Alternatives to knee replacements

Posted by rorygrabowsky @rorygrabowsky, Jan 2 12:43pm

I 'm looking for people that have had injections of some materials into the knee that can give me some info that will help in my decision. The arthritis in both knees are always creating clicking sounds. I don't have pain in the knees, but it's affecting my balance and creating pain in other parts of my legs and more. Please help me.

@rorygrabowsky, I tore the cartilage in my right knee back in the 1970s and had surgery to remove the torn cartilage. I was good for quite awhile after the surgery until I developed arthritis. I had a cortisone shot in the knee when it started bothering me sometime around 2010 but don't remember exactly and it lasted a long time. The arthritis made it worse after about 5 or 6 years and I had another cortisone shot but then I made it worse by kneeling on concrete while working and the pain came back big time. I looked into a stem cell therapy clinical trial but was too old to qualify and not able to afford the out of pocket cost especially since it might not work at my age at the time. From my experience, the cortisone injections only help with the pain and I'm not sure they would do anything to help with balance that's creating pain in other parts of your legs.

Have you discussed your concern about the clicking sounds in your knees and that your knees are affecting your balance and creating pain in other parts of your legs?

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Yes John. Thanks for getting back to me. The orthopedic surgeon said the clicking is the arthritis. I just want to avoid knee replacements. A very Happy and HEALTHY New Year. May I ask your age and what did you finally do for your knee/s?? I'm 71 and the out of pocket after Medicare might be more than I can afford. I tell everyone that they shouldn't get old and poor, which I am. Let me know your thoughts.

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@rorygrabowsky

Yes John. Thanks for getting back to me. The orthopedic surgeon said the clicking is the arthritis. I just want to avoid knee replacements. A very Happy and HEALTHY New Year. May I ask your age and what did you finally do for your knee/s?? I'm 71 and the out of pocket after Medicare might be more than I can afford. I tell everyone that they shouldn't get old and poor, which I am. Let me know your thoughts.

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I'm 77 and had my right knee replacement done April 2019 at Mayo Clinic Rochester. I'm really happy that I finally got it done and did the pre-surgery and post-surgery exercises faithfully which I think made the surgery go much better. I am extremely lucky that I have a good Medicare Advantage plan through Minnesota UCare and my out of pocket was less than $300. Of course I guess I could factor in the cost of the UCare plan at 217/month but I bumped it up to a more costly plan in 2019 specifically because of the knee replacement and the better hospitalization coverage. I was fortunate enough to still be working full time from home in 2019 but retired at the end of the year so my fun money has disappeared so I'm old and now on a fixed income 😊

Here's some information that may be helpful for making a decision. If you have a supplemental or advantage Medicare plan, it would be worth calling and asking them about your options and the cost.

Does Medicare Cover Knee Replacement Surgery Costs?: https://www.ehealthinsurance.com/medicare/coverage-all/does-medicare-cover-knee-replacement-surgery-costs

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@johnbishop

I'm 77 and had my right knee replacement done April 2019 at Mayo Clinic Rochester. I'm really happy that I finally got it done and did the pre-surgery and post-surgery exercises faithfully which I think made the surgery go much better. I am extremely lucky that I have a good Medicare Advantage plan through Minnesota UCare and my out of pocket was less than $300. Of course I guess I could factor in the cost of the UCare plan at 217/month but I bumped it up to a more costly plan in 2019 specifically because of the knee replacement and the better hospitalization coverage. I was fortunate enough to still be working full time from home in 2019 but retired at the end of the year so my fun money has disappeared so I'm old and now on a fixed income 😊

Here's some information that may be helpful for making a decision. If you have a supplemental or advantage Medicare plan, it would be worth calling and asking them about your options and the cost.

Does Medicare Cover Knee Replacement Surgery Costs?: https://www.ehealthinsurance.com/medicare/coverage-all/does-medicare-cover-knee-replacement-surgery-costs

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I went With United Health care Senior Plus. No out of pocket but I double dip as a Veteran and get free meds except in an emergency like this case of this Isymthus that flared up quickly

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@rorygrabowsky

Yes John. Thanks for getting back to me. The orthopedic surgeon said the clicking is the arthritis. I just want to avoid knee replacements. A very Happy and HEALTHY New Year. May I ask your age and what did you finally do for your knee/s?? I'm 71 and the out of pocket after Medicare might be more than I can afford. I tell everyone that they shouldn't get old and poor, which I am. Let me know your thoughts.

