Knee replacement surgery for PA

[lankyloo]

Has anyone thought about - or had knee replacement surgery for psoriatic arthritis? I've been taking cyclosporine & methotrexate for many years, I can't take any of the new biologics becuz of a heart condition, so am consider surgery. Please be advise. Thanks. :)

[MikeK]

Hi Lankyloo!

Welcome back! :cool: It's been a while. Sorry about the reason.

Ladyandy (who sadly hasn't posted here in a very long time) had several joint replacements (including both her knees). Since we haven't heard from her in quite awhile, we have no idea how well she is doing. There's also a very good chance that she won't see your post, she here's a link to a very old post (circa 2003) where she discusses it: http://www.psoriasis.org/forum/showthread.php?p=20861&highlight=knee+replacement+surgery#post20861.

I hope this helps.

Good luck.

Keep us posted. And, please don't be a stranger. It's always good to hear from you!

Mike

[lankyloo]

Hi,

Nice to hear that you missed me! I've had my heart condition for 14 years, so it's not a new thing. I've just been busy in my life, since my last post! ;) I hope someone turns up that has had the surgery, or is considering it! Keep me 'posted' ha! ~Dawn

[raydon14yp]

I have had both knees & hips replaced over 20 years ago. This was due to PA. I suppose I would be in a wheel chair all those years if I had not had them replaced. I have Xrays at least annually & they all look as good as new. The criteria for having joints replaced is if you cannot function during the day and sleep at night. The replacement joints that are used today are the same as they were over 20 years ago. I think if you keep your weight down, the joints wear very well.

[lankyloo]

Thanks for the info, I really appreciate it. Well, I have 1/2 of the criteria met, problems getting UP from a chair, and walking. But I have no problem at night. I will keep ya'll posted. :)

[einna]

Knee replacement is actually much more advanced than it was only several years ago. Better fitting components and better wearing materials make for better results. There is also a minimally invasive knee and a unicondylar knee replacement. The uni knee is for people whose knee is worn on one side only (either medial or lateral). I've worked as an orthopedic scrub nurse for years specializing in joint replacement.

Simple xrays will indicated how badly your joints have been worn. Pain and mobility are other factors in deciding to go for the surgery. A consultation with a good orthopedic surgeon who specializes, rather than dabbles, in joint replacement is the way to go.

The final and most important step is your ability and determination to dedicate yourself to your post op rehabilitation. No you will not dance out of the operating room. You will have to work at regaining your strength and mobility. But for every post op patient I have seen, it was worth it for them.

Hope this info helps.

Annie

[raydon14yp]

You are correct in your post on joint replacements. You covered all the necessary information. Good for you!!!

[meghan_e]

I just had an ACL reconstruction REVISION (a do-over on an ACL surgery 16 years ago) about 3.5 weeks ago.

The original surgeon used an early 70s technique to do my knee. The incision was 6.5 inches long. He put my entire leg in a cast for 4 weeks! It took me nearly 9 months of intense physical therapy to walk without crutches. I was sick to the anesthesia for 24 hours after the surgery.

My new surgeon (Dr. Colin Eakin in Palo Alto, CA) used the latest techniques. Even though he had to remove old hardware, it took him less than 90 minutes. He put my leg in a continuous passive motion machine (CPM) and an ice pump/cuff as soon as I was recovered from anesthesia. I told the anesthiologist I'd had problems in the past. He gave me an anti-nausea drug and used a new anesthesia. I was actually hungry and eating about 2 hours after surgery! LOL

I was able to crutch to the bathroom (with help from a couple of people) that same day. In about 2.5 weeks, the CPM had given my knee 110 degrees of motion. I've been using the stationary bike for the past 1.5 weeks. In total, it is 3.5 weeks after surgery, and my quads are gaining strength. I can use 1 crutch, although I'm supposed to use both crutches! :-o

All of this was ordered by the doctor prior to even starting physical therapy.

It's one thousand years different! While an ACL revision and knee replacement have slightly different post-op recoveries, they have a great deal in common.

1. Immediate CPM use after surgery
2. Constant ice
3. Light years of improved anesthesia
4. Light years improved hardware, glues and materials
5. Light years improved surgical techniques
6. Almost immediate physical therapy

Most of my friends who've had hip and knee joint replacements in the last 3 years had far better function in those joints than the non-replaced joints. Ankles, and most upper body joints are a bit trickier and require more research to find the right surgeons.

