Well folks, I got back from the ortho. We discussed my right knee issue. It has not been getting relief from the enbrel whereas the rest of my joints have. It seems that I have OA in the right knee. He looked at my past two xrays and scans to confirm this. The only solution is a TKR. With the people here that have had this, TKR, how were the experiences.
I go to the Rhumey tomorrow and we will discuss this further.
That's not fun. I have not gone through this personally, but my impression is that this is one of the most successful types of joint replacement. . .That and hips.
I'm going through this with my wrists, which have OA. And apparently inflammatory arthritis is a risk factor for OA.
Yes I have oa in my wrist ad well. The only joints that the drs see with PsA is Achilles heal and two fingers. Now I have an answer for my Enbrel not working in those areas.
I do anesthesia for total knees frequently. It is a very beneficial procedure. It is done very frequently, so finding a competent surgeon should be easy. Total knee replacement is one of the most painful procedures out there. Planning a good pain strategy BEFORE surgery is important. Talk to you anesthesiologist the morning of surgery. I have found the best anesthetic with the least post-operative pain is a spinal with long-acting narcotic mixed in the spinal “cocktail” plus a femoral nerve block catheter. A second nerve block, a sciatic nerve block, can also be performed, but is not necessary if you get the spinal narcotic.
I had my right knee replaced in Oct. 2011. It was the best thing I could have done. It is important to start the exercises to strengthen the knee now and go to your rehab after the surgery. I had gotten to the point where I needed a cane all of the time. The only time I need a cane now is when I am walking on an uneven surface.
Marta
My father had it and it went fabulous. My friend had it and it did not. It depends on the quality of dr. you get. The recuperation is the bummer but in the long run, you'll love the new knee you'll get. Physical Therapy is great.
I’ve had two TKRs, can’t get more experienced than that! 
so here goes:
Do it.
Learn the physio exercises and start doing them religiously, starting today. If you are strong and flexible before surgery, things will go much better after.
Make yourself a place where you can do physio with distraction. You may want a reading light, a tv, and maybe a video player, laptop, magazines, Etc. Plan on spending a LOT of time there.
Oetboy is right. Go for the spinal, not a general anaesthetic. Ask for a femoral block. I had one without and one with. With is better.
After surgery, take as many painkillers as they will give you so that you can do the physio.
When you are home, take a max dose of your strongest painkiller before doing the worst of the exercises. Do not tough it out! The better you control (maybe i should say “numb”) the pain, the more you can exercise. Never mind if the drugs turn you temporarily into a space cadet! Having great knees is worth it.
Three things to remember: physio, physio, and physio. Start today.
It’s tough, but having a “shot” knee is too. And when you recover from this, your knee will be strong, flexible and pain free!
Go for it, and good luck!
OK, after all of that, I thought I’d just add "What Not To Do – a True TKR Story"
An acquaintance of mine was going for a TKR. I told him all of the above. But he really didn’t need advice: he’s in the army, so hey, this wasn’t going to be a problem. He knows tough, he used to run with a heavy backpack! Well, after surgery, he refused pain meds cuz he could tough it out. He was absolutely rigid with pain, of course, and then got blood clots. They treated him for that, but then was on strict don’t-you-move bed rest. By the time the blood clots cleared, healing had begun and physio was all the more difficult. He went home and he did give the physio his best shot, but despite that, after several months of hard work, his flexibility was less than 90 degrees. Back to hospital he went, and they “broke” the soft tissue to loosen it up. (If anybody knows how this is done, I’m not sure I want to know.) He was back to square one, having already had several months of misery. And he began his recovery all over again.
Moral: take the the maximum dose of pain meds you can and bend bend bend, as soon as you can after surgery. I started as soon as I was returned to my room, before the surgical drugs had completely worn off. Don’t think for a moment I wanted to!
It is hard, but it is so worth it.
You might ask about a Partial Knee Replacement... There is a Doc up the Bitteroot who helped develop it, folks come from all over to get it. he says its almost ALWAYS an option. Almost a non surgery. One of my Golf Buddies had One of Each. The "partial" knee was actually in worse shape than the TKR he had a few years before. He was back on the Golf course in a hair over a month..... Same with my niece (but shes a pro)
Heres a list of guys doing it around you (I think)
http://www.biomet.com/lessIsMore/findADoc/index.cfm?page=results&h=2485&z=29003&m=150
Heres Info:
This pretty much sucks, and I am so sorry to hear this. I do not have experience with this, but I hope you are able to find peace with whatever decision you and your doctor come to. Good Luck. ~Angie~
I'm going to give a differant take on this. Not to be a downer to the ones that have had them replaced. I've had 4 of them, both got loose and revised.
Before it's said my surgeons were not competent...they each had gotten loose after 7 yrs only, due to osteolysis. a component part breaks off, and, then too technical for me, but then all havoc happens slowly
I was 48 when i got my first one, 3 yrs after my diagnose of RA...but i did fall on that left knee hard when i was younger. And i never got relief with triple DMARDs at times, NSAIDS, prednisone, till Enbrel got invented, around 1999..I got my first dose in 2000.
Here is the kicker, you can still get a flare in a TKR, they remove the synovial lining, but it grows back..Had my Remicade 3 weeks ago, and knee feels fine. So that proofs the flare in the TKR theory.
I did see my ortho in August complaining about knee pain, and a popping in that knee..It's even audible to everyone else. I did request a copy of his notes from that visit, to take to my rheummy. A part of that unit might have to be changed, not a total knee...it's a polyethylene exchange..but they got to open the scar up again.
I'm to see him in 6 months again. It still clicks and pops when i walk at the stores....but i wrap it with a knee sleeve, i like a wide ACE bandage, and that really really helps, when i walk. What else with that left knee, thats wrong, is a varus valgus laxity, i am assuming this is a deformity in my leg. Whatever all that mumbo jumbo means, i'm just saying
youcan use some kind of knee brace in the mean time.
I had each knee scoped before the TKR, maybe they don't do that as much these days, but it did help the pain for year or 2.
Heck, i would do it again..The first few days were hard, but they get you on your feet the next day, they pull the catheter out, you walk slowly to the bathroom!, with your IV pole
It was a much easier surgery than the ankle fusions, non/weight bearing, and using crutches, or a wheelchair...
Let us know what your rheummy said about your meds, try to enjoy the holidays, and try using a brace..Some ortho's will give you a big one, but i kinda like the wide Ace bandage....plus it keeps your knee warm