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Have you called United Healthcare? Saves me alot

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I'm satisfied with Cigna. and can't change until next October.

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@johnbishop

I'm 77 and had my right knee replacement done April 2019 at Mayo Clinic Rochester. I'm really happy that I finally got it done and did the pre-surgery and post-surgery exercises faithfully which I think made the surgery go much better. I am extremely lucky that I have a good Medicare Advantage plan through Minnesota UCare and my out of pocket was less than $300. Of course I guess I could factor in the cost of the UCare plan at 217/month but I bumped it up to a more costly plan in 2019 specifically because of the knee replacement and the better hospitalization coverage. I was fortunate enough to still be working full time from home in 2019 but retired at the end of the year so my fun money has disappeared so I'm old and now on a fixed income 😊

Here's some information that may be helpful for making a decision. If you have a supplemental or advantage Medicare plan, it would be worth calling and asking them about your options and the cost.

Does Medicare Cover Knee Replacement Surgery Costs?: https://www.ehealthinsurance.com/medicare/coverage-all/does-medicare-cover-knee-replacement-surgery-costs

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can you tell me bout the replacement, how long was the rehab, what was the pain level after the surgery and when were you able to walk without assistance. Just tell me what you can and remind me why you didn't do injections of any materials.

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@rorygrabowsky

can you tell me bout the replacement, how long was the rehab, what was the pain level after the surgery and when were you able to walk without assistance. Just tell me what you can and remind me why you didn't do injections of any materials.

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@rorygrabowsky : Just adding a few comments…. Had knee pain due to some arthritis, and partially torn Meniscus, and some cartilage floaters in knee. Cortisone injection did not help, so had knee “clean-out” surgery in 2019. Did not really help matters, even after another cortisone shot, and a series of hyaluronic acid injections. Caved, and had knee replacement surgery September of 2018 at age 69. Quite a bit of pain, as is to be expected from a major surgery. Ditched walker within 4 days of surgery, and was walking short distances on neighborhood streets within a week. Rehab is a bitch, but having been in good shape generally, and being able to join a facility with a heated indoor pool helped matters a lot. However, I did not know about PRP or stem cell treatment before my 1st surgery, or the replacement decision, otherwise I might have tried those first.

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@rorygrabowsky

can you tell me bout the replacement, how long was the rehab, what was the pain level after the surgery and when were you able to walk without assistance. Just tell me what you can and remind me why you didn't do injections of any materials.

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@rorygrabowsky, My reason for not having any more injections was that they would not have helped me. I had bone on bone pain before the replacement and was told an injection would no longer help. I had one about six months prior to the knee replacement and it helped for about a week and then I did some more damage to it by working on my knees on concrete and the pain was back like it was prior to the cortisone shot. That's when I decided I needed to do the knee replacement. I think you have to wait for 3 months after a cortisone injection before you can have a knee replacement.

When I met with the surgeon he gave me some pre-surgery exercises to do while waiting for the replacement surgery which was scheduled a month later. I actually think the exercises are good for all of us elderly types to maintain mobility and flexibility. Here's some cheat sheets that explain the different exercises.

Before surgery knee exercises: https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/total-knee-replacement/preparing-for-surgery/before-surgery-knee-exercises
Post Op knee exercises: https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/total-knee-replacement/after-surgery/knee-exercises

I also have an exercise bike at home which helped a lot during the home rehab. I had my TKR on the 1st of April, 2019 and the weather was not great in Minnesota so it put a crimp in outdoor walking for the most part although I was able to get out and walk in my driveway using a walker the first and second week after my surgery. I then used a cane for about a month until I was able to walk OK without it. I think I felt I was almost back to normal about 2 months after my TKR. I still take stairs gingerly but I think that's more due to my degenerative arthritis and my age (not wanting to fall or trip!).

The goal of the surgeon and care team is to get you out of the hospital the day after your surgery so the the physical therapist at the hospital gets you up the morning after the surgery and starts you on the post op exercises and makes sure you can walk OK and shows you how to go up and down a small staircase they use for post op. The most important lesson I learned from my post op rehab was icing and elevating the leg. This helps control the swelling and reduces the pain. I wasn't having much trouble with the pain but the swelling was there and my follow up with the surgeon about a month after the surgery, well lets just say he gave me the what for because I was not elevating and icing the knee enough. So anytime I wasn't exercising or doing something, I iced and elevated my leg. I did it when I was watching TV, reading, working on the computer or just napping on the sofa.

