Query Reg: Lumbo-Sacral Spine Problem and advanced Osteoarthritis/Total Knee Replacement Surgery My 80-year-old mother has advanced osteoarthritis(OA) in her both knees for last many years, more in the left leg and she is advised Total Knee Replacement (TKR) for that. She is not a diabetic but has hypertension (high BP) and is overweight. However, from last 2-3 years, a new problem has developed in her legs. In 2008, the problem appeared in her left leg. Then for a year or so, it remained subsidized. But from last 3-4 months, it has surfaced in her right leg now and is more severe. The pain/problem is not a constant. Its irregular and episodal. There is not much pain or discomfort while sitting for even 4-5 hours. The main problem occurs after sleep/bed rest of even 2-3 hours, when she has to get up from bed. She is unable to move, bend her right leg, take side and get up from bed and sit. She complains of very heaviness and stiffness/stoniness in the leg, and is unable to move it. There is a severe pain when she tries to do that. She is able to sit up only after taking pain relievers/applying gel etc. on back/leg. The pain in her lower back and hips is moderate. There is a weakness in her legs, now more in right and is unable to stand/walk for more than few minutes/steps.She drags her right leg/foot, which is unable to hold chappals, etc. properly. There is a stiffness in her toe/ front half portion of right foot, calf portion There is a little swelling around her ankle also. She feels heat/hot air emissions from her groin area also. The report of latest MRI of her Lumbo-Sacral Spine done in August, 2010 is as under: Follow Up Case of SPONDYLOLISTHESIS(Grade I at L4-5 level) AND SEVERE DEGENERATIVE SPONDYLOARTHROPATHY, presently shows: 1. MILD POSTERIOR OFFSET OF L5 VERTEBRA WITH BROAD BASED POSTERIOR PROTRUSION OF L4-5 DISC, SEVERE DEGENERATIVE FACETAL ARTHROPATHY AND LIGMENTUM FLAVUM THICKENING SEVERELY INDENTING THECAL SAC AND NARROWING BILATERAL NEURAL FORAMINAE AT L4-5 LEVEL (LEFT RIGHT) 2. MULTILEVEL DISC HERNIATIONS, OSTEOPHYTOSIS, SEVERE FACETAL ARTHROPATHY AND LIGAMENTUM FLAVUM THICKENING FROM L1-2 TO L5-S1 LEVELS WITH SEVERE THECAL SAC COMPRESSION AT L3-4 AND L4-5 LEVELS AS DESCRIBED--Thecal sac Diameter at L3-4 and L4-5 levels is 7.0 Nerve Conduction (NCV) studies of both lower limbs were also done, the conclusion of which is The above electrophysiological findings are suggestive of bilateral L5 and S1 radiculopathy . She is on NSAIDs, muscle relaxants, pregabalin. Despite that, the pain/problem has aggravated these days. In view of the new problem in her legs, my questions are: (1) What should be our line of treatment now? Whether the treatment of her new spine problem or TKR surgery should be our first priority? (2) Would it be useful and advisable to go in for TKR with this new problem in her leg? (3) What is the cause of so much stiffness in her leg etc. after rest/sleep of even 2-3 hours that she is unable to get up from bed? (4) Would Facet joint and Nerve root injections be useful in her condition? (5) Is she suffering from RA also? Thank you