Post operative risks and MS

[PatHC]

Dear Dr. Kantor,

My dilemma is not about whether I have MS or not but advice on another procedure I am due to have carried out.

In September last year I had problems with my legs to the point of being unable to walk for a time, which ended in being referred to an orthopedic surgeon. An MRI on my knees in January this year revealed that the right knee has some reduced space, bits of bone / debris and a tear in the meniscus cartilage. This was anticipated as it has given me problems for approximately 12 years. An arthroscopy was recommended and is booked to go ahead on 1st May.

However, the surgeon felt that the main problem with my legs that I had been referred for was probably neurological –and adviced me to talk to my neurologist.

I had a further meeting with my neurologist last week to discuss the symptoms I had experienced in my legs. I was diagnosed with mild MS in December last year and during the diagnosis phase we had not considered my knees / legs as I had been told by my GP it was a physical injury, caused by overuse. The neuro has now ordered an MRI of the spine, a full neurological exam (it did not include my legs last time) and an LP if the first 2 tests are not conclusive. He also said 'Are you sure you have enough pain in the right knee for surgery?', as he is now sure that my leg problems were typical for MS.

During my leg problems the left knee was much worse but no problems were detected on the MRI.

My questions are:

Should I go ahead with an arthroscopy or delay it  until my MS diagnosis process is complete?

As the operation is predominately diagnostic, although he does think my knee will be more 'comfortable' afterwards, would it be an unnecessary risk having a full anesthetic for a diagnostic operation,  are there extra risks with MS in this?

Thank you and sorry to be so long winded but the story is a real mix up of symptoms being mistaken by both me and my GP.

Pat

[Dr. Daniel Kantor, MD]

It is difficult to say because it is not clear to me from your question whether the doctors (who actually know you) think that your problems are related to your knees versus MS.

[flowerfloosey]

I have had similar problems and just had an arthoscopy of my right knee. I had an excellent anesthesioligist for both a hip replacment and knee surgery. He went over all my medical records and felt that general anesthesia was much more safe for me based on not "fooling around" in my spine where MS does it's damage (spinal fluid). My knee is much better after a meniscus tear debridement. Good luck

[PatHC]

My question was with regard to risks of anesthetic and MS and as I said in my message the arthroscopy was booked for 1st May and has now been done.

Thank you for your reply.
Pat

[Dr. Daniel Kantor, MD]

While some people think that epidural anesthetic or intradural may be dangerous in MS, it is not entirely clear

The genral rule is that if anesthesia is necessary, then it should be used (and general may actually be safer but overall, obviously, it is not for anyone -- MS or not).