Knee replacement,

Hello and Happy Holidays to all you good people! I know this has been discussed in other threads before but just a hopefully quick question if I may.

A couple of months ago I finally came out of what turned out to be an 8 month long significant and totally awful flare. :tired_face: Of course with my orthopedic doctor seeing only emergency patients during the Covid lockdown I didn’t even bother trying to wrangle an appointment. He had already looked at my knee (twice) and said it was nothing that titanium and plastic couldn’t take care of. Oh. Joy. So I spent 8 months hobbling around with a knee brace and a cane combined while trying to decide when I wanted to start replacing body parts. After the flare subsided I noticed that the evil knee had noticeably deteriorated and the El Diablo sacrum was still screaming. (I’m really hoping my altered gait is causing that.:crossed_fingers:) So I suppose now that I can no longer bend over at all and support any weight with that knee I can no longer put off the surgery. I can also no longer rely on it not deciding to buckle at some inopportune time. Soo…

Being able to properly walk would be rather fabulous but I would also really like to be rid of some pain. That would be OUTSTANDING! My question is, how many have gone down this road and has it made a difference pain wise? Ironically, even though the joint is damaged I have not really had that much pain in the joint proper. Most of my pain is enthesis related. Obviously the damage is not going to reverse itself so the surgery is inevitable but I’m wondering if it will possibly address the pain? I have an appointment with my orthopedist day after tomorrow to talk about it and just wanted to get the take on it from some fellow PsAers.

Merry Christmas!

I haven’t had a knee replacement myself but I know someone with PsA who has. She was diagnosed with PsA (or then junvenille arthritis plus psoariasis as it was called then) aged 18 months old. And sadly that caused significant joint damage for her. So aged 40 she had her first knee replacement. It was a total success. However her recovery was slower than someone who had a knee replacement without PsA, so be aware of that. The pain and swelling post surgery went on longer than with a patient who hasn’t got PsA. But she’s thrilled with the end result.

Joint replacement surgery is all about reducing pain eventually. People who have hip replacements can never quite believe how it so reduces pain, even immediately afterwards. But also be warned a knee replacement is very painful surgery. My mother had a knee replacement and said she had never experience such pain as she recovered. She didn’t have PsA. Another friend of mine also without PsA had a knee replacement just last Autumn and also said the same thing. It’s damned painful initially but if you keep with the programme and the icing and the PT, it does get better. Hope your appt with the surgeon goes well.

I too know someone who had an excellent result from knee surgery. Last I saw of him, in a photo his wife sent, he was working on the upper floor of a half-demolished building - he seemed to be kneeling :astonished: I have damaged knees and cannot kneel on a fluffy rug.

PsA went for my knees first and both were very swollen for a few years. I was unable to walk at all for a fair while and the ability to do so returned very slowly with treatment. They have caused me significant pain in the past but that has lessened to almost nothing. I was told I’d probably need joint replacements but that has not proven to be the case so far. Apart from some stiffness which prevents kneeling & crouching, I have a good range of motion and am quite able.

I’d say don’t be in any hurry, explore options carefully, interrogate your orthopedist to within an inch of their life! Sounds to me like you may have got away with it. And yet, as you’ve probably gathered, I would embrace the surgery option if I really had to, even though a good recovery requires considerable patience & a lot of PT.

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Thanks Sybil and Poo (LOVE your moniker!)

I’ve heard that the vast majority of people having knees replaced were very happy with the outcome. Eventually. My surgeon did warn that the pain is over the top and off the charts for awhile in the beginning, “Most of my patients really hate me right after” So I’m preparing myself for the worst. :pleading_face:

I probably wouldn’t even be considering it if I had not become so hampered. The knee is collapsing inward and is now visibly crooked. I haven’t been able to kneel on even a padded surface for over a year. And now that bending over is out of the picture I’m thinking I’m pretty much out of options.

Life does not take place at waist level and above. My sacrum/SI, whatever one wants to call it, has become so very painful and quite an issue. I’m really hoping that my effected gait is a chunk of the problem and that getting the knee fixed will help. :crossed_fingers: Fortunately my orthopedist is excellent. Unfortunately, the closest rheumatologists and spine doctors are 1,000 miles away so for now my best bet is to do what I can here in town since my options for seeing one of the others are pretty slim.

Thank you both again! And Merry Christmas. Or whatever holiday you may celebrate! :+1:

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My father-in-law had double knee replacement at the same time. He didn’t experience very much pain at all except from the incision. It is very important to go into it with as much muscle tone as possible. and the post surgery ice treatment makes a huge difference. He had an ice water pump system that really helped.In the first week, if inflammation is kept to a minimum, the recovery is much faster. Of course, everyone has a different experience. A physio may be able to teach exercises specific to prepare you even if typical mobile exercise is difficult. Merry Christmas to all!

