Is this the beginning of the end of the line for my knee?

February 28, 2009 1:11 PM

Anybody have experience with early onset osteoarthritis (specific to knee)?

I recently lost about 85lbs and have been working out twice a week with a trainer since late November. I've always had some crepitice (crunchy sounding knees) going on, but it started to progress into pain and swelling about a month and a half ago.

I finally gave in and went to see an orthopedist who immediately thought it was torn cartilage and wanted to do cortisone injections along with an MRI for confirmation. I wasn't so keen on the cortisone without a definitive diagnosis, so held off on that. Well, the MRI came back clear for any torn cartilage, but he said that I am showing evidence of orthoarthritis. I'm 38 (will be 39 in October). He drained the effused fluid from my knee and did one cortisone injection.

His suggestion was to do a series of three Orthovisc injections. My gut (before doing any research at all) was to not do it. After reading some studies showing little to no efficacy after the shots, I'm even more inclined to not do it. I talked to a couple of friends that are Physical Therapists at Kessler Institute and they said that for every one patient they see who hyaluronan injections work, they see four more who receive no benefit.

It just seems that there aren't many other options in store. Maybe PT? Live with it and hope for the best?

I'm thinking that I might try and get a second opinion at Hospital for Special Surgery in NYC, though from looking at their site and their Hip and Knee Center, it seems that they're more surgical-centric than I think I need at this point (the orthopod I saw told me that I will likely need a replacement at some point, though wasn't willing to peg a time frame).

Can anybody shed some light on this for me? Anybody have similar experiences?

Thanks!

posted by dancinglamb to health & fitness (9 comments total)

Please get a second opinion. I was erroneously diagnosed with osteoarthritis in my shoulder (after first being diagnosed with bursitis). Arthritis is a tough diagnosis to hear because of the very serious life-long effects including the prospect of joint replacement. (which, as I understand it, is strongly discouraged for someone under 50).

I jumped on line, did some research to find a top-notch practitioner in my area, and received a corrected diagnosis of tendonitis. My new doctor explained that everyone, as we age, develops some arthritis in their joints (as did I) but it was not the thing that was causing me trouble. Like you, I prefer a conservative approach. I did some physical therapy and just recently took a cortisone shot. It's worth hearing what another doctor has to say before deciding on a course of treatment. I hope you feel better soon.
posted by inkyr2 at 1:35 PM on February 28

My father eventually ended up getting a new knee at 70 years old. He held off that long because he was told that artificial knees only last 15-20 years depending on how active you are, and he has no wish to be undergoing a second lot of surgery at 90 years old.

Get a second opinion and try to find exercises that are lower impact on your knees if possible, swimming perhaps?
posted by arcticseal at 1:55 PM on February 28

Congrats on the weight loss. I've lost over 200 pounds in about 18 months and about 100 pounds ago the osteo crept up and bit me. The pain was so bad walking was getting to be impossible, let alone working out. Regardless of the exercise, including eliptical and bike, the pain was constant.

Luckily, I found a good doctor. He told me that scoping would make it feel better temporarily, but it'd be a waste of time and money. An honest opinion, as a few months later a study was published saying the same thing.

http://www.medicalnewstoday.com/articles/121067.php

Anyway, he suggested a shot of cortisone followed by a series of three injections of Synvisc. I think it's like your product. It's simply hyaluronic acid.

http://en.wikipedia.org/wiki/Hyaluronan

I did no research before I got the injections, which I am glad I didn't. Results are all over the place. For some people it does nothing, others get worse and some, like me, it does wonders. While the initial relief was from the cortisone I believe Synvisc helped me. But, had I read online some of the stories of others I might not have gotten the injections.

When I hit the 180 pound loss I went back to the doctor to have my knee xrayed again. There was more space compared to the prior xray. Do not get me wrong, more is a relative term. The doctor, again being honest, couldn't tell me if this was simply the relief of pressure from losing the weight or what.

Long winded response, but for me Synvisc was an absolute lifesaver. I was able to go back to working out an hour day without any pain. My knees have been tip top since.

Articseal is absolutley right ... my doctor told me they like their patients to outlive their knee replacements. A nice way of saying it's for older people.

Oh, one more thing, I found that New Balance 1123s are a must for anyone overweight and trying hard to lose weight. They are pricey, so it's an investment.

