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TKR out of the question when you've got PN?
Hello, fellow PN'ers!
I'm suffering a double whammy. A triple whammy? Whammy No. 1: I'm 80. Whammies Nos. 2 & 3: I have large-fiber PN – no pain, but poor balance – and a left knee that aches with arthritis. My right knee is already a TKR, so I'm familiar with the procedure. I'm doing PT for my poor balance, but much emphasis is on building leg strength. My therapist and I both recognize that the most effective exercises for rebuilding leg strength are the same exercises that aggravate my arthritic knee (e.g., squats, thrusts, sit-to-stands), so I'm relegated to "gentle" exercises. I feel my bum knee is hampering my chances of rebuilding leg strength. But at 80, with PN-related balance issues, I'm pretty sure I'm no longer an ideal candidate for a second TKR. Has anyone else found themselves at a similar crossroads? Has anyone 80 or thereabouts, with poor balance and bad knee arthritis, ever found a workable alternative to a TKR? I'm obviously on the hunt.
Ray (@ray666)
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An exercise bike is good for building up lower leg strength. I know it has helped me.
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3 ReactionsI'm "only" 66 years old, and have been dealing with osteoarthritis and neuropathy in my feet for over a decade now. I've had problems with my knees for over 30 years, and underwent a partial left knee replacement in 2018, even though we were hoping they'd do a TKR once they got in there. That knee still gives me problems, as well as swelling and pain. Now my right knee needs a TKR, but my orthopedist wants me to lose 40 pounds before he'll do the procedure. I have constant pain and numbness in my feet, along with balance issues. If I have to walk for more than 10-15 minutes, I need my walking stick to help maintain my balance. I've never even considered not having the surgery because of the nerve damage in my feet.
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1 ReactionHi Ray, I had my right knee replacement done in my mid 70s and like you I don't want one done on the left knee even though it may have to happen some day in the future. I try to work on my leg muscles daily and because I can't walk very well I mostly exercise on a Teeter FreeStep Cross Trainer which is like an exercise bike but you also use your arms. At 82 I don't yet have any pain with the left knee but I know it's bone on bone so not much cartilage left in knee. Next year I'm going to try and figure out how to walk more outside other than doing laps with a shopping cart at the grocery store 🤣. Too cold now and winter is right around the corner. I've thought about using one of those stretchy knee braces that gives a little more strength to the knee but haven't got one yet.
One day at a time my friend!
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3 ReactionsHello, @bajjerfan A coincidence! I just walked into my workroom and powered-up my Mac laptop for two reasons: (1) to check Connect and see if I'd had any responses to my PN & TKR question, and (2) to go for a ride on my recumbent bike (which just happens to be here in my workroom). So you see what I mean by a coincidence? 🙂
Ray (@ray666)
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2 ReactionsHi, John
I hadn't realized we had similar ouches in this area, too! It can be difficult to get adequate exercise. I find this particularly frustrating since my PN doesn't having me looking for pain medications. About the only thing I can do to improve (even minimally) my bad balance is work on rebuilding leg strength – and that's where an arthritic knee has shown itself to be a major obstacle. I'm hoping I'll be able to consult with my orthopedic doctor in the coming days. He may have a suggestion –– a wrap, strap, or brace of some sort –– that I'm not thinking of.
As you say, John: One day at a time!
Ray
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1 ReactionHi, @mrmacabre. I hadnt mentioned earlier that I'm also "addicted" to orthotics. Because of my laughably flat feet, I was first fitted for orthotics way back in the 1980's, and have worn them ever since. Of course, to wear my orthotics, I must wear my shoes, even when I'd much rather go about barefoot. If I go around barefoot, however, my joints – ankles, knees, hips – lower back, too, will soon start complaining. So, in my search for some sort of knee relief, my addiction to orthotics has to be taken into consideration.
All the best to you!
Cheers!
Ray (@ray666)
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1 ReactionSo sorry for the needed second TKR. I needed a new hip at age 84. I asked the doc if I was a good candidate for surgery at that age. The reply I got was that even if I were 94 and needed a new hip, I would be a candidate for surgery;. If I were 94 and needed a hip or a knee, surgery would be encouraged because it would help keep me mobile, out of a nursing home, and much more able to move than to not have the surgery.
I recovered well, it took me longer than when I was younger (I've had TKRs when I was about 65 and 70 and no problems to date w/ either).
If possible have support at home after surgery for longer than you think you'll need it. It took me about 6 weeks, my daughter left after a month and came back a few weeks later to find me almost w/o food in the refrig because I didn't have the energy or, at that point post-surgery to be sufficiently organized to make arrangements to use InstaCart or some other way to get food into the house. I was not upset about it. I managed, and loosing a few pounds didn't hurt!
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1 ReactionHi, @joanland
When you say, "If possible have support at home after surgery for longer than you think you'll need it," I heartily agree. Unfortunately, I don't have anyone here at home to support me. When I got my first TKR, my partner, who lived two miles distant, moved in with me. And she was a huge help! Sadly, she has since died. The notion of a TKR and weeks of critical recovery but without a helper here at home weighs heavily on me, making think a second TKR is to be avoided if at all possible. In any event, I'll pow-wow with my orthopedic doc next week to hear what he has to say. I can't imagine I'm the only person who's met with him and who faces the obstacles I'm facing: 80 years old, PN-related poor balance, a bone-on-bone knee, and living alone.
My very best to you!
Ray (@ray666)
@ray666 , I hesitate to suggest this because you sound like you've already been through the wars, and all the stuff that helps us defer the TKR is stuff that you've done, but I have to say that the single most useful thing I went through in regard to buying time was fixing my gait. I've lost weight, had knee injections, contemplated and may try acupuncture, been through PT to work on strength and found that I am also limited by the pain and balance. All of that helped. However, the years I bought by working with a therapist trained in observing and improving gait (he focused normally on dancers, which I emphatically am not) were striking. Took maybe a year, because how you walk is a big habit to change, and included bracing my hip for a few months to reduce the torque on my left knee.
So...something to discuss with your orthopedist?
@ray666 I'm pushing 79 hard. I've had both total hip and total knee replacements since I was diagnosed with idiopathic distal axonal sensory polyneuropathy . I don't think that the neuropathy symptoms have changed or worsened as a result of those new parts being installed. I know that another TKR is in my future but I just had a steroid injection to buy some time.
During the day when I'm up and about, my balance is, at times, not the best although that may be a result of some instability with the knee needing replacement. Also, many days I feel like I'm walking on a thick, spongy surface. I still stay as active as I can, even on rough terrain. I take gabapentin only at night so that I can get pain-free sleep. I've accepted that this is as good as it's going to get and am trying to make the best of managing the symptoms.