Hope this helps give people confidence!

-Meghan

[meghan_e]

In a followup to the previous post, I do want to add and emphasize that you need to do your research before any major non-emergency surgery.

1. The web has tons of info on surgery techniques and new materials.
2. Call physical therapists and ask them who they think of as the top 5 surgeons in the area.
3. Make appts, if you can, with those surgeons and interview them. Surgeons are different creatures than regular docs.
a. Pay attention to whether they listen to you all the way or cut you off.
b. Do they answer your actual questions, or just give general answers.
c. What is their usual post-op plan?
4. The Arthritis Foundation has a book called "All you need to know about Joint Surgery". It's really comprehensive.

Best wishes,
Meghan

[vshorter]

But how does having an on-going auto-immune inflammatory arthritic condition such as PA affect your elegibility for joint replacement? Wouldn't the new joints and/or surrounding tendons/tissues still continue to be under attack? :confused: What effect would this have on the replaced joints and/or recovery?

My rhuemy had led me to believe that because of this I would most likely not be a candidate, or maybe I misunderstood and it is because my PA is not under control or stable yet.

Any thoughts or input on this from anyone? I'd really be interested as my left shoulder is almost frozen and have tried steriod shots to no avail. :(

Vicki

[sonchi]

Got PA in the foot and knee recently besides disbled finger a couple of years ago. Can hardly walk well all of a sudden. Worrying that my knees would be like my finger down the road. I am wondering if I would be able to run again later on after a surgery when I need a knee replacement. So sad I lost job recently also largely because of my health. Feel so depressed.

[meghan_e]

Joint replacement surgery is done on rheumatoid arthritis (RA) patients all the time. So the inflammatory disease itself is not usually preventing surgery, unless it's very active. All of my post is only general information, it's not specific to individual cases.

Joint replacements are done when the cartilege between the two bones of a joint is gone. By the time a joint replacement is needed, the bones have been rubbing together. PA is less likely to cause this particular scenario than RA, but it does happen. When it does, it's just as destructive.

The hardest part of coping with PA is when the cartilege is intact and it's the tendons and entheses that are causing the major problems. Surgery is not as effective unless it's a very targeted spot. They can go in an repair ruptured tendons and scrape out tendon sheaths that are severely damaged. But if it's multiple tendons around one joint (which has happened to several of mine), steroids, biologics, anti-inflammatories and pain killers are the overall most effective. Ice, of course, is crucial as always, in controlling the inflammation.

I'm not covering the details and probably missing some obvious points. So gather information from multiple sources. ;)

Best wishes

[ouchyk]

Got PA in the foot and knee recently besides disbled finger a couple of years ago. Can hardly walk well all of a sudden. Worrying that my knees would be like my finger down the road. I am wondering if I would be able to run again later on after a surgery when I need a knee replacement. So sad I lost job recently also largely because of my health. Feel so depressed.


Hi sonchi,

Sorry to hear about your job loss. There are laws to protect you from being fired due to this disease :(

http://www.psoriasis.org/advocacy/assistance/discrimination/index.php

I hope that your treatment will help you get back on track and able to walk again without pain. MTX has helped ton's of people and I hope it helps you as well.

It helps to vent when your depressed and please let your doctor know that you're down as well. I'm sure he/she will be happy to help you.

Karen

[ouchyk]

Megan,

Thanks for the explanation about surgery, I hope that you all will continue to heal. That was an excellent question Vicky. Geesh, I hope that I will never need anything replaced. Are you all pain free with the replacements or at least better?

Karen

[vshorter]

That was a much better explanation than what my doctor gave me. He had said that surgery to my shoulders could be done but would probably give me less range of motion than if I just treated as I do now (biologics, anti-inflammitories & pain-killers). I assume he was refering to the tendon sheath scraping. Boy, does that sound painful! :eek:

Thanks again for your very informative post. :cool:

Vicki

[sonchi]

ouchyk, thanks for the concerns.

discrimination is very hard to prove to sophisticated employers. They have more resources and may even change personell files or leave a paper trail against somebody. may worth a try but then may have to go to court. who has the money, time and energy. if no winning, years would pass with no job, with all savings spent. I wonder the law can only be used against some unsophisticated employers. It may be rare.

nice to have a group of caring people here.