Sam’s left knee: An update

Note: At some point soon I hope to have things to blog about besides my left knee! Promise.

The surgeon looked at my x-rays and my MRI and said, “Ouch. That must hurt.”

There’s pretty much no cartilage and no meniscus left apparently. I’ve run out and there’s no growing more. I’ve got bone rubbing and grinding on bone and that hurts.

On the treatment side, things have gotten better with physio but there’s still too much pain and I can’t do lots of the things I used to love.

Hence my visit to the knee expert.

I told the doctor I’d given up soccer. I’ve also given up running and Aikido. But I don’t want to give up long hikes, bike rides, skating, skiing etc.

He tells me that I’m an easy candidate for total knee replacement given the amount of damage to my knee but he worries that I’m too young and too active.

Instead, we’re going to try to fend off knee replacement for another ten years, maybe even fifteen.

Here’s the plan:

Step 1: Try Monovisc injections

Basically it’s injecting lube into the joint. They’re $400 and it’s not covered by our provincial health plan but it is covered by my benefits. Again, I’m feeling lucky. No risk. Some people find huge relief this way. Others not so much. We’ll see. I had the first one today. Weirdly not painful but strange feeling.

Step 2: Unloading knee brace

For long walks and other activities that strain the knee, I’m getting a custom knee brace. They are supposed to work well, if you use them. Lots of people don’t. They’re clunky and not that that easy to get used to. On the upside, I don’t need to wear one at work, just walking to and from. Also, I’ll wear it on long dog hikes. Might be a great argument for commuting by bike. Again, thank you benefits.

Step 3: Physio, physio, physio

I’m so lucky to have good benefits.

Step 4: High Tibial Osteotomy

If all this doesn’t work, I’m also a good candidate for another surgery that falls short of knee replacement and buys me some years. It’s recommended for younger, active patients. (I like that description.)

“Osteotomy literally means “cutting of the bone.” In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint. Knee osteotomy is used when a patient has early-stage osteoarthritis that has damaged just one side of the knee joint.”

See here.

“A high tibial osteotomy is generally considered a method of prolonging the time before a knee replacement is necessary because the benefits typically fade after eight to ten years. This procedure is typically reserved for younger patients with pain resulting from instability and malalignment. An osteotomy may also be performed in conjunction with other joint preservation procedures in order to allow for cartilage repair tissue to grow without being subjected to excessive pressure.”

And here, complete with an animation of the procedure.

In the meantime, I’m thinking strategically about saving my knees, what’s left of them, for the things that I love. No more knee damage for the sake of training. More on that thought later!