Knee replacement

Roger, I don't know how old you are, but your changes sound like a knee with lots of wear from use. Basically, the cartilage that pads the ends of both long bones that meet at the knee joint is eroding and becoming thinner and thinner. This is gradually eliminating the cushion between the bones. When it is gone, you will definitely have pain. You have a little extra fluid in the knee under the knee cap, probably due to the loss of cartilage cushioning. "Intra-articular loose bodies" refers to junk, usually torn bits of cartilage, floating in the joint fluid. These can cause pain and swelling and are often the culprit in sports or other traumatic knee injuries.

Because you have no loose cartilage, the relatively simple arthroscopic surgery often done, say, on football players, would be of no help. Its purpose is to remove loose junk in the joint. Based on your x-rays, you likely will need knee replacement at some point. Only you can decide when you've reached that point. The longer you wait, the more likely you will begin to have pain and limited function in the joint. However, since these are alleviated by knee replacement, waiting is unlikely to cause problems that will last after surgery.

Another thing to be aware of is your walking gait. If you begin to favor that knee to protect it, you can damage the hip joint and develop hip pain also. Since limps develop slowly, it's helpful to have a friend or family member check your walking gait once in a while.

My personal opinion is that the time for surgery is when you are changing your lifestyle to accommodate a bad knee, or when you're having significant pain. Keep in mind, though, that I always wait longer than I should. I walked with pain for several years waiting for a 'convenient' time for my knee replacement. The day after the replacement I was walking short distances, with a walker, but without pain. Two days later I walked out of the hospital and a week after that I put the walker away. So I know I should have done it sooner, I suffered unnecessarily.

Good luck to you, and keep us poste on how you're doing.

Roger, I've had knee replacement, repair of a bad leg fracture with a plate and screws and two shoulder surgeries. The knee replacement was by far the least painful for me, and the easiest rehab.