healthy. when that time comes you have to be good with giving up normal kneeling and any vigorous sport, for a life of golfing, walking and maybe some doubles tennis.

If the pain is intolerable the relief with surgery and all the rehab will have been worth it.

Some generalities: location location location. Sounds like medial compartment for you vs patello-femoral (knee cap) and that’s more of an indication for surgical intervention if truly advanced and painful long term.

But there has been too many times to count where patients have these problems simultaneously and the patella issues end up being the main driver of the pain symptoms. As noted somewhere here this is known as a "Chondromalacia Patella"

So find this out, get some pt if so to include ultrasound, heat, ART, joint mobilizations, use the various strap braces available, use the Voltaren advised, try a level 5 cbd lotion/cream and use otc nsaids as needed (but not long term - any nsaid - because while they can help with the short term pain they can and do actually make the condition of arthritis worse long-term, Believe it or not). This last paragraph of advice holds true for all orthopedic concerns.

Ok now if this is all done and still you’re hurting (sounds like you skipped right to this, but you can always go back), so then the next course of Rx post conservative therapies is the injections.

If one maybe two Cortizone shots do not work long-term than any further can cause further damage in many ways (especially seen upon surgeries), so then you get to where you are now with the various lubricant/hyluranic shots like synovisc and the other ones listed in this thread. Give these time, unlike a quick acting drug they take longer to reach peak efficacy.

Relatively new to the treatment paradigm is the PRP (platelet rich plasma) others have mentioned. If caught in the mild to moderate stage is the seems to have dramatically positive potential. I would certainly try it before submitting to a life-changing TKR.

Finally for you and everybody else do not underestimate the potential of the supplement route for prevention, protection and treatment of any osteoarthritis issue.

Toga listed one that I am not even aware of, but I think there can be no question anymore about the validity and usefulness of the various supplements out there to protect our knees hips and other joints.

For example myself, I am almost 60 had a lifelong history of high-level sport, Multiple knee hip ankle and shoulder injuries of various types, and I think the supplements I’m about to list have been tremendously helpful for me so far avoiding the fate of all of my friends, family, and patients who have had so many problems surgeries and ultimately replacements with their joints.

For 30 years now i’ve been taking fish oil, MSM, glucosamine sulfate, chondroitin sulfate, cytyl myrostoleate, hyaluronic acid all for their joint/cartilage protective and healing properties and turmeric/curcumin, quercetin, bosewellia, etc. for their natural anti-inflammatory properties. Wouldn't do the collegen listed elsewhere though, molecularly, it's too large a compound to effectively get in the areas needed to be effective.

Just recently sent myself for a whole bunch of x-rays because I thought I was starting to get some old man significant arthritis issues (turns out it was other softer tissue issues and not DJD - degenerative joint disease).

My dr pcp looks at me like some lab rat when he sees me as an overweight now older person but whose X-rays remain pretty clean, still off any meds and whose blood numbers shouldn’t be as good as they are.

As for somebody my age, with my sports and medical history, I should have a lot more arthritis than I do, which as it turns out is almost none. Similarly for the patients that have been on this stuff, same results. It’s never too late to start and get benefit from these things despite what others may tell you.

Good luck bud.

I concur.

 

[temery]

the strawberry works better than grape.

This is for his knee, not birth control.

 

[Toga]

Interesting study just out.

IM, IA Steroid Injections Prove Noninferior in Knee OA

Intramuscular injections of glucocorticoids achieve a level of pain reduction similar to that of intra-articular injections in patients with knee osteoarthritis.

www.medscape.com

 

[TexanMark]

Interesting study just out.

IM, IA Steroid Injections Prove Noninferior in Knee OA

Intramuscular injections of glucocorticoids achieve a level of pain reduction similar to that of intra-articular injections in patients with knee osteoarthritis.

www.medscape.com

Cuseregular cuz we know you'll love to respond ;-)

 

[Hogtowncuse]

For those of you spending lots of cash on Voltaren, but who also are covered under a drug plan, there is a prescription product called Pennsaid which has the identical active ingredient as Voltaren. I have no vested interest in Pennsaid but the math of claiming its' cost in your drug plan MAY be less expensive than buying Voltaren at your local drug store. Just an fyi...

 

[texascpa]

For those of you spending lots of cash on Voltaren, but who also are covered under a drug plan, there is a prescription product called Pennsaid which has the identical active ingredient as Voltaren. I have no vested interest in Pennsaid but the math of claiming its' cost in your drug plan MAY be less expensive than buying Voltaren at your local drug store. Just an fyi...

