chronic knee pain

[ejgerr28]

i am 53 years old. i had surgery for torn meniscus in left knee on 10/13/2007, and i have been in pain since. i am currently receiving my 3rd round of synvisc. i have had 3 or 4 cortisone injections,  they seemed to be helping but the times in between have gotten shorter.  my dr. keeps telling me i'm too young for knee replacement. he tells me it's arthritis, i can't believe it.  i am not overweight (147 lbs.), however, before the surgery i weighed 128 lbs. i was very active, walking 2 to 3 miles at least 5 times a week, but the last time i tried walking i could only do about 3 blocks. the pain is intensifying, i cannot sit for long periods, when i drive, it is worse.   i started taking chondroitin glucosomine about 3 weeks ago. i do NOT want to take pain pills. the naprosyn, motrin has taken it's toll on my stomach. my doc gave me celebrex last week, this couldn't even touch the pain. i went back to aspirin.  is there anything i can do? my 3rd injection is tomorrow and i want to ask for a copy of my medical records to get a 2nd opinion. Am i being unreasonable? i am not anxious to have surgery, and my friends think it's great that my dr. is not in a rush to do surgery, but i cannot tolerate the pain any longer. i am at my wits end. please help, liz

[JS858]

My recent OS said 10 years for TKR and I only have one chance.  I've also heard other OS say 15 to 20 or longer depending.  I went to a siminar on joint replacement and it scared the heebe jeebe's out of me.  The OS said if a 2nd TKR on the same knee is needed that more bone will be comprismed and the patient will experience much more pain with every replacement after the first.  I'm 50 y/o, OATS failed  LK, microfraction failed RK, now have problems behind the knee which was exasberated with yoga & pilaties.  My gosh!  Not sure where to turn.  Hopefully the 3rd OS has pain shots and PT that can help me.  So much confusion on TKR.  

[Michael L Gross, MD]

Most likely, you are suffering from some combination of osteoarthritis and post-traumatic arthritis.  It sounds like you and your surgeon have done everything possible to avoid a knee replacement.  One comment about you weight.  You indicate that you have gained twenty pounds since your arthroscopic surgery.  Getting back to your original weight can only help, and may reduce your symptoms substantially. A combination of gentle low impact exercises with diet control will be essential.
If knee replacement is your final option, then age should not be a boundry.  Improvements in implant design and surgical technique have produced greater prostheses longevity and has led to total knee replacement in younger patients.  Many surgeons agree that if your symptoms have become a significant limit on your life and lifestyle, and all else has failed, then total knee replacement surgery is warranted in the younger patient.
Finally, depending on the findings on your xrays and physical examination, you may be a candidate for a partial knee replacement rather than a total knee replacement.