Knee pain

Is Knee replacement advised for someone on Lupron with multiple distant Mets? I asked my MO and I heard him say no but my wife heard it would be okay. Has anyone had knee replacement?
I had to stop walking on treadmill because of knee pain, my primary care doctor took xrays and said my knees have they have little padding, he mentioned arthritis; I believe it is from taxotere and lupron and the weight I have gained. The primary care doc gave me a steroid shots in both knees but I had little help from it. Now he wants to shoot something else in my knees. But I may see orthopedic surgeon instead.
Larry E

I have taken injections in both knees for about 8 years. Not steroids as that is problematic as far as health is concerned. I have used either Monovisc or simvisc. They worked very well for knee joints completely devoid of Cartilage. It pains me to say ( pun intended ) they have slowly quit working and now my choice is live with the pain or get new knees.

As far as replacements while on HT I don't have a clue.

Be well.

Roger

Larry, I’m in a similar position. I’m only on a short (6 month) course of ADT, a few weeks after I started Firmagon (since switched to Lupron), my already arthritic, twice operated on, knee got really bad. I tried cortisone, and monovisc, didn’t help. Thleyve both helped me in the past.

Talking to my RO’s Nurse Practitioner, she told me that pain in joints is a side effect of ADT, and it’s very possible that my knee issue is being exacerbated by the Lupron.

Based on that, I’d avoid surgery for now, but see what your ortho says.

There is a new treatment, that some claim, works well, called platelet Rich Plasma injections. No;t covered by health insurance, but it’s being used, started out for pro athletes, but plain guys like us are starting to use it.

I plan on asking my ortho, at Hospital for Special Surgery about it. Here’s an article, from 2013, that explains it very well. If you want to see more recent articles, just google “PRP and knee Osteoarthritis”

https://www.hss.edu/newsroom_prp-treatment-potential-for-knee-osteoarthritis.asp

Dogdays, I asked my physical therapist about PRP yesterday, he was a little iffy, as it’s not yet proven, and it’s expensive. He brought up stem cell therapy though, and was more positive on PRP than stem cell. I don’t recall his reason

Dogdays id be interested to hear what ypur Ortho says, if you remember, can you report back? Or just shoot me an email if you prefer.
Thanks

Thanks everyone!
I am going to see an ortho doctor and try what he suggest.

Dennis - I would be interested to hear what your doc says; but I do understand if you forget to ask. I am in a Lupron fog often and it takes away my memory. It also makes for awkward silent moments when I'm in a conversation.
Larry E

Thanks Pratoman,
I will find out Tuesday if my knee caps are bad.

Very odd, but, in the last 2 days, my knee is about 75-80% I proved. Even walked. Mile and a half today. I guess physical therapy really works.
I’d like to see the two Drs who told me I need knee replacement and do some really bad things to them.

InTheShop said...
I keep telling you, swing by my shop, I'll fix you up with a new knee cheep. I got tools, hinges, lumber and two kinds of plastic.

Bring a quart of rum.

