Grade 4 knee arthritis

[cars3876]

I have just been diagnosed grade 4 arthritis of knee and orthopaedic doc says at that stage needs replacement. I am not in severe pain as i hear other pain suffer greatly with pain. My knee however feels very unstable and uncomfortable on stairs and driving. Does anyone else have severe arthritis with no great pain?

[Constance13]

If you're not in pain I certainly wouldn't have the knee replaced yet. It's a LONG and painful experience.

Try using tubular bandages or a knee brace to stabilise your knee.

[cars3876 in reply to Constance13]

Thanks i will look into brace perhaps. I cannot use compression due to arterial disease in legs. Thanks for your answer.

[DorsetLady]

Your consultant wouldn’t recommend a replacement if he didn’t think it was necessary…..and if it’s unstable on stairs and driving you need consider whether you are likely to fall down stairs and injure yourself more severely or cause an accident when driving.

Obviously having an replacement unnecessarily is a no brainer, but if you really need one, then better to have it done sooner rather than later.

[cars3876 in reply to DorsetLady]

Thanks for your answer. This is private consultation as I'm in kenya and no nhs here. So consultant perhaps more keen than an nhs one to do surgery. I asked the question really as I thought i would be suffering more pain than i am in fact can't really call it pain. So from what i read most people in a lot of pain and not very mobile before replacement. This consultant feels do it before i get to that stage and fit enough for op. I am 72

[DorsetLady in reply to cars3876]

I did guess about being private actually - and obviously it’s a factor!

I can only go by my replacements (3 in total - thank goodness for nhs!) - and they were all extremely painful before operation …

…fortunately for you, your knee isn’t or at least not yet. But if it is unstable, it may only be a matter of time.

I had to have my right hip replaced only 6 months after left knee - and honestly it hadn’t cause me much problem before hand, but it did deteriorate very quickly.

I was 71 when first op done, and 73 when last one done (shoulder).

And despite what Constance said, all were relatively easy to recover from luckily - but if you aren’t in excruciating pain beforehand I can understand the impetus to have it replaced is not quite the same.

Good luck on whatever you decide.

[cars3876 in reply to DorsetLady]

Thank you so much for your reply and yes if I was in a lot of pain now i would not hesitate. I suppose we all recover differently from surgery but thsnks again for your input.

[DorsetLady in reply to cars3876]

Should have clarified - all were painful pre operation / but brilliant after!

[cars3876 in reply to DorsetLady]

Oh good to hear post op was good

[Bcol]

I have to agree with DL with this one, there is no way, particularly in the present climate, that your consultant would have recommended this if they didn't feel it was neccessary. In terms of the replacement, full recovery time, for me, was around twelve months before I felt totally normal (not sure I've ever been normal but you know what I mean). Yes, there is pain at first but again for me that didn't last that long. Although I had been in such pain before then perhaps that's a perception point. Personally I would have it done as soon as you can, again as DL says if you are walking, going up and down stairs let alone driving the possibilities and outcomes of an accident don't bear thinking about. I'm sure the surgery is a lot shorter and more up to date than when I had mine done twenty odd years ago.

[SueJohnson]

Assuming you can brace it to stabilize it, so there is no danger of an accident, it would depend on your age. since knee replacements usually last only 15 to 20 years before you will need new surgery.

[cars3876 in reply to SueJohnson]

I am 72 I think looking into brace firstly. Thanks for reply

[HeronNS]

I don't know what stage 4 means. I do have significant level of OA in both knees and because of separate injuries had a lot of trouble for many months. I have the orthopod's card and can call him directly "when I'm ready for knee replacement". This is background to what my current situation is. I do exercises from my physiotherapist and a book called Treat Your Own Knees. I had to immobilize my right knee when I walked for a few weeks so it could heal from the injury. A cheap elastic brace from the pharmacy was all I needed. For a while I used something called urban poles, not Nordic style, so I could offload weight from my knees to my arms. The product Flexiseq was recommended to me and I find it very helpful.

Before my injuries my knees did not hurt, although maybe a bit stiff at times. Today they do not hurt, I am walking normally again. The book actually states that many people with severe knee arthritis do not have pain. As things are now for me there is no need to proceed with plans for knee replacement. I am 74 and have polymyalgia rheumatica, no other significant conditions, apart from widespread OA.

[HeronNS]

Adding to my long comment, the exercises, which include use of a pedal exerciser, are really important. Strengthening muscles will improve stability. Using walking poles gives you more security. Some of the knee exercises are specifically focused on improving sense of balance.

I think your choice is either have the operation sooner rather than later, or see if there's a way you can avoid the need for surgery altogether.

[cars3876 in reply to HeronNS]

Thankyou for your reply. Stage 4 is the most severe stage of OA practically bone on bone and would be when replacement is needed. My knee problem dates back to bad motorcycle accident 40 plus years ago so inevitable arthritis would set in. My recent fall of full weight on knee prob put tin hat on it. So i just put pain at time due to fall so was surprised to have severe OA as had been ok before that. I will certainly look into using a brace and do think it sensible to build up muscle to support joint. I was just surprised to have severe OA with no pain or mobility problems but perhaps thst may change now. Yes i do need to look at my choices. I think the consultant was thinking as its going to deteriorate further better do it while i fit enough for the op. Thanks for your input very helpful.

