Meniscus repair or Total Knee Replacement

[touch]

I'm 69 years old and in pretty good shape. Unfortunately i tore my meniscus a couple of weeks ago and an MRI confirmed a Complete Tear at Posterior Root of Medial Meniscus.

I've been to see Dr Bancha Chernchujit at Bangkok Hospital and he recommended a meniscus repair.

I've also heard that for patients over 60, it might be better to do a TKA Total Knee Replacement.

I'm not a medical professional and I just don't know which treatment is best for my situation.

It's an impossible situatin having to make a medical decision without having the knowledge.

Maybe @Sheryl or somebody else have information that can help???

[retarius]

Personally I would go for the most conservative treatment first ie the meniscus repair, or maybe even Platelet Enriched Therapy, prior to meniscus repair. You can always have a TKR later on if more conservative treatments don't work. 

Knees are difficult joints and TKR is not a sure fire treatment like a hip replacement is, especially if your post-op physical therapy is not tip-top. 

[2long]

This forum is full of SAS Navy Seals and virologists, not orthopeadic experts! 🫣🙃🤭

They try their best to only do a TKR once per leg, because a second one (when the first wears out) is very hard to do. So, if you're fit at 69, @retarius has the better answer for you. TKR's rarely last more than 20 or so years and it sounds like you might have more than that left in your tank.

Good luck!

[carlyai]

There's a world of difference between a menicus tear and TKR.

If you get the right doctor they can repair the menicus.

If you are older they may not repair it, just cut the bits out that may be causing problems, which the did with me.

I've also had a TKR and not fun.

I was one of the unfortunate ones who had a big problem with mine and am on my second revision and it's a lot better now.

Seems the patellar button was about 2mm too big (I had a new knee cap as well) and I kept getting lots of scar tissue.

I'd still have the other knee replaced as better to be able to walk than not due to the pain.

 

[scubascuba3]

No brainer meniscus repair. I have a partial tear and it settled down after a while without an op

[carlyai]

11 minutes ago, scubascuba3 said:

No brainer meniscus repair. I have a partial tear and it settled down after a while without an op

Trouble is some tears (like mine) cause the knee 'catching' as you walk and a feeling that the knee gives way.

[Sheryl]

A torn meniscus is not an indication for a knee replacement. Those are indicated only for severe joint degeneration,  usually from osteoarthritis or very severe trauma. If you had that the MRI would have described it. What exactly does the MRI say about the condition of the knee joint?

 

While partial meniscal tears can sometimes heal on their own, a complete tear does require surgery. Which can be done arthroscopically.

 

Only reason to do a TKR rather than meniscal repair would be if the knee joint was so severely degenerated by osteoarthritis that you were within a year or two of needing a TKR anyhow. The fact that you are aged 69 in no way means this is true.

 

Dr. Bancha is very well qualified. But  if you feel need for  a second opinion, best knee specialist in country is  https://www.bumrungrad.com/en/doctors/panya-wongpatimachai

 

 

[proton]

Friend had knee replacement last year, months of pain and physio after, it's not something to have done unless absolutely needed

[scubascuba3]

1 hour ago, carlyai said:

Trouble is some tears (like mine) cause the knee 'catching' as you walk and a feeling that the knee gives way.

i had similar feelings, it apparently flapped over, sometimes it would get caught in the knee, now that is extremely rare

[RAZZELL]

A mate in Bkk has had a knee replacement. 

 

Swears he would never do it again. His other knee he is having PRP with good results.

 

RAZZ

[John49]

I twisted my knee about one year ago.

I had an MRI of knee and the report mentioned ‘partial tears’.  

I have since heard that there are 3 grades of tear, but no mention of ‘grade of tear’ in my report (from Bangkok Hospital).

 

I limped for many weeks and thought that the tear would not heal, but here we are nearly one year later and all is well. (Possibly my tear was on the outer 2/3rds that have a blood supply and can heal??)

 

Not sure about the longevity of tear repair; I had a negative report from someone who had two tear repairs that did not last…

 

I have two family members who have had TKR in both legs.

They really suffered a lot post op. for many months.

Seems like you need to work really hard on post op physio for a good long term result.

Like someone said above, 'not to be taken lightly'.

[bkk6060]

You heard over 60 TKR?  Who the heck told you that?  I have had the Menicus repair. I walked out after surgery, 6 weeks later after some rehab felt 100%.

 

[Sheryl]

I also cannot imagine where OP would have heard this. I suspect he either heard it from someone very uninformed or confused what he heard.

 

It is never a question of meniscus repair vs TKR unless a TKR was already in the offing due to very advanced degeneration.

 

With a complete root tear, the preferred treatment is surgery.

 

 

[carlyai]

[carlyai]

Sorry, trouble editing at moment.

Picture after second revision and now (about 1 year apart). I worked on rehab extremely hard.

