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Second Opinion?

I am 44 years old.  12 years ago I had surgery for a torn lateral meniscus on my right knee.  About two years ago, I started having pain in both knees, but worse on the right knee.  Orthopedist kept  sending me away for about a year with just cortizone shots.  He said there was probably nothing he could do, I just have extremely bad cartilage for someone my age and I'll need a knee replacement in my 50s.  Finally, he was able to get the HMO to allow an MRI, and, based on looking at the MRI, he decided I had worn the articular cartilage off the end of my femur, leaving exposed bone.  He said there was microfracture surgery to correct that.  But first, I also had torn my medial meniscus, and I had a bone bruise on the femur where the cartilage had worn off.  So he proposed operating on the medial meniscus, then when it healed, giving me a knee brace to take the pressure off the bone bruise so it could heal, and then doing the microfracture surgery.  This was all before he operated and had a chance to actually see what was going on inside my knee.

I had surgery about three weeks ago.  My concern is that a) he didn't operate on the medial meniscus, he ended up removing the rest of the lateral meniscus that was still there after the last surgery, and scraped out all kinds of shredded cartilage.  His diagnosis indicated I have runner's knee as well, under the kneecap, so there was some scraping there as well, and b) he decided that I didn't need a knee brace, the microfracture surgery or even physical therapy.  I had to insist on a referral for physical therapy.

My knee was feeling fairly good after the surgery up until a couple days ago, and now it hurts on the lateral side as bad as ever, when I am putting weight on it in a certain way that I can't control --- meaning it is intermittent.  But when it starts, it is excruciating and takes a bit to stop.  I am guessing this is the bone bruise?  

So my questions are:
1) Is it normal to not recommend Physical Therapy after a surgery like mine
2) Is it normal to tell a patient they have a torn medial meniscus and then not operate on it (mabye the other one was worse?)
3) My ortho is one of the primo knee replacement surgeons in this area.  I run into people that have had knee replacements by him.  So was he maybe not the best doctor for my problems because he focuses so much on knee replacement?

He also basically told me that I could limit my exercising to biking and swimming, and I might not need a knee replacement later in life.  Or, I could go back to walking and hiking, and I'd probably need a knee replacement in my 50s.  He said I have terrilble cartilage and every time he sees me he asks me if I have any family members or relatives with arthritis (I don't).

I am discouraged that the bone bruise (I think?) pain is back so bad.  He told me to come back in six weeks if I was still having trouble, but he hopes he won't see me again ----- What?  I just felt like I was some sort of hypochondriac that he didn't take seriously and so what if my activities are limited the rest of my life, there is nothing else to do about it.

So next question:
4) Is this the way HMO patients get treated?  Do I just need to push a lot harder to have something done.  Or could it really be as he is describing - nothing really else can be done.

Sorry for the extremely long explanation.


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