Knee surgery..been there? done that?

[Silverfox]

So...
I have researched several old archives on knee issues the best I could on this forum and still have a couple of questions..


Some background..I have some osteoarthritis in my knee from a couple of injuries and suffer an uneven wear pattern..which has left me somewhat bowl-legged and uncomfortable ..especially on descents..what has led me to consider surgery at this point is that my gait is messed up and occaisionally effects my hip and back on that side..

I have tried many things...stretching, strengthening, an occaisional cortizone shot, euflexxa, etc but have reached the point of the "next step" ..

I have consulted with several docs who consider me excellent candidate for TKR ..(total knee replacement) and expect that hiking would not be an issue..
so the questions are

Am I really the only one with achy knee out there? On some group hikes it seems that way.

And, has surgery, be it TKR or ACL been an option for some folks and how has it worked out..

thanks..beautiful day..I'm going out showshoeing...

Moderators..if this post redundant please delete

november2, 2010...
as a side note..I see coldfeet brought the post back..man..I sound pretty drugged up on some of those feb 2009 posts...but anyway , TKR done in feb 2009..since then single season winter 2010, summer 2010, probably fall 2010 getting in shape for winter..no looking back..no side affects.no vitamin I..no problem..except for work..hiking 4 or 5 days in a row..Let the good times roll

 

[rocket21]

Am I really the only one with achy knee out there? On some group hikes it seems that way.

Absolutely not. That said, your knee issue is dramatically more severe than mine and it's amazing you've been able to still do some significant hikes despite it!

 

[Kevin Judy and Emma]

Knees

I can't speak about TKR or ACL, but I did shatter my miniscus and had to have emergency knee surgery. As fate would have it I did this in a stupid frisbee accident when I was 4 peaks shy of my 1st 48.

I did it in mid July, was back on the trail in mid August, maybe a little too soon. I didn't climb any hills at first, worked my way back up, but finished my 48. Climbed Cabot August 15th, then went on to the Bulge and the Horn, which was definitely pushing it beyond what I should have done.

I finished my 48 on Wildcat A on September 15th, then wiped out my knee on the way back down. Didn't hike for a few weeks after that, but started playing hockey again in mid October with a brace for awhile.

None of this was as serious as the surgery you are thinking of, but it might give you an idea of a timeline. I did my exercise faithfully everyday and went to weeks of therapy, and happy to say, I've done a lot more mountain hiking since this surgery than I did before it happened.

Arthroscopic surgery really is the least invasive way of fixing things, but what you're looking at sounds a lot more invasive and may take a lot longer to come back from.

My hip on that side bothers me a lot more than the knee I tore up, no doubt from compensating for the knee by walking funny. Doctor says I have osteo-arthritis in it, but I will not consider hip replacement until I can't walk!

I truly wish you the best of luck. If it were me, I would exhaust all possible avenues of dealing with this before I let them cut me, but that's just me. You know how your body feels, do what it tells you.

We'll try to send those healing vibes to get you through this!

KDT

 

[Stan]

I had a torn meniscus, which occurred while constructing a stone retaining wall, and about a year and a half later I finally had arthroscopic surgery which, except for the guy waiting outside the pre-op room for my my organ donor card to kick in, who I had to shoo away, went very smoothly and the result I'd say was very successful.

Other knee surgeries are not so simple and aside from total knee replacement I don't believe the cartilege can be repaired or replaced. However, a lot of people swear by chondroitin and glucosamine so I'd suggest you give that a try, a lengthy try as some will probably attest, before you resort to something as drastic as replacement.

Meanwhile, I'd suggest whatever measures you can take to alleviate the compensating gait which could eventually lead to complications elsewhere. Pain killers (ibuprofen, steriodal injections) help mask the pain but don't heal the basic problem. A brace or "tape" could help support the knee and minimize further deterioration. Building up the leg muscles also helps but you are probably already doing that just by virtue of hiking up grades with a backpack. Carry body weight appropriate to your bone structure which I personally believe is an important factor in these kinds of injuries. Good boots can, again in my opinion, effect the lower body structure from the hips to the feet.

There is no silver bullet for what you describe or for most other injuries either. They take a cncerted effort on many fronts. Nonetheless, as a last resort, we can be thankful of the wonders of medical science.

 

[roadtripper]

This is only a minor suggestion, but check out the Sorbothane UltraSole insoles for your hiking boots. They have the best cushioning of any insole I've found. I suffer from a non-union tibial stress fracture and this product has done wonders for me. It destroys the other 5 or 6 insoles I tried before it.

 

[bikehikeskifish]

FWIW, I was able to eliminate the pain associate with patella-femoral syndrome through a strengthening and stretching regime. It took a solid 10+ months to get back to hiking 4Ks and probably 15-18 months to be 99% pain free.

You can read all the gory details, if you wish (warning: IT'S LONG) here:

http://www.vftt.org/forums/showthread.php?t=18392

Tim

 

[Fisher Cat]

So...
And, has surgery, be it TKR or ACL been an option for some folks and how has it worked out..

