Ten years ago I was training for a 4th Marathon. After long mileage sessions, I would experience pain in my right knee that would go away after icing until that one time when it did not. When I arose the morning and began to walk I felt the most excruciating pain in the right knee. The diagnosis was swelling in the right knee joint, and I was advised to stop running and take a pain killer until the swelling went away. Over the next two months, the swelling and pain worsened as sometimes my knee would lock (meaning the bottom and upper bones of the knee would stick together). In addition to knee pain, pain would radiate down the inside of the bone of my right leg and from above the ankle bone. After consulting an orthopedic surgeon and having x-rays and an MRI, the results were negative. The doctor suspected a torn meniscus disk and arthritis which were common in long time runners but did not necessarily show up in either x-rays or an MRI. Exploratory arthroscopic surgery was scheduled after 6 months of agony in each step.
The surgery revealed a severely torn meniscus and serious inner knee arthritis. The surgeon cleaned out the torn meniscus and shaved away the arthritic bone area. He indicated that I was left with almost bone-on-bone. After going through physical therapy and getting the leg muscles back in shape, the pain of the bone-on-bone was still there. The next step was cortisone injections which did not work. The final diagnoses – replace the knee or live with the pain. The problem with living with the pain is that you may have to take strong pain killers that have serious side effects and are addictive in addition to perhaps using a cane for walking to relieve the pressure on the affected knee.
My Path of Action
I have met many people who have had a similar story to mine that ended up with a total knee replacements without seeking alternative treatments that could have postponed the surgery for 9-10 years or altogether. A total knee replacement is major surgery (as I will discuss in a later article) that carries major risks which you only want to experience once in your life for any given knee. Given the 15-25 year lifespan of replacement implants, having a knee replacement early in life may mean having two surgeries on the affected knees given average life spans.
I felt that I was too young to have a knee replaced and pushed for other solutions and was referred to another orthopedic surgeon who provided alternatives to knee replacement. This was a “knee saver” that made it possible for me to delay the total knee replacement for 9 more years.
What made it possible for me to delay the knee replacement surgery for 9 years was the following therapy:
- The injection of Synvisc which is liquid lubricant for the knee joint and is re-injected periodically as needed
- The use of a knee brace for long walks and hikes
- The buildup of the muscles around the knee through biking and weight lifting that resulted in stabilizing the knee joint and provided a little more knee separation.
- Giving up running and sports involving jumping such as basketball
There are many causes of knee pain and each individual should discuss their situation with their surgeon and determine whether the above course of therapy is appropriate for them. If the surgeon does not view this therapy as being applicable to you, seek another opinion! If, you receive the same diagnosis from the second surgeon, then maybe the above treatment is not for you. But, for those with arthritic knees and little or no meniscus, the listed therapy could forestall a total knee replacement for several years.
Synvisc
Synvisc is a lubrication fluid which is injected into the knee in typically three shots one week apart. By lubricating the knee, Synvisc allows the upper and lower bones of the knee joint to slide over each other rather than locking or grinding past each other causing severe pain. It can take about 3-6 weeks before you feel the effect of Synvisc in reducing knee pain. In my case, the pain was totally gone for 90 percent of my activities. In the other 10 percent which involved long walks and hikes, the pain would come back.
Over time, the lubricant will need to be re-injected for the treatment to be effective. Initially, I received the injections every 6 months and was advised that I could receive 4-5 treatments. After this point, many patients develop a reaction called Synviscitis which causes knee inflammation and the treatment will have to be stopped. I never got to this point and I had 9 series of shots spread over 9 years. The last 3-4 injections series that I received had time intervals of between 15-18 months rather than 6 months.
Building up Muscle around the Knee
Once running was ruled out, I switched to biking eventually building up to about 120-130 miles per week over hilly terrain. This exercise kept me in similar shape to running and allowed me to get out on the roads as I did when running. It also had an unexpected result of building the muscle tissue surrounding my knee. I began to notice after the first 2-3 years that as I gradually increased my biking the interval between when I needed to have another series of Synvisc shots lengthened eventually from 6 months to 18.
By building up the knee muscles I was able to extend the time period between injections. The lengthier time frames between the series of shots enabled me to have more series than the typical individual because the longer time frame between shots reduced my sensitivity of Synvisc.
Knee Brace
As indicated, the Synvisc allowed me to perform 90 percent of my daily activities pain free. What it did not work for was lengthy walks or hikes over 2-3 miles of steady or moderate difficulty. What did work to address these situations was the use of knee braces.
There are many different types of knee braces used to avoid knee pain depending on the specific condition. In my case, my knee brace is one that pulls the interior part of the knee apart providing enough separation to prevent bone-on-bone situations. My brace allowed me to do extensive walking and hiking without pain and when combined with the Synvisc, I could do anything I wanted to except for running and playing basketball due to the jumping. This was an acceptable trade-off.
The use of a knee brace is not without issues. Wearing a brace can make you self-conscious as others focus on your knee. Some of the heavy duty ones can be bulky to wear and carry around. All will typically require a knee sock to provide added resistance for the brace to stay in place on your leg. I had two braces, one for heavy duty hiking up mountains and steep trails and a light weight one for use at work on an occasional basis or short walks. The lightweight brace can be easily worn under suit pants. A typical brace will cost around $900-1,200 and are usually covered by insurance.
If you should decide to get a brace, you should use a trained orthotics person who can properly measure a brace for you.
Conclusion
Undergoing any surgery has risks and major surgery increased risks. By delaying total knee replacements until you are in that age period that one may last you your life improves the quality of your life through avoidance of additional surgery risks. This discussion may be moot as time goes on and medical science develops better knee implants that will have a longer usage period. Additionally, for those who still have a substantial amount of their meniscus disk remaining, new disc tissue can be grown prolonging knee life. Improved surgical techniques that can reduce the damage done to the knee during surgery may also improve knee life and reduce the risks and amount of therapy involved currently with knee replacements.
Dreaming Again
It is 4 months after my total knee replacement of my right knee, I am now reading articles about others who have had one or both knees replaced who have returned to running 10Ks, marathons and triathlons. Since I realize how painful a total knee replacement therapy and recovery is, I am not ready to let myself think too far down this path at this point. I am now up to walking about 3 miles each day and think, if I can swim the 2.1 miles, I should be easily able to bike the 112 miles and, if I can improve my walking pace and get the distance up, then walking a marathon or completing a full triathlon may be within reach. Then again all runners are dreamers.