Congrats again on your weight loss and good luck. I know how hard it is to keep the momentum going.
posted by zymurgy at 3:09 PM on February 28

inkyr2- Yeah, I wasn't too crazy about this first doctor. I didn't particularly like him the first time I saw him, but went back because I wanted to see the MRI results. I liked him even less after the second appointment. He didn't even suggest the possibility of anything other than OA, or the potential for conservative options like PT, swimming, etc. I'm not able to take NSAIDs due to stomach reasons (I have a lapband, hence the weight loss ;) ), so he just blew right through everything and went for the HA injection solution.... That's why I'm kind of leaning toward heading into NYC to see somebody else for their opinion. I'm just not sure if it should be an orthopod, a sports med person or a rheumatologist...

articseal- Yeah, the limit on the replacements is about 15-20 years. I also don't think I'm anywhere near the point of last resort. It's awesome that your dad was able to stick it out that long. My trainer is hesitant to start having me do any lowerbody work without my doctor's blessing, which essentially means I need to find somebody to prescribe me PT.

zymurgy- Awesome weight loss!!! I've lost the 85lbs in about 18 months and I'm only about 15-20lbs from my goal. I know that the weight thing had a lot to do with beating up my knees (my left one was reconstructed about 20 years ago due to a skiing injury). What was your experience immediately after the injections? Is it true that you've got to be off your feet for the first few days? Does it hurt more than those freaking fluid draws and cortisone injections? Thanks for the input and your willingness to describe your experience. How long ago did you do the series of Synvisc and are you planning on doing it again? It's my understanding that it's only good for about six months and then you have to do it all over again. And then, the more often you do it, the greater chance for a complication of crystalisation in the joint due to the HA.

I'm just soooo loathe to jump on this. It seems that no matter what happens with me, I always end up with the most inane side effects. I only just feel like I've completely gotten healthy (ok, healthier), and now this. Two years ago, I had my left Achilles tendon lengthened, only to have to have that ankle reconstructed/stabilised two months after that. I finally was walking on two feet like a normal person for about eight weeks and stepped out my front door, to roll and break my *right* ankle. Didn't fall, just rolled it. And to complicate matters, I developed a blood from the break. The left foot wasn't totally healed and couldn't take the full weight bearing, so I was essentially walking on two broken feet simultaneously for about six weeks. That ended up requiring repeated cortisone injections to reduce inflammation on both sides until they could both heal. *sigh*
posted by dancinglamb at 6:49 PM on February 28

While you are mulling over the various extreme and expensive suggestions for relief, pick up a bottle of glucosamine chondriotin and follow the directions on the bottle. I have had several people tell me that worked astonishingly well for them.

There is a folk remedy for arthritis, probably not OA, but it is honey and vinegar (1:1), preferably local honey. I have also heard anecdotal positive things about this as well.

Good luck with this.
posted by Yimji at 7:16 PM on February 28

Yimji- I looked at a bunch of different bottles tonight when I was at Costco but became kind of overwhelmed. They also all seem to be roughly horse-sized pills. I am somewhat limited in how big (sizewise) the meds I take can be. There was one that looked reasonably small enough, but it was something like $66. Cosamin DS, maybe? I decided that I needed to come home and read up some more before jumping off that bridge, as well.
posted by dancinglamb at 7:42 PM on February 28

There is a good report by the Arthritis Research Campaign on the effectiveness of complementary therapies for all three types of arthritis. It is worth reading, although it does - obviously (as it is based on secondary research data) - generalize. Some people that I know do find Glucosamine/Chondroitin effective, whereas this report concludes that it may not be. My friend buys hers at Wholefoods Market. You're right: they do look like horse pills! But I gather that they have zero side effects, so you have nothing to lose in trying them.
posted by Susurration at 8:49 PM on February 28

Be sure you're getting glucosamine sulfate and not glucosamine HCl; only the former has been shown to be effective for OA.
posted by olecranon at 1:37 PM on March 1

I have done some research on oesto athritis and found that as we age our body becomes filled with toxins and hormones through food related eostrogens this plays havoc on our bones and people become estrogen dominant which means that the progesterone in our body becomes depleted It is progesterone that indeed keeps our bones from thinning .
Have a look at some sites on natural progesterone creams The one i use is serenity from wellsprings It has ceased all my pain and the good part of this information is that it reverses oesteoporosis Please look it up for yourself I wish you well
Linn Garden
posted by Healinn Garden at 3:16 AM on March 3