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OA Knee Pain (IN 2 PARTS)
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OA Knee Pain (IN 2 PARTS)

It has been a terrible few days. We have had a series of small little storm symptoms coming in and out. I have so much OA knee pain. I was dx with OA in my knees at 17 years old. I have been dealing with it for 32 years! I have tried years of meds, heating pads, cortisone shots, weight loss, aqua aerobics, physical therapy, Synvisc etc... I have limited mobility. I can get only about a 90 degree bend in my right knee on bad days, about 95-100 degrees on good days and I can’t straighten it to save my life. My balance is way off.

A year and a half ago the radiologist report said I had moderate OA damage that also involved my patella. The insides of my knees are more involved than the outside. My knee now feels worse than it did then. I wonder what he would say now? It feels like it’s getting to be bone on bone time. I walk with a painful limp that favors my right leg. When my pain is a little better I still have a limp. When my OA is raging it is difficult to walk and or stand. My strange gait has now caused pain in my lower back. My hips are starting to develop OA pain. My right thigh muscles have atrophied over the past few years.
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1083596_tn?1313398276
Dear Gkneez,
Many thanks for posting this question via my forum.I really appretiate that you have given too many minute details while asking about your doubts.
After reading your history i would suggest you to opt for a knee replacement surgery as the more we wait the worse would be the post operative picture, reason being the muscle weakness/atrophy.
Due to arthritis, the cartilage of the joints get damaged, thus exposing the nerve endings.Once the nerve endings are exposed, each time the joint is moved, the patient experiences pain.The amount of pain depends upon the number of nerve endings involved.Due to pain while  moving the joint, the muscles around the knee contracts, so as to bear the pain in a better way.This results in decreased joint movement and since the usage of the muscles decreases, causing atrophy.
So you can see that it's all a cycle related,Hence a surgery will break this circle,
                     Each implant has a rough time period.A normal knee implant lasts anywhere between 15-25 years.Hence second surgery may be required, after that age.
I have kept my answer as simple as i could.
However if you feel that you need more clarification, please discuss.
regards
5 Comments
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892665_tn?1259175314
Part 2
Last winter my physical therapist had me doing 1½ hours of PT three times a week. Plus he gave me an hour of at home exercises 3 times a day. My PT kicked me out of PT after 3 months because I had gotten as much as I could from PT even though there was no real improvement. I still couldn’t straighten my knee and still had limited mobility. My balance was still off. My muscles did begin to gain a small amount of size perhaps I didn’t notice much. When my physical therapy was over it began to atrophy again even with continued PT at home. The physical therapist said that I would be lucky to have 90 degrees after a TKR. He suggested that I have a TKR sooner than later.

My Osteo Surgeon Dr is trying to buy me some more time before having a knee replacement. I'm only 50 and she of course would like me to wait as long as possible before a TKR.  I received another round of Synvisc shots this November. There is no difference in pain levels or in my limp. I do have a small amount of increased mobility when I bend my leg. I still have difficulty bending down, putting on pants, socks, and shoes. Unlike the last round of Synvisc I am still having PAIN. The shots this November didn’t seem to work.

Meanwhile, I can’t sleep because of the pain. My Vicodin is not touching the pain. If I take more that one pill a day I can't sleep at night. I have been trying to tough it out and only take one a day. That leaves me in pain.

Without the sleep my Fibromyalgia and Chronic Fatigue is really raising their terrible little heads. I wonder if my Fibromyalgia is increasing the pain I feel from the arthritis? How long do I wait? How old is too young? Does this ever end? I wonder if my Fibromyalgia is increasing the pain I feel from the arthritis? Am I ruining my chances of mobility by putting off the TKR?
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892665_tn?1259175314
Dr. Ghosh,

Thanks for answering my post. I have a few additional questions concerning a TKR. I do agree I feel that I am ready for the TKR, 32 years is enough pain. My questions have to do with any complications regarding having a TKR and its recovery with my Chronic Fatigue Syndrome and Fibromyalgia.

Will rehab and surgery be complicated because of my CFS/FM? I have so little energy as it is with CFS that I am worried about the added stress and tiredness that a major operation will have on me.  Will Chronic Fatigue Syndrome become a factor in my rehab? How do you suggest I get through the physical therapy afterwards?

Since fibromyalgia is one of a group of chronic pain disorders that affect connective tissues, including the muscles, ligaments, and tendons. Will I suffer from additional muscle pain and weakness. It is difficult for me to stand more than a few minutes when I am in a flare. I would suppose that the surgery would put me in a flare because of the stress on the body. I understand that the OS will need to cut through muscles. Will this post surgery resulting muscle be compounded by the FM?  Will this effect my rehab?

My other question is concerning pain. Granted I am in PAIN 24/7, although I am not use to it I feel mostly as muscle pain and I have learned to deal with much of it with the help of medicines. It is said that people with fibromyalgia actually have a much lower threshold for pain than those who don't have the syndrome. This means that even a gentle touch could cause excruciating pain in someone with fibromyalgia, which at times it does. The research says that it seems that those people with fibromyalgia actually experience a change in this signal once it reaches the base of the spinal cord. Here, the pain signals are actually magnified, causing extreme and chronic pain. It seems that people with fibromyalgia actually experience a change in this signal once it reaches the base of the spinal cord. Here, the pain signals are actually magnified, causing extreme and chronic pain. I know pain relief will need to be an important discussion to have with my Dr. My questions is how much pain can I expect? Will I experience more than a usual patient? How would you suggest discussing this my Dr. without sounding like I am druggie?

My last question is will when will I be able to get back to work? I am a single mom I don't have a lot of sick days. I teach second grade and I can work surgery close to one of my one month vacations to help out financially. Some days I barely get through my day at work as it is now due to fatigue. What can expect my fatigue level to be as I return to work? Would my medical problems make returning to work more difficult? How many weeks would you guess I would be off work?

Thank you so much for your help
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1083596_tn?1313398276
Dear Gkneez,
Sounds like a lot of apprehension.
Please note that fibromyalgia and Pain after TKR are generally not related.
If the surgery is fine and your doctor puts you in good post operative medicines for pain relief, the pain should never happen. But this should be followed up with an excellent physiotherapist, else the pain will persist due to muscle atrophy.
The magnitude of pain, i can't quantify presently as i have not examined you.
You should/can discuss all these in details with your doctor also, and he will be able to guide you much better as he would have had examined you properly.Don't worry, he will not think about you as "Druggie".
And lastly, if all is well, within 6 weeks you will be able to do mild work, all by yourself.
Regards
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892665_tn?1259175314
Dr. Ghosh,
Thank you for all your comments. I appreciate your help.

Gkneez
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