Questions you might want to ask your surgeon or care team before the surgery…
– 8 Questions to Ask Before Knee Surgery: https://www.arthritis-health.com/blog/8-questions-ask-knee-surgery
My personal thoughts for questions…
– What type of hardware do you recommend/use for the knee replacement?
– Will I get an allergy test for the bone cement, metals, etc. used in the replacement components?
– Can you explain the risks – possible nerve damage, etc.. ?

Other members may be able to provide other questions, but I would make a list and take it with you when you talk to the surgeon.

Best of luck whatever you decide!

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Rory. I would strongly recommend not doing anything until Covid is under control. My husband
had TKR Oct 27. Then had a revision due to suspected infection(extreme pain)
He contracted Covid in hosp or rehab center, and it has been a nightmare Hospitalized 5 times. He is just starting to feel a little better. Lost 30 lbs. No appetite. Does not sleep well. Huge setback on knee PT. Kidney damage due to antibiotics (high creatinine level) which I had to administer by PICC line. He is 78.
Wait till corona is not a risk.
I think one is able to change from Medicare and a supplement to an Advantage plan at any time. Not just during open enrollment.
Joan Flynn

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@ellerbracke

@rorygrabowsky : Just adding a few comments…. Had knee pain due to some arthritis, and partially torn Meniscus, and some cartilage floaters in knee. Cortisone injection did not help, so had knee “clean-out” surgery in 2019. Did not really help matters, even after another cortisone shot, and a series of hyaluronic acid injections. Caved, and had knee replacement surgery September of 2018 at age 69. Quite a bit of pain, as is to be expected from a major surgery. Ditched walker within 4 days of surgery, and was walking short distances on neighborhood streets within a week. Rehab is a bitch, but having been in good shape generally, and being able to join a facility with a heated indoor pool helped matters a lot. However, I did not know about PRP or stem cell treatment before my 1st surgery, or the replacement decision, otherwise I might have tried those first.

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@ellerbracke cortisone shots are always a gamble. If the doctor doesn't get the exact right spot they do no good. I finally did find a doctor who hit it every time and it did provide quite a bit of relief. I also had Synvisc when the cortisone was no longer helping, and that was a huge help for a while. I have discovered since then that the best doctors to go to for these shots are the physiatrists – doctors of physical medicine. They use guided imagery so they can hit the spot consistently. Eventually, I did need TKRs on both knees.

The second TKR had to be delayed due to a low platelet count. During the wait, I exercised a lot and the improvement in my supporting muscles made a huge difference. I was waiting for 3 years. I highly recommend exercising but anyone who is waiting for a TKR should check with their orthopedist to know exactly what exercises that doctor advocates. Mine loves the recumbent bike and water jogging.
JK

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@rorygrabowsky

can you tell me bout the replacement, how long was the rehab, what was the pain level after the surgery and when were you able to walk without assistance. Just tell me what you can and remind me why you didn't do injections of any materials.

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@rorygrabowsky I realize this was directed to John, but I have had two TKRs.

I had injections, first cortisone then when that no longer helped, Synvisc. When that stopped helping much it was time for a TKR.
There was pain after surgery of course, but for me, it subsided fairly quickly, except when I tried to sleep at night. These days they are very strict about prescribing opioids but the first time I had a replacement I was able to get them for about 6 weeks, enough to take one at nighttime. They are saying that ibuprofen is as effective as opioids for pain but I can't take them, I can only take acetaminophen which frankly does not help a lot.

I don't think I stayed on top of rehab as well as I should have. I never quite achieved the flex that is generally strived for. I was able to walk without assistance fairly quickly. I never used crutches, they are difficult for me, so I went directly from a walker to walking independently in a couple of weeks or less.

When you are on Medicare you are eligible for a physical therapist to come to your home as long as you are "homebound". The PT I had was great. I wish I could have kept him longer but I really wanted to get out of the house to do things and when you having the in-house you are only supposed to be able to go out for doctor appointments and to church.

Good luck with your decision. Please let us know how it's going and if you decide on surgery how well that goes.
JK

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