Many many older (near 80 yrs) people riding bikes etc after TKR. 

[notrub]

Decades of skiing in France ate the cartilage in my left knee.  My replacement was done by a surgeon in Annecy who only does knees. (I had paid an extra surcharge of 500 euros for the special 'sport surgeon/anesthetist team') (Most of my friends have had a new knee, many have 2)

 

French healthcare provided 21 days of inpatient 're-education' at a special hospital in Plateaux  d'Assey. I did not appreciate the importance of getting more than 90 degrees bend (mine is about 135) and I learned about the joy of being able to climb stairs and the fear of not.  Many people find their knees blocked at less than 90 deg. and must engage in painful maneuvers to try to unblock it or have another operation.  I saw one lady in Krung Tep who was told to stay in bed following the op and now has a straight peg leg type of affliction ever after. 

 

I was up and walking a day or 2 later but was cautioned about over use as the surgeon had packed the cut with painkllers b4 stapling it up(!).  The joint has no problems for me but the op involves yanking the kneecap out of the way while the replacement is being fitted and this has had some lasting numbing that occurs on my lower leg (I suppose). 

 

This op was good for me but the re education is essential or you will be disabled for life.  Cannot stress this enough.🙏🏼🙂

[richard_smith237]

Years of skiing & football…. The resulting complex tear of the meniscus was ‘cleared up’ (trimmed up) with minimal arthroscopic surgery mid 2023 and is a few months from getting back to 100% normal, but still couldn’t play football yet (probably requires 12 months for something that ‘twisty & stop-start’)…. 

I also had the ‘click & grind’ issue when walking which was quite unnerving & told me something definitely had to be done. 
 

Dr. Panya at Bumrungrad did the work after reading recommendations on this forums.

 

 

 

[richard_smith237]

Slightly off topic, but useful for this topic:

 

Recovery: 

a) with plasma injections.

b) with stem cells injections.

 

Anyone with any experience of this ?

Cost, where, effectiveness ? 

[BigStar]

7 minutes ago, richard_smith237 said:

Slightly off topic, but useful for this topic:

 

Recovery: 

a) with plasma injections.

b) with stem cells injections.

 

Anyone with any experience of this ?

Cost, where, effectiveness ? 

 

 

Friend of mine did plasma for her hip pain. Very minimal relief. A hip replacement will be coming up.

[scubascuba3]

I reckon this plasma treatment is mainly placebo, i know someone who had injections in his big toe 

[carlyai]

38 minutes ago, richard_smith237 said:

Slightly off topic, but useful for this topic:

 

Recovery: 

a) with plasma injections.

b) with stem cells injections.

 

Anyone with any experience of this ?

Cost, where, effectiveness ? 

I had a Spinal Chord Implant (SCI) for back problems. Several years ago.

My pain doctor said he was putting off knee surgery to wait for the stem cell therapy.

Things are rapidly progressing but I am not sure if they have perfected it yet.

[carlyai]

1 hour ago, notrub said:

Decades of skiing in France ate the cartilage in my left knee.  My replacement was done by a surgeon in Annecy who only does knees. (I had paid an extra surcharge of 500 euros for the special 'sport surgeon/anesthetist team') (Most of my friends have had a new knee, many have 2)

 

French healthcare provided 21 days of inpatient 're-education' at a special hospital in Plateaux  d'Assey. I did not appreciate the importance of getting more than 90 degrees bend (mine is about 135) and I learned about the joy of being able to climb stairs and the fear of not.  Many people find their knees blocked at less than 90 deg. and must engage in painful maneuvers to try to unblock it or have another operation.  I saw one lady in Krung Tep who was told to stay in bed following the op and now has a straight peg leg type of affliction ever after. 

 

I was up and walking a day or 2 later but was cautioned about over use as the surgeon had packed the cut with painkllers b4 stapling it up(!).  The joint has no problems for me but the op involves yanking the kneecap out of the way while the replacement is being fitted and this has had some lasting numbing that occurs on my lower leg (I suppose). 

 

This op was good for me but the re education is essential or you will be disabled for life.  Cannot stress this enough.🙏🏼🙂

My firstTKR didn't go well, as I said before, because the patella was too tight. Just 2mm the Dr said when they took it out again after shaving that much off the patellar button.

After the op I woke up with one of those knee stretching machines, so pain on pain.

Out of the mob that had TKR with my specialist I was the only one with a problem and that included some with double TKR at the same time.

Major scar tissue which the physio had to keep breaking 3 times a week.

He would roll a towel up under my ankle, say 'are you ready' then slowly push my knee down to the bed. The force got stronger until my knee was straight on the bed.

Kept doing it, with breaks until I'd had enough.

I could feel the tearing under my knee and after weeks he finally said he had done as much as he could. 

