Knee damage (Good and bad news)

Hi folks,

I saw my pain management doctor today, and the bad news is that it looks like my left knee is pretty destroyed (degenerative join disease, little cartilage).  However, I am excited because I'm finally going to be on a pain control regimen, which means I can get more active before surgery!  To the pool I go!  My question for folks is: what has the pain reduction been like after significant weight loss?  I'm only 34, but the doctor said I'd be looking at knee replacement in the long term.  I'm hoping that the weight loss will cause a lot of changes.  

Both of mine are "stage 4" which means that double knee replacement is now a matter of when, not if. My weight loss helped somewhat, but degeneration of my joints over the last 11 years has negated any pain reduction from the weight loss.

Hi Bette,

Thank you for responding!  Yes, I would imagine that will be the case for me as well, but it has to improve some. I weigh over 500 lbs right now!  I didn't get a stage.  I'll have to ask about that next time.  

I really expected to get much more relief from the pain in my knees than I acrisply got even after I lost almost 200 pounds. I didn't have my knees xrayed until I was about a year out from my RNY and wasn't getting much relief from the pain in my knees.  I just assumed that they hurt from carrying so much weigth and that -- like so many people that I read about here -- I would get a lot of pain relief once I lost the weight.  Nope.didnt happen that way. Once I had the X-rays, I was told that I had "severe" tri-compartmental arthritis in my left knee and "moderate" in my right knee.  (I haven't heard of "stages" of arthritis.  Neither my orthopedic surgeon nor the one I saw for a second opinion used them... they stuck to the mild/moderate/severe categorization.)

The problem is that if the pain is caused by actual physical deterioration rather than just pain from carrying too much weight, that deterioration is permanent and, especially if you have a lot of bone spurs and/or are "bone on bone", all you can do is try temporary fixes until you get a knee replacement.

You can get some idea of how much of it is weight/pressure related and how much is degeneration/deterioration by flexing and extending the knees back and forth a few times while sitting.  The pain you feel while doing that is NOT going to improve with weight loss. There is no way to know, though, how much of the load bearing pain will go away.

I did Synvisc One injections in both knees for four years and  was taking Tramadol every day for almost three years (and then Vicodin more days than not for about 2 years) before I finally got up the courage to have the first knee replacement done.  My orthopedic surgeon also wanted me to wait until I turned 50 if at all possible since the replacement knee is only good for up to 20-25 years (and often less than that) and you can only have two replacements in a lifetime with the current technology. (There isn't enough of your own bone left to do it more than twice and even the second one is apparently often often less successful than the first in terms of joint flexibility and pain relief.)

I had the first knee replaced in March 2012 and had the second knee replaced in November of the same year. The surgery, recovery, and physical therapy hurt more than anything else I have ever done, but I am now able to walk at a brisk clip without pain for the first time in about 15 years, and it is wonderful! I still have some odd pain in one leg just below the knee (I have an apt on the 18th to have the ortho surgeon look at it, but my PCP thinks it is a tendon issue) and still have some stiffness in one of them periodically (which is easily addressed by icing it for about a half hour).

I don't mean to be discouraging, but I honestly wish that before I had my surgery I had read a post here from even one person whose knee pain didn't go away after they lost weight.  If I had, I might not have been so disappointed by (and so mentally unprepared for) not getting much pain relief and still needing the TKRs sooner rather than later.

Lora

Constant  knee pain was the final straw that pushed me to WLS. I was taking  vicodin and Naprosyn all day, every day just to get through the day.

A lot of weight had to come off before I felt a difference. Now I don't have any pain at all. Well, that's not  entirely true. I injured my left knee by wearing inappropriate shoes when I  started  walking/jogging. I now wear a knee  brace if I exercise long distances just to support my knee.

I'm the rare exception in that the weight loss "cured" my joint pain. I'm 52 and my highest weight was 449 lbs. Prior to surgery my knees felt like they were bone grinding on bone. My PCP says  she can feel arthritis in the knee but it's nothing like it was before.

I had an RNY on 9/8/14 and found that walking was terrible since I could no longer take my arthritis medications. In October I had my left knee replaced and I did great. I recovered so well that the surgeon agreed to replace my right knee in December. At 9 months post-op, I am now able to walk, climb stairs and ride my bike 10 - 15 miles a day.  Remember, you cannot take NSAIDS with an RNY.  Good Luck... 

Thank you!  That is very encouraging to know! I am actually getting the VSG and the NSAIDS are a part of that decision.

Hi there! 

It's also a matter of when, not if, I will have TKR but I also went into WLS hoping for some pain relief. My goal is to get into much better condition before having the knee replacements, though my surgeon (I've had a few arthroscopy/repairs over the past 6 years) hopes I can manage for a few more years, due to the expected lifetime of the replacement joint. (Sounds like ****rogirl!) 

Giving up NSAIDs (due to RNY), and having to walk, even around the hospital corridors, was super difficult immediately post surgery.  I've lost a little more than 33 pounds in the 4 weeks post surgery, so I can't say I have significant loss. But I can say that I have felt some good relief from the weight loss so far. Those pounds off my knees are making things more manageable already. I'm managing with ice packs and external analgesics at night at this point, but I'm not sure how I will feel when I get into more strenuous workouts.  

Have you settled on a surgery yet?  The NSAID restriction applies to RNY, but I believe you can continue to have NSAIDs with either DS or VSG. this may be an important consideration for you from a pain management perspective.  

Good luck to you, and congratulations on starting your journey!  

Hello!  I have decided on the VSG partially due to the NSAIDs and my age.  I'm only 34, so I really don't want to go malabsorption at this point in my life.  I (hopefully) will have quite a few years left, and that's a long time to live with some of the less pleasant side effects.   I have heard that for every pound that you weigh, 4 pounds of pressure is put on your knees, so that means that you have already taken 120 lbs off your knees!  I'm just so sad to know that my knee was this bad.  I was hoping that it would at least be in moderate shape so that weight loss would solve most of the problem.  But, what can I expect after all?  I have had many, many slip and fall accidents on that knee and I'm super super obese.  Don't you love that term? haha :)

I wish I had the sense to look into this when I was your age.  I would have saved myself 20 more years of knee damage.  So you should feel good that you're doing this now. You're right that you have many, many more years ahead, full of life and joy and good health.  While you may not see a total relief you can see that many folks who've lost a lot of weight have seen considerable improvement.  Hey it's not going to get worse, right?  My doctor told me 9 pounds of pressure on the knee for every pound in our bodies... Regardless it's a lot of pressure off the joints already.  I feel the difference.  I hope you do too!