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Suggest Treatment For Severe Knee Pain And Difficulty In Walking

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Posted on Mon, 3 Apr 2017
Question: This is a question for an orthopedist only please:
I am a 62 y/o male, still working as a CVICU RN. In Nov, 2016 I started with severe back of the Rt knee pain when I walked, and it migrated to the medial side. It was severe and made my life miserable. I had difficulty walking (this is my "good" knee). There was not a specific activity or injury that caused this, absolutely no pain in this joint prior to the sudden onset. I saw an Ortho. He injected it and sent me for MRI, showing a complicated meniscus tear along with (Surprise) arthritis. He suggested arthroscopy. I have scheduled it in 2 weeks. My question is: although my knee does not feel "right" and I am guarding it, no twisting, and when I walk on uneven ground, I am symptomatic. But generally IT IS IMPROVING every day, I feel. I have reluctancy to have this arthroscopy done. I do go to the gym and am focusing on my legs more to get ready for this procedure. But I still question if I need it. I have already postponed it once. My internist said I really should have it done or I risk having more issues down the road especially with my MRI findings. My ortho said I should get it done but my symptoms have steadily improved even after my last visit with him. MY FMLA is in place, time off approved and this ball is rolling. I need more professional input. For reference, I have had an open arthrotomy and meniscectomy in 1968 on my other (bad) knee and 8 yrs ago arthroscopy on it as well as a result of 8 bad injuries to it. This situation I face makes no sense, because I did nothing to bring it on. I know what a true knee injury is. This is one blowing my mind. Any input is appreciated, thanks. XXXX
doctor
Answered by Dr. Aashish Raghu (6 hours later)
Brief Answer:
Arthroscopy vs Arthroplasty

Detailed Answer:
Hi XXXX,

Thanks for the query

The meniscus tear can be a degenerative tear which occurs in the setting of knee Osteoarthritis.

Usually Osteoarthritis is common past 60 years age especially if your other knee is injured so more weight is being preferentially borne on the normal knee leading to earlier degeneration.

Avoid squatting, cross leg sitting, climbing stairs and kneeling. Avoid Arthroscopy if you can bear the pain. Wear knee brace. Perform quadriceps strengthening exercises.

If these measures do not help you for 2 months, then you can consider surgical intervention.

Take an Xray of the knee because medial knee joint pain is suggestive of knee Osteoarthritis. If you have significant arthritis then Arthroscopy won't help. Only knee replacement may be a solution in severe knee arthritis with/without meniscus tear.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Aashish Raghu (18 hours later)
Thanks Dr XXXXXXX for your input, your time is greatly appreciated. Please see my attached MRI report. Sorry for for the pages being out of order. My symptoms began last November, and have decreased remarkably without any pain meds or NSAIDS. Although I am not symptom free, I am improving. As I said before, just 2 weeks ago, my internist encouraged me to have the arthroscopy because of the condition of my meniscus, saying it may cause problems if I do nothing. My next questions to you are.

1. Can the deteriorated meniscus complicate mobility in the future, fragment and become loose in the joint? I have no loss of ROM, nor do I have swelling. ( I am 200 lbs and about 6 ft and go to the gym 2-3 x week)

2. Would I benefit from making the meniscus smooth with arthroscopy?

3. My ortho says he can also "smooth" the arthritic surface thus making me more comfortable.

Does any of this this sound reasonable?? This is month # 4 since the onset of symptoms.
Your answers should complete my questions regarding this problem. My pre op work up is on 4/1, and my procedure is scheduled for March 24, so I need to make my final decision very soon.
Thanks.
XXXX
doctor
Answered by Dr. Aashish Raghu (14 hours later)
Brief Answer:
Xray

Detailed Answer:
Yes, the meniscus can become further degraded and form possible loose body.

Meniscus shaving can reduce the chance of degeneration to some extent but prior knee condition is important to note.

Please upload the knee Xray then only I can comment on the effectivness of the Arthroscopy procedure.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aashish Raghu (1 hour later)
Not sure if I deleted my reply to you. My X-ray was done at the drs office, so I do not have access to it.
I have had a torn meniscus that was fragmented in my other knee and thAt was traumatic for me as a teen. I would not want that to happen again. That fact alone might sway my decision.

I understand you have difficulty guiding me because of the lack of information, but it sounds like smoothing the articulating surface could help preserve the joint? I just don't want to make things worse.
Thanks again
XXXX
doctor
Answered by Dr. Aashish Raghu (19 minutes later)
Brief Answer:
Cartilage loss

Detailed Answer:
You have significant cartilage loss. There will be only possibly mild reduction in pain after Arthroscopy. Arthritis has set in
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Aashish Raghu (2 hours later)
I sure wish there was a clear cut answer. Based on your first impression though it sounds like you suggest avoiding arthroscopy. Is the likelihood of meniscal fragmentation low?
doctor
Answered by Dr. Aashish Raghu (24 hours later)
Brief Answer:
Joint pathology vs Meniscus

Detailed Answer:
The fact that you already have knee joint cartilage loss, the meniscus treatment will not alleviate your pain completely.

Your joint degeneration is another cause of the pain and that needs to be treated.

Meniscus fragmentation will be accelerated in arthritic knee.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aashish Raghu (2 hours later)
Thank you very much for your help. Your last response was of great value to me in making my decision. You have answered many questions. Thanks for taking the time.
XXXX
doctor
Answered by Dr. Aashish Raghu (1 minute later)
Brief Answer:
Get well soon

Detailed Answer:
Thank you. Get well soon. Do follow up with me on your progress.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Aashish Raghu (16 minutes later)
Will do. I am thinking this will be an easy recovery. My leg is strong and non traumatized going in. Keeping my fingers crossed. I even have my anesthesiologist picked out, we have spoken and he will certainly take good care of me.
doctor
Answered by Dr. Aashish Raghu (27 hours later)
Brief Answer:
Good Luck

Detailed Answer:
That's great! Hoping for the best for you
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5478 Questions

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Suggest Treatment For Severe Knee Pain And Difficulty In Walking

Brief Answer: Arthroscopy vs Arthroplasty Detailed Answer: Hi XXXX, Thanks for the query The meniscus tear can be a degenerative tear which occurs in the setting of knee Osteoarthritis. Usually Osteoarthritis is common past 60 years age especially if your other knee is injured so more weight is being preferentially borne on the normal knee leading to earlier degeneration. Avoid squatting, cross leg sitting, climbing stairs and kneeling. Avoid Arthroscopy if you can bear the pain. Wear knee brace. Perform quadriceps strengthening exercises. If these measures do not help you for 2 months, then you can consider surgical intervention. Take an Xray of the knee because medial knee joint pain is suggestive of knee Osteoarthritis. If you have significant arthritis then Arthroscopy won't help. Only knee replacement may be a solution in severe knee arthritis with/without meniscus tear. I hope I have answered your query. I will be available to answer your follow up queries. Regards, Dr. Aashish Raghu