How can i delay TKR for simply 4 months?

Bones, joints and muscles
1

Hello all...im looking for any suggestions regarding my left knee.

I am a 50 yr old teaching tennis pro. Five months ago (Dec 2014) i had major rotator cuff surgery on my right (dominant) shoulder. All went well and I was told I'd be back to work in 4-6 months. My plan was to do the surgery in winter and id be ready to go for the BUSY summer season.

My problem is... all of a sudden, for no reason whatsoever. my left leg, from the hip down to the knee has apparently flared up with the most painful arthritis. I can barely walk, let alone think about returning to work.

- alittle history on my left leg...I've had 3 surgeries on my left knee ending with a total ACL replacement about 20 years ago. I KNOW i am bone on bone on my knee but it has never prevented me from working, running, playing/teaching tennis nor any other physical activity. Every 9-12 months however the knee does fill with fluid and my range of motion becomes hampered. But I simply go get my knee aspirated followed by a cortisone shot and I'm ' good to go' for another 10 months. (all the while i am aware that the day will come that a TKR will be inevitable)

The conundrum is I've been resting the past 5 months. I have placed no pressure on my leg the whole while I've been rehabbing my shoulder and there's no fluid build up whatsoever...yet the pain is excruciating!

So as usual i went to the doctor and while no aspiration was needed i had my usual cortisone shot (Kenalog) injected in my knee and also the hip which X-rays showed some minor new arthritis.

Results-absolutely NO relief! My reliable cortisone shot which has been serving me grandly for years had no effect whatsoever.

I then insisted a few weeks later that a different brand of cortisone (depa-medrol) be used thinking my body has become immune to the Kenalog- NO RESULTS!

Desperate i then had a series of "some new lubricant" injected in the knee one injection a week for 3 weeks- NO RESULTS!

Ok..ok i get it the inevitable has come. It's now time for a Total Knee Replacement (TKR) But it's just not reasonable, i can't wrap my head around the fact that while rresting my shoulder...putting no trauma on my leg whatsoever, my left leg, hip/knee is in soo much pain...let alone the idea of having one major surgery immediately after another...ITS JUST TOO MUCH!

Im desperate. I'm looking for answers WHY this is happening...could there be a simple answer im overlooking? Additionally does anyone have any suggestions as to what i can do to get back on the tennis courts just 1 LAST SUMMER, then i shall acquiesce and do the TKR.

Please PLEASE...someone help! 😟

Sincere thanks,

TENNIS IN CHICAGO 🎾

David

2

I don't think its anything to do with rest or anything you have or haven't done, your knee has got to the stage where injections won't work any more. Tkr is your only option.  We have all been there and you will just have to face the inevitable I am afraid.  There are no answers, your knee has had enough and needs replacing, especially now arthritis has set in.

3

What a dilemma. The body is so complex these things are hard to grasp. BTW, I'm in KC and I finally had to change doctors about e years ago so I could have all the resources of a teaching university. I'm 2002 I was just beyond retirement age and decided to work anothe year or two. One day in early Sept i was o u t on a call and felt a strange swelling in my knee. 3 hrs later I started to leave and the most horrific pain and swelling I've ever had hit my knee. I almost fell and literally had to drag myself to the car which became a nightmare getting into. That night e.r. and pain meds. Next morning my orthopod. He nor anyone in the practice had a clue. Surgeries began and finally, through an orthopedic oncologist it was diagnosed as pins, a rare tumor that normally surfaced between teenage and 40's. I was almost 66. I won't go into all the rest of it but 12 years later I am getting ready (next month) for my 11th surgery, the 5th that will actually be a complete opening of the knee and insertion of the 3rd prosthesis. Needless to say, I'm no trained, qualified orthopod but I sure as hell have enough time and expense to be one. (Medicare billing is approaching 3/4 of a million). My surgeon has called on me to meet with a couple of others that suffer this same fate. All of this long mindedness doesn't pertain to your situation but just shows you the delicate nature of this organism we call the human body and as I know in my case, the tendency to think whatever abuse I give it, it'll be like Timex and keep on ticking. I suspect, in your case like mine, something just snapped. No explaination. I would suggest if possible, an appointment at a medical school that has a recognized ortho clinic or e en a trip to Mayos in Rochester. Unless you have been hospitalized in the last 3 months you don't need a referral. They would like your last set of xrays and mris. They do require a 4 day window for a stay. If you would like to contact me through email use the envelope in the corner across from my name. Good luck.