I've tried Pennsaid several times. Rarely did it help. That's just me, though.

 

[CuseLegacy]

I've tried Pennsaid several times. Rarely did it help. That's just me, though.

Everyone reacts differently that's why, even though it works for me, I won't advocate Hempvana.

 

[Cuseregular]

Cuseregular cuz we know you'll love to respond ;-)

Interesting study just out.

IM, IA Steroid Injections Prove Noninferior in Knee OA

Intramuscular injections of glucocorticoids achieve a level of pain reduction similar to that of intra-articular injections in patients with knee osteoarthritis.

www.medscape.com

Good stuff and makes complete sense. Check this paragraph out from my original post on this:

As Is the case with many issues affecting our bodies the inflammation whether under the radar chronic micro inflammation or gross over the top obvious macro inflammation, they are often the driver of many disease states as well as orthopedic injury presentations.

If the inflammation is addressed with the shots whether in the muscle which is under the facia but connects directly into the capsule and bone itself via tendons, the cortisone will ultimately and hopefully positively affect any inflammatory state right there in the muscles, as well as diffuse and get right into the cartilages of the knee itself since they’re so close and attached to one another (check this anatomical picture below and note how the muscles attach right into the deep aspects of the knee).

It’s a positive development that they don’t necessarily have to go deep into the joint through all the structures which will increase the inflammation (as dasher was experiencing), as well as potentially open up more avenues for infection.

This is certainly a good positive development in the treatment of knee pain.

 

[HOFCeluck]

Good stuff and makes complete sense. Check this paragraph out from my original post on this:
View attachment 200954

As Is the case with many issues affecting our bodies the inflammation whether under the radar chronic micro inflammation or gross over the top obvious macro inflammation, they are often the driver of many disease states as well as orthopedic injury presentations.

If the inflammation is addressed with the shots whether in the muscle which is under the facia but connects directly into the capsule and bone itself via tendons, the cortisone will ultimately and hopefully positively affect any inflammatory state right there in the muscles, as well as diffuse and get right into the cartilages of the knee itself since they’re so close and attached to one another (check this anatomical picture below and note how the muscles attach right into the deep aspects of the knee).

View attachment 200956

It’s a positive development that they don’t necessarily have to go deep into the joint through all the structures which will increase the inflammation (as dasher was experiencing), as well as potentially open up more avenues for infection.

This is certainly a good positive development in the treatment of knee pain.

What if you’re just really awesome at IA injections

 

[RoatanCuse]

Here’s some info, FWIW. Flew up to Texas Orthopedic Center in Houston last week for a full knee replacement. Saw Dr. Goytia who has done only knees for over 15 years. X-rays revealed bone-on bone and osteoarthritis. They employ only specialists for diff parts of the body here. As a quick aside: Five years ago I accompanied my wife up here to see their hand specialist.. She had broken her wrist and only a CT Scan revealed 5 tiny chips unseen by the doc who set it originally.
The hand specialist took them out and put in a titanium “T” plate to strengthen things. No more cast. And two months later it was working normally w/o pain.
Now back to my knee. Yesterday I got a general anesthetic and woke up 2.5 hrs. later feeling pretty good. They had blocked a nerve, too. I walked around the room and down the hall in the afternoon...plus, the PT guy went thru a few exercises with me. I woke up at six this AM and prepped for release. Went thru more PT exercises around noon, then left...using a rolling walker. . Monday I start 2 weeks of PT here for an hour a day. Then I fly home to continue the exercises for 2-4 weeks, using a single crutch or a cane for the first two weeks. Then, it’s back to swimming and riding my bikes. Pain was never over 5/10 for me, but he gave me a week’s worth of Hydrocodone just in case. A few minutes ago, I just walked slowly to the bathroom and back to bed with no aids...just by myself. Texas Orthopedic does 3000 full knee replacements per year and he told me not to bother with the interim “fixes”. My knee was too far gone. It had hurt for 2 years And I had tried all the supplements. They get a 10/10 rating from me!!! I’ll be 80 in Nov. 6’1”, 180#. He said if I was 30+ lbs. heavier it would have hurt more and I would likely have required the procedure 15-20 years earlier. Good luck to everyone. Just my $00.02. PS: an ice pack helps immense!

