Now I need knee surgery

Went to the ortho today and seems I need to have minor knee surgery. Has anyone out there had surgery since being diagnosed with PsA? I have a complex tear of the meniscus and pain meds/cortisone shots haven't helped - have an awful time going up and down stairs, curbs, etc. I can walk for a bit and stand for a bit, but the popping and clicking is driving me crazy.

I am only on methotrexate and folic acid, and some arthritis strength Tylenol, which does NOTHING for the hand pain, so I am worried about having to use crutches. I also need back surgery - that pain is getting so bad, but I want to fix my knee first. The back surgery is going to have to wait for a while longer. Heck, I've waited 3 years, what's another few years? ha ha ha

Any insight would be helpful. Thanks!!

No insight. I just wanted to wish you luck with all of this.

Hi, NYazz I had two knee replacements before I was diagnosed, and a hip replacement after. What kind of insights are you looking for?

There is no such thing as minor surgery with PsA. Whether you need it or not is a a discussion between you and your doc. Involve yout rheumy. We tend to have more complications from anesthesia and the surgery itself because of inflamation. post operative pain can be a problem if pain meds and/or predi is regular part of you treatment. They some times can't increase the amoints of pain meds beyond what yo are already taking. Often you will have to stop many of your meds prior to surgery especially NSAIDS, biologicals and the DMARDS because of bleeding and infection risks. Lots of folks report flairs and a pretty good wait for their meds to start working again. Each one of us has a different view. I have alist of surgeries I could have. All are on the not yet list. Back surgery is on the if hell freezes over list or drop foot maybe list..

Ask your rheumy if the surgery will help. You may clean up a joint, but depending on where your disease is at, the only pain that may be relieved is you surgeons. (They worry about house payments too) Just because a study shows a problem doesn't mean thats where the pain is coming from........

Seenie - just wondering how the healing goes after surgery. I know each person is different in their pain tolerance and healing depending on how bad their PsA is.

tntlamb - I am not thrilled with my doc right now, and really don't want to pay for a visit just to get an answer. I never get to talk with him if I don't make an appt. I am only on methotrexate right now, and the surgeon is not worried about it because it is just an arthroscopy. My bones are fine, no arthritis showed up in MRI or x-rays. I am kinda on the fence about the surgery, but I am tired of not being able to go up and down stairs or off the curb, or getting up from the ground, etc. I do read everything you all say.


I experienced the same knee problems as you. Because my PsA was not under control it eventually led to knee replacements like Seenie.

My experience has shown that if you are suffering the pain and damage you are having you need to have your PsA treatment reviewed/changed. Enbrel and supporting medication have meant less symptomsand this has allowed me to exercise with light weights, stretches, walking, bike riding and swimming. This has meant the back surgery I "had to have", according to a surgeon, is not necessary as the additional muscle is supporting the damage. Where I couldn't raise my right arm because of damage to the shoulder joint, I can now raise 7 kgs of weights with it. The surgeon said I had to have a joint replacement!

I suggest you do everything you can to get your PsA under better control before thinking of back surgery and before having the necessary knee cleanup. My second knee replacement did not stop being swollen until PSA was diagnosed and effectively treated 15 months later. They both look like normal knees now.

Yes, Allan’s story and mine have some similarities. My knees went very bad very quickly from OA (so they thought) and were replaced. They healed quickly and I recovered fast. Then I got erosions in my mid-feet, and they diagnosed PsA. After that, my hip went downhill fast. I was on methotrexate and leflunomide when the hip needed replacement, and the surgeon told me to quit the mtx for a month before the surgery, because there is some research suggesting that it may slow healing. LOL, I discovered during that month that methotrexate wasn’t quite as useless as I thought! After surgery, in fact the incision didn’t heal as quickly as the incisions had done with my knees. I was in hospital a few days longer than expected because of the oozy incision. Only a bit of a delay, nothing serious. After that, my recovery was swift. I began Enbrel (a new drug for me) two weeks after, and resumed mtx a month after the surgery.

The difference between Allan and me is that he got aggressive treatment faster than I did. I was far too willing to trust the rheumatologist and let her do “low and slow” trials with DMARDs which have only a mediocre record of success. I was worried the whole time that my disease was damaging me, but I felt I had to trust her judgement. During that year, my hip went from moderate OA (that’s what they called it, and I had a horrible feeling they were wrong) to total destruction. When they did the surgery, the degree of inflammation in the joint was extreme. PsA, obviously, not OA.

Back story (because I want as many people as possible to know what happened to me, so that they don’t end up like me): STOP READING RIGHT NOW if you’re thinking “Here she goes again” …

I managed to get a second opinion from a specialized PsA clinic just before the surgery. They assessed my PsA as aggressive and severe, with a lot of damage. They said the only treatment alternative was a biologic, which I have started. Within eight weeks, I am feeling better than I have for the last 20 years. Too late for my knees, hips and feet, though. I should have trusted my gut feeling that my rheumatologist was wrong. Again: if you are not comfortable with what you are being told, or the treatment being prescribed, get another opinion. It’s you, not the rheumie, who will suffer if they are wrong.

Off my soap box now.