4

Ohh Susan 😥 it's just not fair. I know you're probably right, but its analogous to being told you're going to be executed by a firing squad at dawn. I'm in a hysterical panic clawing and scratching trying to escape.

Tennis is my lover, it's literally all i have. Everything seems to be taken away from me just....when im close to complete peace and happiness.

I know...I'm wallowing in self pity

Grant me the serenity to accept the things i can't change..

The courage to change the things i can...

And the wisdom to know the difference.

Ohhhh my 😥

5

Definitely self pity and I sympathise, but it could be worse.   Look at the comments from OFG to see what he has been through and is still going through, poor man.  You can still play tennis with a new knee, if you need one!

6

Ohh how i hear you Oldfatguy...ohh how i hear you.

The delicate mechanism of the human body.

How we take it for granted with the potency of youth, and how we pay the price with age.

What an interesting time of year to recognize this. With memorial day upon us let's think and pray for the men and women who have given their life, liberty and body parts for us all!

7

Thank you Susan. I have and am reading OFG's story.

WOW

8

I've also had the rotator cuff surgery, and the TKR . .You may love tennis, but unfortunately it rather looks as if tennis doesn't love you too much!  I hope you can get some relief, but with both hip and knee pain, looks a little difficult for this summer??  

9

I do know what you are going throu and there is life after joint replacements.

whilst I was doing my dive masters course, I had a scuba diving accident..

" the bends ". ...untreated ( another story ) I had my first hip replaced at age 37 due to AVN caused by the scuba event. 

I had my passion job also working in the OR for my treating ortho surgeon. 

And had a total of 5 joints replaced by age 42..

naturally I lost my passion of scuba diving too high risk to go again, and I also lost my job, as. I couldn't physically lift the sterile equipment out of the autoclave

so yes I do know, I lost my job, my passionate sport. But I tried different things, now I do aqua aerobics swim laps in a fashion as my shoulders are reverse. And I've taken up art and been published in a few magazines.

so although you are worried about now there is a future you just have to find. A new one, living in pain is not an option that's not living.,,

just me 2 cents worth,, 

10

Hi David,

First of thanks again for your wise words the other day....I don't know that what I have to offer will equal your words. But my knee(s) story is similar. My knees have bothered my for 35 years, I am 57. They would be horrible, one at a time, pain swelling, etc.... I'd need a brace for awhile, then it would be fine for months or a year or so. Then several years ago I started with cortisone shots. At first, they were a great relief, lasting a year or more. Then it got to the point I needed shots every few months. Finally the shots did nothing. Then I tried the cartilage building injections, which did nothing. Right before my knees went to the point of no return, 2 years ago, I was walking 8-10 miles, jogging and hiking. I felt so betrayed by my knees and I couldn't understand why they wouldn't get better like they had for most of my life. My OS explained that they had come to end of their road. I know intellectually that we are lucky that we are alive at a time when we get a second chance with iur knees. Sometimes it's just not east to accept. Sounds like you are in good shape and tennis is on the lust of "ok" activities for TKR. The only other thing I would add us to do the surgery when you are ready and convinced that your knee is at the end of its road. Good luck!

11

That is brilliant Mary.   Just goes to show tgere is life adter sport.  Xxx

12

I was thinking about your question as to why, after months of rest, our knee is suddenly so much worse, and in the early hours of the morning unable to sleep (as usual) a possible answer occurred to me!  while playing tennis at a pro level, I magine your muscles were in tip top condition, enabling your knee joint to  be usable inspite of the bone on boner condition.  while resting after rotator cuff surgery, you have probably lost that muscle tone (it happens almost immediately!) and now the muscle structure around your knee is not strong enough to support the bones properly . .hence causing all this new pain.  Not sure if improving your muscles again would help, but it sounds as if you are on the verge of needed TKr.  Advice that you can play again after is a little optimistic in my view.   You want that new knee to last you as long as possible, and high impact sports are bound to shorten its life considerably, even discounting that the pain will stop you for perhaps a year . . .At nearly six months, I still find getting up and down stairs painful, let alone playing tennis!

13

Good morning Martinarvelo.

I think you may be onto something. I've heard the same thing from different sources.

I personally find it hard to believe. It's not as if i was on my back for 5 months. After 2-3 months i even went to the gym to work on my legs with cardio exercise.

But there was something you said that interested me ("...it happens almost immediately&quot Please tell me about that.

I don't understand why...especially considering the above.