 

[dasher]

Here’s some info, FWIW. Flew up to Texas Orthopedic Center in Houston last week for a full knee replacement. Saw Dr. Goytia who has done only knees for over 15 years. X-rays revealed bone-on bone and osteoarthritis. They employ only specialists for diff parts of the body here. As a quick aside: Five years ago I accompanied my wife up here to see their hand specialist.. She had broken her wrist and only a CT Scan revealed 5 tiny chips unseen by the doc who set it originally.
The hand specialist took them out and put in a titanium “T” plate to strengthen things. No more cast. And two months later it was working normally w/o pain.
Now back to my knee. Yesterday I got a general anesthetic and woke up 2.5 hrs. later feeling pretty good. They had blocked a nerve, too. I walked around the room and down the hall in the afternoon...plus, the PT guy went thru a few exercises with me. I woke up at six this AM and prepped for release. Went thru more PT exercises around noon, then left...using a rolling walker. . Monday I start 2 weeks of PT here for an hour a day. Then I fly home to continue the exercises for 2-4 weeks, using a single crutch or a cane for the first two weeks. Then, it’s back to swimming and riding my bikes. Pain was never over 5/10 for me, but he gave me a week’s worth of Hydrocodone just in case. A few minutes ago, I just walked slowly to the bathroom and back to bed with no aids...just by myself. Texas Orthopedic does 3000 full knee replacements per year and he told me not to bother with the interim “fixes”. My knee was too far gone. It had hurt for 2 years And I had tried all the supplements. They get a 10/10 rating from me!!! I’ll be 80 in Nov. 6’1”, 180#. He said if I was 30+ lbs. heavier it would have hurt more and I would likely have required the procedure 15-20 years earlier. Good luck to everyone. Just my $00.02.

I am now convinced that I will need fkr. I just can't walk for a long period of time. I will keep this in mind.

 

[RoatanCuse]

Here’s some info, FWIW. Flew up to Texas Orthopedic Center in Houston last week for a full knee replacement. Saw Dr. Goytia who has done only knees for over 15 years. X-rays revealed bone-on bone and osteoarthritis. They employ only specialists for diff parts of the body here. As a quick aside: Five years ago I accompanied my wife up here to see their hand specialist.. She had broken her wrist and only a CT Scan revealed 5 tiny chips unseen by the doc who set it originally.
The hand specialist took them out and put in a titanium “T” plate to strengthen things. No more cast. And two months later it was working normally w/o pain.
Now back to my knee. Yesterday I got a general anesthetic and woke up 2.5 hrs. later feeling pretty good. They had blocked a nerve, too. I walked around the room and down the hall in the afternoon...plus, the PT guy went thru a few exercises with me. I woke up at six this AM and prepped for release. Went thru more PT exercises around noon, then left...using a rolling walker. . Monday I start 2 weeks of PT here for an hour a day. Then I fly home to continue the exercises for 2-4 weeks, using a single crutch or a cane for the first two weeks. Then, it’s back to swimming and riding my bikes. Pain was never over 5/10 for me, but he gave me a week’s worth of Hydrocodone, just in case. A few minutes ago, I just walked slowly to the bathroom and back to bed with no aids...just by myself. Texas Orthopedic does 3000 full knee replacements per year and he told me not to bother with the interim “fixes”. My knee was too far gone. It had hurt for 2 years And I had tried all the supplements. They get a 10/10 rating from me!!! I’ll be 80 in Nov. 6’1”, 180#. He said if I was 30+ lbs. heavier it would have hurt more and I would likely have required the procedure 15-20 years earlier. Good luck to everyone. Just my $00.02. PS: an ice pack helps immensely.!

 

[tbonezone]

i tore all the upper quad muscles off my knee just last month. had surgery and they drilled thru the knee cap and re attached them. rather debilitating . the leg doesn't bend so well. outta the hard brace and into the adjustable flex. getting stronger every day. walking ( kinda gimping) without crutches. stairs are a major BEECH. but i hope to be released and get back to work soon. in a limited capacity no doubt. tough getting old.

 

[CuseFaninVT]

i tore all the upper quad muscles off my knee just last month. had surgery and they drilled thru the knee cap and re attached them. rather debilitating . the leg doesn't bend so well. outta the hard brace and into the adjustable flex. getting stronger every day. walking ( kinda gimping) without crutches. stairs are a major BEECH. but i hope to be released and get back to work soon. in a limited capacity no doubt. tough getting old.

How did you do that????

 

[NineOneSeven]

How did you do that????

Probably practicing his zone rotations from the center spot, i.e. sprinting to the corner to defend the 3.

 

[UpstateSM]

Should get a medical card for the pain if that’s not something you’re against, dasher. I’ve only heard good things from the people I know (a small number) who have used legal cannabis for pain related issues.

Definitely makes CR threads a more enjoyable read, too.