Knee injections and knee replacements

See, that's where I come in...LOL  I was over 300 for each surgery, unfortunately.  The surgeons here are of the belief, as I am, that it is a double edged sword.  You need to exercise to lose weight and you need lose weight to exercise and both are inhibited by those knees. So, they will operate at the heavier weight because they understand we can't get the weight off when we are in so much pain from the knees.  One issue tho is that they expect a patient will gain 50 pounds or so after surgery from immobility.  And I did. But the ability to exercise was now possible and I was able to lose weight after getting the band.  (Unfortunately for me, other issues came up with my neck and spine to stop most exercise).

Anyway, taking age into consideration and the ability for each to do what it takes including deal with the pain, many surgeons are now understanding that it might be better to replace the knees to make movement possible.  Just depends on who you see I think.

how is the injections different from any OTC pain reliever?

There are two kinds of injections: steroid injections such as Cortisone  (which lessen the inflammation and therefore the pain) and viscosupplementation injections like Synvisc and Supartz (which use hyaluronic acid or a similar substance to replace the natural lubrication of the knee that is missing in arthritic joints). Not he former is a single injection and the latter can be one injection, two injections at least a week apart, or three injections at least a week apart.

Although some steroid injections include a local anesthetic that will numb the joint for several hours after the injection (I loved it when my PCP started using those!), neither type of injection is a pain killer.  They just address the source of the pain.

Steroid injections generally take effect very quickly, but the others take several weeks to reach maximum effect.

Both are of limited value to people whose arthritis is severe/advanced, and they can only be given at certain intervals.  They often become less effective as the arthritis worsens.  Insurance usually covers steroid injections but coverage of the viscosupplementation injections varies quite a bit (from no coverage, to partial coverage, to full coverage (subject to whatever deductibles and co-pays your policy has).

Lora

I had both knees replaced at age 47 before my RNY. I tried injections but they did not help me. I do not notice clicking, but do get an occasional pop but not anymore than with my bio knees. You will be limited on some activities after replacement but the pain goes away. I was amazed at being able to sleep thru the night without pain. I was told never to run or kneel and I do not have the same range of motion but I function well. I do set off the metal detectors at airports but its a small inconvience.

I am not around much but, I had trouble with knees before surgery and after the cortisone injections didn't work so well, they did an arthroscope on my left knee.  That is where they go in and remove loose cartilage and smooth bone edges.  It was an outpatient surgery.  I went home with a walker, I didn't feel safe on crutches.  I was off my feet for 3 days (not completely I could walk and get up some)  and then it was OK to get back to the everyday without putting too much strain on knee.  I did the exercises they said to do and within 3 weeks was back to normal, but no jumping or high impact exercise yet.  At 6 weeks they started the synvisc in 3 injections.  For me that lasted 1 year.

Fast forward t 6 years and I had the scope done to the right knee. Same basic procedure for the surgery but I had 10 PT visits after and they used orthovisc.  The left knee was good for all of that time but was beginning to bother so we did the orthovisc in it as well.  I should go get my 2nd round in my right knee but I have been putting it off.  I exercise at Curves 4 days a week and do zumba every other week along with it. really believe it was having the arthroscope first that did the trick.  Whatever you decide on Good Luck.

Dear Cathy,

I have had chronic OA for over 25 yrs now, I am 58 yrs old now, and have had 16 orthopedic surgeries. Having had the bariatric did not help the OA, the Dr told me that upfront. But, however after losing 126lbs, it did help with all other health problems. The other exception is Fibro, and esophageal problems.

 To answer your question, in the beginning the Dr had me on NSAID's. The one of choice since it came out is Celebrex, I take 200Ml, 2 x day. Then I had 2 Arthroscopic surgeries to 'clean up' the torn cartilage etc., also I had a series of Hyalgan shots which (at that time) was once a wk for 5 wks. That helped a lot for 10 months. I did that as we were traveling to Europe and I wanted to be sure I could walk. I did!  But, over time the knee got much worse and finally I had to have a knee replacement. That was in 08. Be absolutely sure you have the best Dr. Get 2nd and 3rd opinions, keep a copy all test results on disc's and reports as well. 

In my mind there is a wrong way and right way. This is what I did. Total knee replacement, for women. Men and women move differently and we require a knee that will rotate a certain degree to walk up and down stairs properly. From the hospital I went into an inpatient rehab facility. There, I underwent extensive PT, lasting hours a day 6 days a week. I was there for four weeks. Then once home PT came to me, and finally I went out to PT. Overall I stuck with it for 4 months. Now, here is the good news. Here I am 6 years out, and no one, not even a Dr can tell I have an artificial knee. No limp, no problem with stairs, no pain, full flexion.

I will tell you it was no picnic, you need a strong resolve and be surrounded by good family/friends. You will have no life during that time. But, in exchange you will be getting a much better life in the end. Nothing is for free. You have to be willing to put in the work, hard work, no matter how bad it hurts.

The one thing that happens to many people is one leg is 1/8th" longer than the other now, which has caused the hips to be misaligned. That in turn has caused lumbar joint pain. I do need surgery in that area, but not due to the misalignment. My Podiatrist put a 1/8" lift in the heel of my shoe, and orthotics in both shoes. Now my back is much much better. You may want to keep that in mind. 

In Oct. I am booked to have a full rt shoulder replacement. Much worse than knee or hip. But the rotator cuffs went on both arms, and even with repair this shoulder is a mess. I have put it off for a long time. But no longer. I will follow the same format as I did for the knee. I already have my name in for arrival at the rehab facility. 

Just know that each and every person is different. A lot depends on your Dr's. It took me a long time to put my team of Dr's together, so they will work in tandem instead of against one another. More than anything I listen to my gut, no one knows me better than me. Not even a Dr. Do a lot of research, know the information before going into the Dr. That will allow you to ask important questions and tell the Dr you mean business and are serious about your health.

I hope I have helped answer your questions, if I do anything else to help just let me know. Good luck!

I just wanted to second your comments on picking a high quality surgeon!  The right (or wrong) surgeon -- and his chosen rehab protocol -- can make a world of difference.  I was surprised to find some surgeons with very lax PT requirements, and anyone who has had a knee replaced knows how critical the PT is to full recovery.

My ortho surgeon had an excellent reputation with two other surgeons I asked (my general surgeon and my bariatric surgeon) and is part of the treatment team for our minor league baseball team. The hospital also has a special "Joint Center" (with private rooms for everyone, and with steps to practice on if you have steps at home, and even a "car" to practice getting in and out of).  Some people who had surgery elsewhere were just given written instructions on how to handle the steps and car.

Knee clicking tends to occur when the joints are being extended, and at times, it can be accompanied by severe pain. The knee starts to click because, more often than not, there is a part of the knee that is not in its proper position.

http://www.doctorshealthpress.com/pain-articles/knee-clickin g-causes-and-exercise