But i do know that i was playing at a high level even with the torn rotator cuffs. When i was diagnosed i was stunned to hear such a dramatic diagnosis...if my cuffs are torn then how could i be playing like i am? They said because the muscles surrounding the cuffs are so built up from decades of playing they are compensating for the torn cuffs underneath.

Id also like to express my sincere appreciation that you were even ' thinking' about [ME]! A big part of my resistance to giving into the TKR is that im alone. It's just me and my beloved dog Venus. I know I'm acting out like a spoiled child fighting this...but im scared. I'm prone to catastrophizing...and all sorts of awful scenarios build up in my head...what will happen to Venus the 3 days im in the hospital? She's everything to me...i can't just put her in some kennel-i saved her from off the streets. What's going to happen to me once i get home- who's going to cook, clean and tend to Venus and me? I like being independent...but what if "they" (a ficticious THEY that i create in my mind) decide to send me away to some nursing home at 50 yrs old never to see freedom again and Venus is thrown to the wolves.

I know...all absurd thoughts. But that's what's going on in my mind...let alone losing my vocation...my means of self support.

Im very grateful Martinavelo for your thoughts. I am in the gym trying to rebuild those leg muscles but-OMG 5 minutes after i stop the pain is excruciating.

I'll end with this...i found a study about something called REGENERX...some kind of stem cell therapy where they rebuild the cartilage somehow. Im desperate i know and grasping at anything and everything to avoid "the death penalty."

But Martinvarelo to think that someone, somewhere over the rainbow 🌈 was actually thinking about my well being brings a tear to my eye.

From the bottom of my heart-

Thank you

14

Once again you have nailed my feelings Joyce. Yes..it's just so difficult to accept when just months prior we were jogging and playing and skipping and jumping.

It seems that aging can be such a humbling experience. Am i being punished for something i did when i was young?

Why do i find myself alone during this aging process. It'd be so much easier to have someone who loves you around to help carry the load (see my note to Martinvarelo)

But tell me about the "cartiledge rebuilding injections" I've never heard of that....maybe????????

15

That is brillant Mary!

Thank you. It is difficult to let go of anything we all love so much...but hopefully as you say...there is a new and possibly even better life after ...!"

From my heart ❤

Thank you

16

Aw shucks!  Actually, Tenerife . . quite a long way from you and over quite a few rainbows I suppose!  the reason I said how quickly you lose muscle, is that when I had my first arthroscopic exercise, the surgeon said I couldn't put the leg to the floor for ten days. . He says he told me to do exercises, but if he did I don't remember that!  So I didn't / / and when I went back after ten days my quads did not even respond . . the leg was visibly thinner from lack of any muscle, and in the end I needed electrical stimulation to get the muscles working again. . . Mind you, I am not an athletic sort of person, so I probably didn't have anything like the muscle tone that you would have . . .but I believe once you stop using a muscle it degenerates very fast.  Most unfair how a cat can sleep all day , never exercise, and yet leap huge heights  when they need to!  Regarding all your other worries, you do need to find a solution for Venus . . and if he/she needs a lot of exercise, someone who will  cover 'walkies' for a while, but I'm sure they will not incarcerate you in a home at the tender age of fifty!  the opposite will almost certainly be true. . out and on your bike as soon as possible!  the first couple of weeks it is difficult to cope. . One of the problems with using a walker or crutches is that you don't have another hand left to carry a cup of coffee for example, or pick something up from one place and move it to another. . . .but if you DO finally have to have the TKR, come back ot this forum and people will give you all sorts of useful advice about preparing for the op . . and making you home TKR friendly!  My only experience of Chicago was a touch down on a flight home from LA . . Looked lovely from the air!

17

there was someone else on the forum who had also had the bends following a computer error on the diving equipment on the barrier reef. . , and subsequently a vast number of joint replacements.  Not something I knew about before being on this forum . . .So glad that you have managed to survive such an awful experience, and actually come out the other end and found new passions!  Wonderful . . . 

18

Lol...the cat analogy is funny!

Chicago is a wonderful place in the summer, and an equally awful place in the winter.

It's one of the few places where it can literally be 80°F sunny blue skies one day and 40°F freezing and windy the next!

Thanks again Martinvarelo, i shall keep in touch.

Btw...you never explained what that cartilage replacement injections were about

19

The injections were called Hyaluronic Acid Injections. They were not helpful to me, but they are to many. Check it out...

20

I was advised to have those, but didn't bother. .went straight to the TKR. I think what David is referring to is a more complicated treatment though.the stem cell treatment I think is pretty much in its infancy, and still rather experimental.  Hyaluronic acid injections don't work for long, so I have been told.