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.