Silverfox, I have had total ACL reconstruction. I tried for years to get by without it and finally the meniscus took too much damage and started to bleed. I had taken cortisone, had it drained of fluid, and all that stuff to try to get by without the knife. It was partially torn in a football game, then totally tore in 1995. Now, I am so thrilled to have gotten it done. I even hiked with the torn ACL, my right knee, favored side of course. I have not had a single problem or relapse with it. I jog, trailrun, lift weights and everything with it. Don't even wear a brace.The rehab was a #@$%&^!, I began questioning why I went through the surgery, but I've never regretted it. Once you break that mass of scar tissue, and you have to, you're home free. They used a section of my patellic tendon to replace the ligament, I did not want cadaver salvage-yeecchh!, for myself anyway! My surgeon got the biggest thank-you card ever. My hero. He was assisted in surgery with another surgeon who turned out to be, of all people, the retired personal surgeon of Tony Dorsett. Pretty cool, huh? Though I don't like the Cowboys at all. He didn't know that, thankfully I was out cold.
Its your decision of course, but it may work for you.

 

[BorealChickadee]

I've had both knee done for meniscal tears. Do anything you possibly can first before surgery. A good physical therapist is worth their weight in gold. A good doc would have you seeing a PT now to stop the accommodation in your gait. That only leads to more and new problems. Speaking unfortunately from exxperience.

I have a friend who has had both hip and knee replacements. His case is extreme but he's a bear of a hiker, skier and backpacker. His determination is rare but it does show it can be done.

 

[Peakbagr]

Had my knee scoped in '98. Good as new afterward but either a small tear or something else has hurt the range of motion and made me a 1.5 legged hiker.
Some things to be aware of per my doc...scoping leads to a greater chance of arthritis to develop. 10 years later, I'm concerned thats an issue but they can't tell for sure unless they go back in to look.
Also, 2 docs have both cautioned me that Vitamin 'I', or Tylenol, taken on a regular or long term basis can have consequences with other systems, in particular your liver. Taking either on an irregular basis or when needed, short time, is OK. They suggested coated aspirin for the longer haul.
This is from my docs and its modified how I treat my knee pain.

 

[DougPaul]

Also, 2 docs have both cautioned me that Vitamin 'I', or Tylenol, taken on a regular or long term basis can have consequences with other systems, in particular your liver. Taking either on an irregular basis or when needed, short time, is OK. They suggested coated aspirin for the longer haul.

You have your drugs a little mixed:
Vitamin I = ibuprofen (antiinflammatory, analgesic)
Tylenol = acetaminophen (analgesic)

asprin (antiinflammatory, analgesic)

Acetaminophen is supposed to be easier on the stomach than the other two and coated aspirin is also supposed to be easier on the stomach than regular aspirin. IIRC, any of the three can damage one's liver. (I've read that ~15% of liver replacements are due to overuse of acetaminophen.)

In other words, it is a good idea to stick to the dose limits on the bottle and talk to your doc for long term use.

Doug

 

[Silverfox]

I've had both knee done for meniscal tears. Do anything you possibly can first before surgery. A good physical therapist is worth their weight in gold. A good doc would have you seeing a PT now to stop the accommodation in your gait. That only leads to more and new problems. Speaking unfortunately from exxperience.

I have a friend who has had both hip and knee replacements. His case is extreme but he's a bear of a hiker, skier and backpacker. His determination is rare but it does show it can be done.

Physical therapy and aggressive stretching and training have kept me mobile and active for many years.. I have been in the PT mode for years having come back from smashed pelvis/broken hip in 1991 to play competitive volleyball and ACL reconstruction in 2001 to get back on the mountains ski and hiking....It comes down to the determination to do what you want to do...I guess I might be somewhere on the extreme edge with your friend..thanks
thanks for the rest of the info coming back in..Rocket..you need to carry more weight to slow you down..I am looking for a sherpa to carry necessary winter gear...
Kevin, Stan, Peakbaggr, Fishercat and everyone..thanks for sharing your experiences and thoughts...no magic bullet..but modern medicine is something..I have no problem going bionic

 

[kmorgan]

Torn meniscus and ACL replacement here. Plus partially torn and re-torn patella tendon on my other knee... Still have some pain at times, live on Aleve too.

 

[Journey On]

Tkr

TKR, right knee. 2/05. longest hike since surgery roughly 12 miles. have not hiked any big mountains, not because of knee just by choice. have climbed noonmark. done many day hikes to ponds, overlooks, etc in all kinds of terrain. have not tried snowshoes.

i have not found stamina of the knee to be any problem. the problems i have are lateral movement and lack of twist in the knee. it is very easy to fall down when knee is in a position where it has to twist (it won't). if foot is firmly planted and doesn't turn you may fall. i have several times.

the other problem is lack of feel due to loss of shock vibrations up the bones. they stop at the artificial knee. no major problem just takes some getting used to.

