Resolved question:
TO whom it may concern,
This consultation is regarding my grandma. She is 76 years old and she has a history of pain in her knee joints. She's been taking the following medications for years:
- Every year she does a Neovise (seringue) injection in both knees
- Arthri-Flex 2 tablets every day
She used to feel fine on those medications. Unfortunately this year the pain didn't go away so she's been experiencing pain in her knee joint for a almost a month now and unfortunately she can barely walk. While sitting down she don't feel the pain, it's only when she's walking. She can manage to walk with a cane but not very easily.
She's already seen a doctor and he asked her for an MRI SCAN. The MRI scan is already attached and her Dr. prescription is attached as well. And based on the findings, he recommended cortisone injections or a surgery. The reason I'm reaching out to you is because we want an additional opinion in this matter and figure out what's the best approach.
She's been taking Arcoxia 60mg as and anti inflammatory and she's using Airtal as a creme on her knee however both medications are not easing the pain.
Thanks
Submitted:
4 Days
Category:
Orthopedic Surgeon
Hello. Thank you for your query at DoctorSpring.com
I have read all details with diligence.It looks that your mother is having osteoarthritis of all three compartment of knee.Knee joint space is reduced on inner aspect of knee.There is thinning of smooth covering over the knee bones,cushions or meniscus which lies inside at knee are also teared.
Injecting a steroid will only remove inflammation but not cure the condition,looking at her age & reports of MRI i am of opinion that she should have surgery like replacement surgery for knee for better quality of life.
Hope this will help you.
With best wishes
Regards
Thanks Dr. for your reply.
My mother is 76 years old and she's already taking medications for HIgh blood pressure and diabetes so she's not a great candidate for surgeries. She's trying to run away from them. Having said that, do you think if we get her Steroid injections for the next 10 years (every 6 months); would it be a good idea to alleviate the pain and serve her the remaining years of her life ? Or do you prefer that we do the surgery today because the steroid injections will worsen the knee and make it in a bad conidition for a surgery.
Adding what is the rate of success of knee surgery replacements ? Would you think she will need a walker or will she get perfectly fine out of it ?
Thanks,
Hello,
Thank you for posting the follow up query.
It is not a good idea to keep her on steroid injection for such long time.It will increase the complication rate & may worse her knee.
In a korean study -
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615258/
It has been clearly pointed out about the prognosis for knee replacement in diabetes.In comparison to non diabetic patients there are chances of about 17% wound complication rate then the 7-8% .So there is not a excess of difference.If diabetes remains in control then one can lead a normal life.
She may walk without walker after replacement surgery.
Feel free to discuss further.
Regards
Thanks doctor for your reply.
My mother can't do the surgery today for several factors one of them being financial.
So the plan is to get her temporarily on Steroid injections however I want to make sure that her knee would still be eligible for a surgery at a later date.
How long can we keep her on injections before the surgery ? Is there any limit for that ? How would we know she's eligible for a successful total replacement knee surgery ?
thanks a lot
Hello,
Thank you for the follow up.
For an effective TKR she should have good health,no anaemia,ndiabetes should be in control,there should not be any other systemic condition which hampers her recovery.knee bending should be not restricted too much,there should not be severe outward or inward bending of knee.
Although recurrent intra articular injection may lead to infection at her knee but you may have them with controlled diabetes.this will only reduce inflammation not the pain.I generally do not give more then 6 in total.
With best wishes.
Regards
Thanks Doctor. Your answers are very helpful.
One last question:
A doctor advised my mom to have injections in her knee joint and another one in her knee muscle. What is the difference and which one do you prefer in her case ?
Thanks a lot,
Hello.
Sorry, but at present I am not aware of any injection which can be helpful in osteoarthritis by injecting in knee muscles. Painkiller injections can be given into muscles, but the buttock muscles are preferred for that.
Steroids can be injected within the knee joint, to reduce inflammation and pain.
With best wishes.