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Thanks for the encouraging words. I just got back from my appointment. Today’s imaging showed more damage since the previous. Shocker. Surgery is scheduled for February 9. I’m having a pre surgery PT session for some strengthening exercises hopefully very soon after Christmas. Guess no one is anxious to take on a new patient Christmas Eve. Can’t imagine why. :laughing: Hopefully this will really help recovery.

Thanks again and Merry Christmas to all you good people!

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Good luck @Mom_cat, hope you get a great result.

Is this surgery on just one knee? Also wondering if your surgeon was able to answer your question about pain.

I reckon @Amos was on the money mentioning muscle tone & obviously this is going to be addressed. I was shocked to hear that the muscles around my knees were wasted when walking was difficult, it wasn’t obvious to me. I’d failed to do the exercises - they seemed pointless but now I know better and in the same situation I’d do them religiously, however tedious / painful they were.

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Glad you had your op scheduled, and will be able to find improvement as a consequence. Had knee surgery many years ago, Removed the two or the four whatever they are called around the knee , and recovered. My tendon or a couple may have been ruptured too but were not touched, as the doc mentioned my probably not needing to use my knee in competitive sports.
It does not look the same as the other knee, And docs say this one has osteoarthitis while it is the other which has psa. When got diagnosed with psa about 5 or so years ago I was about to have both knees replaced as walking was no longer an option, but cortisone shots and then treatment and diagnosis , and changing my diet as well as fasting resulted in my not needing the replacement yet. When will go about having it am confident modern techniques will result in a successful process, so all the best and give us your advice for future operation choices, and happy Chtistmas

Thank you for all you guys’ well wishes.

Yes, just one knee. The other is also beginning to collapse inward but hopefully I still have some good years on it yet. Fingers crossed and knock on wood. :grin:

I’ve heard about the importance of muscle tone/conditioning so was very happy to get the script for pre-op PT. I have tried to keep walking and moving in general in spite of the difficulty since not walking creates a whole new set of problems. I’m hoping I’m not as out of condition as I think I may be. :grimacing: Fortunately I have an excellent orthopedist and trust him implicitly so I’m anticipating a very good outcome. I’m also looking forward to being able to get into my garden this year and really hope I’ll be able to kneel again. It’s gotten verrrry messy and overgrown. Quelle horreur ! :scream:

Thanks again, enjoy your holidays and here’s to hope of a better year to come!

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My wife had a partial knee replacement two years ago. The medial side. She was 60 then. She is in good health except for diabetes, which she only takes pills for. Of course, this was before COVID and I stayed in the hospital with her overnight. They kept changing the ice on her knee all night and she had one of the push button pain IVs. But 5 hours after her surgery that evening, they had her up in a chair. After she had dinner, they got her a walker and told her to get up on it as best she could. They came in every few hours and had her lift and bend her knee as best as she could.

She managed to get up and walk a little. The next morning, they had her up and walking down the hall and back. They said she could go home that evening, but I told them she had to be able to get up and down stairs because I could not help her due to my PSA. We have to go up one flight of stairs to get in our house from the basement. They said okay and kept her until the next day. The next morning, they had her up on the walker and working on going up and down stairs. I was surprised, but they said they have to get people up and moving ASAP are the knee will freeze.

I took her home that evening. I spent a week getting her ice packs and helping her as best I could, but she was able to get around the house with the walker and go to the bathroom and the fridge They gave her a water pump that I would put 4 frozen bottles of water in and and it circulated the cold water through a wrap she kept on her knee. They said it was really important it didn’t swell.

She said she wouldn’t have the other one replaced now, but I think she would if she has to do it.

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Thanks @tamac! Good post surgery info. My husband is a bit stressed about that, but such is life. Fortunately we don’t have stairs to deal with so if I can ambulate without assistance I should be able to get around the house. And since he doesn’t cook I’ll have some things in the fridge that can just be heated up. Of course there is always take out. Also good to know about ice packs. I’ll be sure all the packs I have are in the freezer just in case I don’t get one of those handy frozen water bottle pumps.

Thanks again and Merry Christmas!

I’ve not had knee surgery. I’ve had 2 hip replacements. I hope your surgery goes well and you get relief soon.

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had a femur hip grafting operation a couple years ago, and found great benefit from a machine sending electric impulses strapped on at night, for maybe three months or so, it did wonders for pain and bone healing, in spite of my osteopaenia and not being able to be on methotrexate at the time. I would recommend something of the kind, all the best,

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That was the bone stimulator? I hated sleeping with that after my foot surgery! I’m sure it helped, but it would fall off, or wake me up when the control hit the floor, and so on. Probably not as bad to use on anything but the foot lol.