[HeronNS in reply to cars3876]

I do recommend the Flexiseq. If you aren't in the UK, you will have to order it via A...n unfortunately. I'm in Canada and my son now gives me a supply at usual gift giving times! It acts like wd 40 for the joints, no actual medication, just a kind of lubrication.

In case you aren't aware of this, NSAIDS interfere with cartilage regeneration.

[DorsetLady in reply to HeronNS]

Depends which Amazon you buy it from, if it's UK based it won't deliver abroad, I tried to send similar prioduct to SIL in NZ a couple of months ago....and was told I could only send technology type products! Of course, that may have just been NZ or temporary restriction...

.. can you get from main US site?

[HeronNS in reply to DorsetLady]

My son has had no problems and in fact the Flexiseq website only offered Amazon ordering last I looked. We are ordering from outside the country, not from inside to send abroad, maybe that makes a difference? We use Canadian amazon.

[DorsetLady in reply to HeronNS]

Who knows with Amazon! But glad you have no problem.

[HeronNS in reply to DorsetLady]

Can you order from an outside-the-UK site? Maybe if a product is available in Australia it could be shipped to New Zealand, until NZ has its own Amazon?

[DorsetLady in reply to HeronNS]

Don’t know, haven’t looked into that, will suggest to my daughter, she has an account as well, but my UK one raises pennies for PMRGCAuk …

[chrisj]

I have widespread OA diagnosed around 2000 after x rays, but apart from twinges of sciatica had no real pain anywhere. Sciatica got worse and worse but still no sign of arthritic pain at all.

Currently its bad in one knee now. I saw the rheumatologist last week and he said it wasnt ready for surgery, that it was at stage "moderate". Not sure what that means but it didn't sound too serious.

On 2 occasions over time the pain was so bad I couldn't put my foot to the floor.

First time...I'd walked (on doctors advice) further than usual. I walked for about half an hour rather than the usual 10 mins. In such pain the next day my son rang the doctor who came out and sorted a prescription for pain killers with rest. She told me back then, just before the pandemic news broke, the cartilage was gone and my joints were bone on bone. I was shuffling downstairs on my bottom and I was some time getting over that, have pretty much stuck to a 10 min walk since.

Second time...I spun round on one foot and wrenched my knee....again my son called the doctor out who again prescribed pain killers with rest. Took a week or 2 to be able to put my weight on it again. So I dont know at what point surgery is needed or how bad it has to be....

[DorsetLady in reply to chrisj]

Have you had a recent X-ray? I hope so, because if Rheumy is working off the 2000 ones then things could have changed considerably. Plus the decision for surgery will be made by orthopaedic surgeon, not Rheumy.

[chrisj in reply to DorsetLady]

Had one about 2 years ago which he noted and decided he didnt need to do another one as it wouldnt show much anyway 😑 I just dont understand what he means, I thought x rays were useful in what they show. He made it appear there was no use in doing one and its not the first time I've heard that. Just dont get it. So I'm waiting another 6 months now to be seen again.

I noticed more pain in august this year and was sure it would be x rayed at this last appointment🤫

[DorsetLady in reply to chrisj]

Well I have to say, 2 years is a very long time between x-rays - even 6 months can show a considerable difference……did in my case.

Is it possible to get your GP onside and request a referral to to your local musculoskeletal clinic (if hospital has one) - you will need a recent X-ray to do that….but it may be a way around things.

Always worth a try…..even if operation is not required, they will offer advice, and you’ll be ‘in the system’.

[chrisj]

Thank you. I see my gp on dec 6th, a follow up to an "annual birthday long term health review". I'll ask her..or him..when I see them 👍🙂 Fingers crossed xx

[DorsetLady in reply to chrisj]

Let me know how you get on please.

[chrisj in reply to DorsetLady]

Will do....if memory serves. Keeping your e mail to remind me x

[tigerlily22]

I just had my left knee replacement done with robotic surgery. I was bone on bone and the pain was horrible. I finally relented and had the surgery, which took about 1 hour 15 minutes. Expect to have pain post-op for at least a week, I certainly did, but it was controlled by Celebrex and oxycodone 5g. They don't waste any time making you walk with a walker and physical therapy. Today is Day 17 and I am so much better-have to wait 2 more weeks before I can drive, but I am working on my therapy to rebuild my leg muscles. I say go for it. Thanks to arthritis I've had a cervical fusion, 3 back surgeries and bilateral hip replacements. As you can see, arthritis made a mess out of my skeletal system! I am on Ilumya injections-only need to get the shot quarterly. I wish you well!

[cars3876 in reply to tigerlily22]

Thanks so much for reply. So glad you doing well after op. Yes by sounds of it most important thing is getting moving asap and keeping up therapy after op. You really have had a terrible time with arthritis. Best wishes for good recovery from latest surgery.