PT after surgery was intense and quite painful at first. therapist had me take painkillers before therapy for first couple of weeks. she knew i liked to hike and put me through intensive therapy. well worth the effort.

 

[Gris]

well

do everything you can to avoid TKR. most all other knee surgeries are not too bad (except ACL recon requires mucho rehab) provided you have a good surgeon. research who the good ones are, then get at least two opinions

TKR will take longer to rehab and leave you w more limitations. better IMO to do something less invasive and endure some pain

 

[THORUTON]

I know about hips not knees

I had a snowmobile accident in 2001 and they tried pinning a broken hip but it did not take. 15 months later I had a hip replacement. Due to the atrophy and lack of movement it took me about 18 months but then I was able to hike 4k's and have done a few 12-15 mile hikes pain free. I actually have more mobility in that hip then the other. I hardly ever get out out due to family and work but I have no problems when I do. Don't know if that helped at all but thats my $.02



Thoruton

 

[Trainwreck]

Sorry to hear about your knee.
I too had uneven wear on my knee, from a too tight lateral ligament. I have rhematoid arthritis ad just blew off the searing pain on the downjills, and the clicking in my knee on uphills. Finally an MRI revealed a lot of joint damage and I had surgery this past October. I am bone on bone and my doc showed me the dark area that was my bone marrow showing through. Had a lateral release, with much improvement, however, we did discuss TKR. My doc told me that if I had a TKR, my activities in the mountains would be 'dramatically curtailed'.
If you are in pain all the time, hiking and resting, and vitamin I doesn't cut it, follow the previous advice and get 2 opinions from Sports Medicine Specialists who know what you want to do activity wise afterwards. Make sure the Docs are not in the same practice.
Good luck.
ps. I'll hike with you anytime. I hike alone mostly because my joints often slow me down and I am self conscious about my speed (or lack thereof)
Sandy

 

[Pat T]

After several surgeries (back in high school and college), then several arthroscopic procedures, my husband finally had to have TKR on both knees, about a year apart. He is in his late fifties and had been getting progressively more pain and immobility followed by excessive accumulation of fluid in his knee. Prior to the surgeries, he could not walk more than a mile. Going up or down hill was torture.

The knee replacements were a BIG deal. He was out of work for 2 weeks each time and had to be driven to work for a couple of weeks after that (although he will tell a different story--possibly due to the pain meds he was taking). He was faithful about doing his stretching and PT and he is very happy with the results. There is really only one problem -- he beats me on the uphills but going down hill is terribly difficult and we have pretty much given up on big hikes that involve steep declines. But we did carry our Hornbecks in and out of Preston Ponds this fall and next summer we've vowed to make it all the way to Duck Hole. He has also experienced some minor hip clicking when running (so he just doesn't run for exercise any more) and his artificial knees crackle a lot if he does knee bends.

Pat T

 

[Silverfox]

Thanks for your imput and thoughts everyone

I know everyone's situation is different and everyone's goals and expectations afer surgery are different..

I go in with an open and optomistic mind..the best specialists that I could come up with recommended the similar course of action..I liked one of the docs and facilities much more that the others..the die is cast..wednsday is the day

I fully expect that i will be back on trail midsummer...might not be a 9 hours bond's traverse this year but here's hoping...
thanks for your thougts and trip reports...keep them coming

 

[peakn]

Wish you the best...

Wow! Best of luck Mark. Hope to see you on the trails this summer.

Harry

 

[Rick]

Climbing in the Niagara Gorge in November 1993. was down climbing and had a small leap to a flat area, I landed and my foot hit an outcropping while the rest of me turned 270 degrees I felt a pop and took a 20 foot tumble down a steep slope, landing at the base of a tree that was growing off the side of a 60' cliff.... Tree saved my life.

I knew I did something as my knee swelled tremendously. ER gave me drugs. Went to see one ortho who said leave it be. I am 34 and only getting older and that i did not need to have surgery. I then saw Dr. James, the Buffalo Sabres ortho surgeon. He set me straight about how today (well....1993) in being active meant staying active as people were now doing many extraordinary things once linmited to younger folks, up into their 70's and if I didn't get it done, I would have a trick knee, which would cpontinue to go out on me when I least expect.

Surgery was done 60 days post trauma - Would have been done sooner, butthe knee went out several times and each time it swelled up and it is not good to operate when filled with fluid..

First week was week from hell. Bed-bound. painful. Forced me to quit smoking for good since no one would buy me smokes.

Slowly I got better. Within 3 months I was riding a bike gently.
It took at least 4 months to teach my leg muscles how to run again. Really. How to run again. They lost muscle memory and had not a clue what to do,

I was jogging short distances in 5 months and started backpacking in 6 months. I climbed about 43 of the ADK46 within the next 3 years (completed 4 prior to incident) as well as many 40-50 mile BP trips and a NLP Thruhike in 95.

So, now I find my repaired knee to be in better shape than my good knee. I believe the new ligament they created from my tendon really has held up very well over the years.