Sharon

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Just shoulders here. My niece has had both knees done. The last just this past summer. The technique changed dramatically in just 18 mos time. They wanted to both at the same time and she refused. Regretted it every day until she was able to have the second one done. She doctor/clinic shopped for the second one as well has hardware after a come to Jesus meeting with her uncle. It was done out patient, no nerve block and no narcotics using a Zinner Cruciate-Retaining prosthesis. Its a bit more technical surgery than the typical hammer and glue guys do and the zinner rep cutomizes the prosthesis to prevent any need to cut ligaments) She had the surgery AM left the surgi center by 9:00 that evening and was walking her dog in the Morning. They used steroids as opposed to the ice machine, met her PT in the recovery room. She did do a LOT of PT prior to surgery. Tried to talk her into similar for her first one but she had a better idea thinking she needed to stay in the Hospital which she did and of course got one H of an infection. (infection rates are 90% less in ortho specific surgi-centers) Non narcotic pain managment once out of the Recovery room is days faster healing. nerve block aside from a 5% complication rate are NOT for the patient. they are for the hospital staff’s convience. Anyone who has had poor nursing care and had one quit doing its thing at 3:00 AM (especially after being sent home from an out patient center will testify to it) There simply is NO WAY to manage post operative pain in the presence of a nerve block AND NO WAY should a PsA patient have someone poking things into their spine. Inflammation has a bad way of moving things away from where the gas passer thinks they are… A new joint lasts 20 30years you can always get another if it wears out. There is absolutely (IMO) no reason to put it off. Best to enjoy mobility while you are as young as you can. Having perfect knees in the nursing home does no one any good. Eveyrthing you can do to help mobility and reduce pain has a much bigger payoff in the rest of the body than yo can imagine. Congrats on taking the plunge!!!

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I found the ice water circulating machines on Amazon, but they are about $200 US. The PT was the one that said put 4 frozen bottles of water in it instead of trying to run and buy bags of ice to keep it filled.

WHAAAAT!!! Holy kneecaps Batman! Tell me more! Where is this mystical place doing these magical procedures? I am NOT AT ALL opposed to going out of town for a new knee if it/they are THAT good. I had no idea of any of this. Seriously, I’m not looking forward to replacing body parts but my genu valgus is progressing. Oddly since the OMG, kill me now, 8 month flare subsided the pain is much less even though the leg is noticeably more crooked. If I were able to bend over and/or kneel I might put it off for a while but life does not take place at waist level so…

I know that I need to have the best muscle tone possible going into whatever surgery I decide so I’m doing prehab. I’m also really hoping that part of my sacral pain is from the affected gait and/or that leg now being essentially/functionally shorter and messing with my pelvis. But no need to chase that rabbit on this post. Any information you could offer to get me looking in that direction would be so very much appreciated. As I said, I have NO PROBLEM going out of town for the surgery.

But all that aside, thanks for the info/advice. I don’t do nerve blocks. Even if given the option. I do very well with general anesthesia. Even without the PsA factor it just kinda creeps me out thinking of getting something stuck in my spine and having a body part go numb. Besides my spine is so problematic now they would probably have a bit of an issue doing one.

Well folks, it’s LambMan to the rescue. Again. Tell me, do you wear a cape with your mask? :laughing:

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When you say nerve block, you’re referring to any nerve block? So for example when I had foot surgery last summer, I had a nerve block so that my foot and lower leg were quite numb.

A spinal is a specific type of nerve block. I had previous back surgery, plus I WILL get a spinal fluid leak. I would adamantly refuse a spinal unless it was 100% necessary and I stayed inpatient for the next 24 hours.

I had a leak from a myelogram once. That night I had the headache from hell!! It hurt so bad I had to whisper to talk and the wife had to whisper to me. We called the on call and he surprised me by telling me to drink as much caffeine as I could get in me. He said it helped the body make more spinal fluid. That one I did not know.

It was midnight by then and he said not to go to the ER because he didn’t want them doing a blood patch. He told me if I was a still that bad at 8:00AM comeback to his office for the patch. Thankfully, it slowly got better the rest of the night.

I never have like myelograms and now really worry about them.

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That’s exactly what caused the first and the worst one. I wound of having surgery scheduled for a few days later, and basically suffered an agony for those days. I pretty much could only be horizontal and if I was vertical at all the headache would be crazy intense and I would vomit. It was fun times. Now I know that I need to be kept horizontal to keep the pressure low while it heals up.

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