Ummmm....thanks Andrew, but I think I’ll leave well enough alone. 😂

Almost everyone over 50 has a meniscus tear or a little arthritis so the Lupron doesn't help. After PT and six weeks of rest, I am running again. I also visited with a very good orthopedic surgeon who said that unless I am in extreme pain he wouldn't recommend any surgery. Although he said if I had to do the surgery he could have me running in 6 weeks with some biking and PT. See JAMA article below. I am wearing a soft brace when I run and still doing PT exercises and icing. Another option should you go down this road, is stem cell injections. A friend said it helped him with a shoulder injury, but more research is needed. See this article https://www.hss.edu/newsroom_prp-treatment-potential-for-knee-osteoarthritis.asp
Effectiveness of Physical Therapy vs. Arthroscopy for Meniscal Tears
Jonathan S. Coblyn, MD reviewing van de Graaf VA et al. JAMA 2018 Oct 2
More evidence that PT is noninferior to arthroscopic partial meniscectomy
Despite good evidence showing that arthroscopic partial meniscectomy (APM) is not better than physical therapy (PT) for meniscal tears, APM continues to be performed often. Six previous randomized trials in patients with confirmed meniscal tears have not revealed any significant benefit of APM over PT or sham arthroscopy (e.g., NEJM JW Gen Med Aug 1 2015 and BMJ 2015; 350:2747). However, a metanalysis of five trials did show that some patients benefited from APM at 3 months, but this benefit did not persist at 1- to 2-year follow-up (NEJM JW Gen Med Jul 1 2017 and BMJ 2017; 357:1982). In this study, investigators aimed to determine whether PT is noninferior to APM for improving self-reported knee function in patients with nonobstructing meniscal tears. Patients were excluded if they had tears that caused locking of the joint, were obese, had known ligamentous damage or prior knee surgery, or had severe arthritis. More than 300 patients were assigned randomly to receive APM or PT. At 24 months, outcomes in the two treatment groups were similar. However, 29% of PT patients had received delayed APM. What about complications from APM? In a U.K. study, researchers analyzed almost 700,000 APMs. Serious complications occurred in about 0.3% of procedures within 90 days. about 0.08% of APM patients developed pulmonary emboli, and about 0.14% developed infections that required further surgery.

68 yrs., marathon runner, 35 of 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.

InTheShop said...

Dogdays said...
Andrew,
You gonna work on Prato before or after consuming that rum?

before. ;)

Not happening. Not even before the rum 🤣

I’ve heard mixed reviews. My physical therapist tells me that maybe 10% of his patients are better off for having had the surgery. I have 2 friends one had double knee replacement, it took him 3 years to even be able to get back on the golf course, and he’s turned into a very fat person who waddles when he walks. The otherhas occasional issues but on balance, she’s happy with the result,

For now, the PT seems to be working.

Pratoman said...
I’ve heard mixed reviews. My physical therapist tells me that maybe 10% of his patients are better off for having had the surgery. I have 2 friends one had double knee replacement, it took him 3 years to even be able to get back on the golf course, and he’s turned into a very fat person who waddles when he walks. The otherhas occasional issues but on balance, she’s happy with the result,

For now, the PT seems to be working.

I'll provide some other anecdotal evidence in favor of knee replacement for those who need it. I'm in a very active tennis community where a lot of the senior players have had one or both knees replaced. I would say that 90%+ of them had a positive experience and are considerably better off post-surgery. My wife is a good example. One knee got so bad that she couldn't sleep thru the night w/o pain and was having trouble walking the dog around the block. After her knee replacement and VERY vigorous PT afterwards, she was back on the tennis courts within 3 months and that is pretty typical of the patients around here.

I think much of the success here comes from the experience and approach of the orthopedists. One local hospital here in Naples, FL has the third most knee replacements of any location in the USA. Perhaps not surprising because of the demographics here, i.e. old people but very much out of proportion to the overall population compared to big cities. So the experience is a given. What is not a given is the approach/attitude of many of the physicians who seem to have a good understanding of "active" seniors who want to resume their activities rather than waste away and that's where the post surgery PT comes in from walking hours after the surgery to using knee machines that keep the knee in motion hours each day to daily exercises that work the muscles and ligaments.

One other anecdote has to do with the attitude of the doctors. We have a friend from Michigan who is was 74 when she got her knee replaced. She went to a prominent ortho in Michigan who responded that she would walk fine after knee replacement but could forget about her active sports. She came to FL and found a sports-minded-keep-seniors-active ortho who got her back to tennis and pickleball within 3 months.

Of course these are all anecdotal but I'm a firm supporter of knee replacement for those who need it. It provides for a renewal of active lifestyle...but buyer beware as you choose an orthopedist.

BTW, we have attended several presentations by orthopedists who have discussed stem cell treatment in lieu of replacement and their general conclusion is that "this will come" but it's not yet ready for prime time.

Jim