My sister who took me to physio said she would never ever have a knee op after all my screaming. 🙂

About a year later I had an arthroscope and the Dr said there was scar tissue everywhere, which he removed.

Even with this last revision Dr said still lots of scar tissue before he fixed the kneecap.

Same renowned specialist. 

I asked him why and he said he didn't know. Said some people have trouble. Surgery went well.

For rehab, after the 1 week hospital rehab, I exercised in the pool every day.... walked and walked, rode a stationary bike,  as well as bought a skate board and used that to bend the knee as much as I could stand, every day.

[touch]

Thank you to all that had useful advice.

As to where I heard the "over 60" it was at a private hospital here in Pak Chong.

Since I made the post Dr. Bancha called me, I had asked his assistant a couple of questions, and Dr. Bancha video called via Line.

He explained that a TKR is too aggressive since my knee is in too good shape to even consider TKR.

He repaired my shoulder 10 years ago. A complicated repair that went very well and I do have confidence in him.

At the moment I'm just waiting to see what the insurance company (ACS) will have to say since they claim that Bangkok Hospital and Bumrungrad are over charging and they are not recommending their policy holders to use these hospitals.

[Mark Nothing]

3 hours ago, richard_smith237 said:

Slightly off topic, but useful for this topic:

 

Recovery: 

a) with plasma injections.

b) with stem cells injections.

 

Anyone with any experience of this ?

Cost, where, effectiveness ? 

The medical term for urine is plasma ultrafiltrate.  I have never done plasma injections as filling a glass and applying directly on the skin by hand is simpler plus free. The skin varaciously absorbs the panacea going where required.  

 

A few years ago, I began daily rub downs of my entire body with plasma ultrafiltrate, enhanced further with a prayer for a fully functioning, healthy body and the results were excellent.  Strength, balance, and muscle tone returned.  The nuisance aches and pains of old age dissappeared.  The unpleasant morning stiffness also dissappeared.  A counterintuitive aspect of this is nobody complains of offensive body odor  to me.  God designed plasma ultrafiltrate for people, not concrete alleys.

 

Lots of my contacts have had knee replacements and I would consider this an option of last resort  due to months of recovery, the gruesome looking scar, the rehab nuisance, and one had a stroke shortly after knee replacement surgery requiring brain surgery and 2 weeks in intensive care unit.

[notrub]

I have some friends who have suffered bad surgery results and it always saddens me learning about them.  A German man I know had his hip replaced and they neglected to make that leg the same length as the other.  I remember the surgeon personally measuring my legs and commenting that he would be correcting the slight difference in length with the operation.

 

Here is a picture of my knee today.  The staple photo is posted above.

 

I was interested to learn about plasma ultrafiltrate from Mark Nothing.  Where is this product available from please? And can you provide a bit more information about how all that works please. (a very quick look on google did not produced a description of what you describe).  I use a skin moisturizer called Urea 10%. Is there any connection? 

 

Thank you🙏🏼🙂

 

 

[Sheryl]

10 hours ago, notrub said:

I was interested to learn about plasma ultrafiltrate from Mark Nothing.  Where is this product available from please?

 

 

Thank you🙏🏼🙂

 

 

 

He is referring to urine.

[richard_smith237]

18 minutes ago, Sheryl said:

He is referring to urine.

 

Indeed... it rather seemed as though he gave himself a golden shower each morning.... 

[kwonitoy]

17 hours ago, notrub said:

I have some friends who have suffered bad surgery results and it always saddens me learning about them.  A German man I know had his hip replaced and they neglected to make that leg the same length as the other.  I remember the surgeon personally measuring my legs and commenting that he would be correcting the slight difference in length with the operation.

 

Here is a picture of my knee today.  The staple photo is posted above.

 

I was interested to learn about plasma ultrafiltrate from Mark Nothing.  Where is this product available from please? And can you provide a bit more information about how all that works please. (a very quick look on google did not produced a description of what you describe).  I use a skin moisturizer called Urea 10%. Is there any connection? 

 

Thank you🙏🏼🙂

 

 

 

He collects his pee in a bottle and then rubs it onto his body, and prays real hard

YMMV

[notrub]

I get this (costly) stuff from the dermatologist at the hospital.  Excuse me for being dumb (as in stupid) but I thought urea means urine.  Immersing myself in pee does not appeal but if there is a derivative that helps this aching body of mine I would like to learn of it.  Thanks. 🙏🏼🙂

[GammaGlobulin]

Definitely go with the most conservative approach...the repair....FIRST.

 

If that fails, then go for replacement.

 

A replacement is NEVER as good as human tissue.
I know of that which I speak, in this case, having had femur removed and replaced with titanium and ceramic joint.

 

Save what you can, whenever you can.

 

In my case, the femur was completing shattered, and replacement was the only option.

No pinning of the femur was practicable.

 

Good Luck to you, for sure!

 

 

Edited February 26 by GammaGlobulin