Total Knee Replacement and Hyaluronic Acid Shot experiences?

TripleB

Hall of Fame
Went to the doc yesterday to get the results of an MRI on my right knee.

Turns out I have no cartilage left in there, I have arthritis in the knee, and my meniscus is torn in two places.

At age 54 the doc says he can give me a hyaluronic acid shot (if my insurance approves it), he put me on Celebrex, and said when I can't put up with the pain any longer he'll perform a total knee replacement.

So I'd like to hear any experiences you've had with either the hyaluronic acid shot, total knee replacement, or both. Positives, negatives, results, would you do it again, do you wish you'd have done it earlier, how bad is PT after TKR, etc?

Some background info: had microfracture surgery on the other knee 10 years ago because it didn't have any cartilage in it and it's been great...doc told me then to never play tennis again, that lasted 6 months, been playing ever since with no problems; had a DVT blood clot 3 years ago, don't know what caused it, ran from mid thigh to mid calf, on Xarelto for 8 months to get rid of it...so that's a bit of concern any time I have surgery

Thanks for any and all input!

TripleB
 

Injured Again

Hall of Fame
Hey @TripleB Best of luck to you!

One of my hitting buddies had a total knee last August. Today, he's on court and moving around no worse than he was last August, which admittedly wasn't great, but his other knee is also worn out. He's 60 but was a professional cyclist in his younger days, and both skis and plays a lot of tennis. He did not walk normally for three or four months after surgery and was barely on the court doing mini-tennis at four months. He does say he doesn't have the kind of pain he did have before so that's a win.

I think I've had a meniscus problem for the last two or so years. I've had soreness on the inside of my left knee that entire time but it never affected me until last August when my wife and I went to Colorado and did a ton of hiking, including the summits of Evans and Pikes Peak. I came back with a pronounced click with every step. In December, it had progressed to the point where I saw an orthopedist who took x-rays. I have between grade III and IV osteoarthritis in both knees, and he prescribed PT to try and get my knees tracking better.

I then played terrible in an age group tournament in January and ramped up my training. By March, my knee was hurting to the point where I couldn't walk normally. I went to a high performance athletic PT and while performing a step-up, slightly lost my balance and acutely injured that left knee. I've been basically unable to play normally for about three weeks now, unable to walk normally since the injury, have an MRI for next Monday, and will schedule a surgical repair for what is undoubtedly a meniscus issue as soon as possible after that. The symptoms are what I've had for the last couple of years, only greatly magnified and with the feeling there's something loose inside the knee. So I've probably had a meniscus issue this entire time and never had it diagnosed correctly.

Some things I've learned. First, many people who present with x-ray indications of no cartilage remaining in their knees are still highly functional. Before one of my PT appointments, the therapist asked if I noticed the guy before me. He was in his 60's and very trim and fit looking. He was diagnosed with grade IV osteoarthritis and his x-rays looked typical of someone who imminently needed both knees replaced. Yet, he only complains when he ramps up his running mileage to more than 30 miles a week.

Second, before I acutely injured my knee, I was scheduled for a series of Euflexxa injections, which is the hyaluronic solution. My orthopedist says that it works best in those who have knees that are not totally worn and in those cases can extend the time before knee replacement out from a few to several years.

Third, from another tennis buddy who had two total knees. The first one went fairly smoothly as far as recovery for tennis, but the second one, even though the surgical recovery was better, degraded tennis movement more. I guess even with a less painful total knee replacement, the ability to push off just isn't there.

Good luck to you, and to both of us!
 

socallefty

Legend
Surgery is always a risk for infections and it might work well or not. HA shots are easy to try and should be considered before surgery. I know many people including myself who felt that HA shots worked for 1-2 years in terms of reducing knee soreness after active sports and we are all over the age of 50.
 

S&V-not_dead_yet

Talk Tennis Guru
Went to the doc yesterday to get the results of an MRI on my right knee.

Turns out I have no cartilage left in there, I have arthritis in the knee, and my meniscus is torn in two places.

At age 54 the doc says he can give me a hyaluronic acid shot (if my insurance approves it), he put me on Celebrex, and said when I can't put up with the pain any longer he'll perform a total knee replacement.

So I'd like to hear any experiences you've had with either the hyaluronic acid shot, total knee replacement, or both. Positives, negatives, results, would you do it again, do you wish you'd have done it earlier, how bad is PT after TKR, etc?

Some background info: had microfracture surgery on the other knee 10 years ago because it didn't have any cartilage in it and it's been great...doc told me then to never play tennis again, that lasted 6 months, been playing ever since with no problems; had a DVT blood clot 3 years ago, don't know what caused it, ran from mid thigh to mid calf, on Xarelto for 8 months to get rid of it...so that's a bit of concern any time I have surgery

Thanks for any and all input!

TripleB
Two tennis buddies > 60 get periodic HA injections and both report good effects although varying duration.
 

SlvrDragon50

Semi-Pro
A lot of insurance companies want to see failed injections prior to approving the knee replacement. That said, if you truly have no cartilage left, the hyaluronic acid injection isn't going to do anything, and it's just a formality.
 

Fintft

Legend
Hey @TripleB Best of luck to you!

One of my hitting buddies had a total knee last August. Today, he's on court and moving around no worse than he was last August, which admittedly wasn't great, but his other knee is also worn out. He's 60 but was a professional cyclist in his younger days, and both skis and plays a lot of tennis. He did not walk normally for three or four months after surgery and was barely on the court doing mini-tennis at four months. He does say he doesn't have the kind of pain he did have before so that's a win.

I think I've had a meniscus problem for the last two or so years. I've had soreness on the inside of my left knee that entire time but it never affected me until last August when my wife and I went to Colorado and did a ton of hiking, including the summits of Evans and Pikes Peak. I came back with a pronounced click with every step. In December, it had progressed to the point where I saw an orthopedist who took x-rays. I have between grade III and IV osteoarthritis in both knees, and he prescribed PT to try and get my knees tracking better.

I then played terrible in an age group tournament in January and ramped up my training. By March, my knee was hurting to the point where I couldn't walk normally. I went to a high performance athletic PT and while performing a step-up, slightly lost my balance and acutely injured that left knee. I've been basically unable to play normally for about three weeks now, unable to walk normally since the injury, have an MRI for next Monday, and will schedule a surgical repair for what is undoubtedly a meniscus issue as soon as possible after that. The symptoms are what I've had for the last couple of years, only greatly magnified and with the feeling there's something loose inside the knee. So I've probably had a meniscus issue this entire time and never had it diagnosed correctly.

Some things I've learned. First, many people who present with x-ray indications of no cartilage remaining in their knees are still highly functional. Before one of my PT appointments, the therapist asked if I noticed the guy before me. He was in his 60's and very trim and fit looking. He was diagnosed with grade IV osteoarthritis and his x-rays looked typical of someone who imminently needed both knees replaced. Yet, he only complains when he ramps up his running mileage to more than 30 miles a week.

Second, before I acutely injured my knee, I was scheduled for a series of Euflexxa injections, which is the hyaluronic solution. My orthopedist says that it works best in those who have knees that are not totally worn and in those cases can extend the time before knee replacement out from a few to several years.

Third, from another tennis buddy who had two total knees. The first one went fairly smoothly as far as recovery for tennis, but the second one, even though the surgical recovery was better, degraded tennis movement more. I guess even with a less painful total knee replacement, the ability to push off just isn't there.

Good luck to you, and to both of us!
Have you tried glucosamine for your meniscus?
I had one popping back in/healing in a couple of weeks and so did a younger coach.
 

Fintft

Legend
Surgery is always a risk for infections and it might work well or not. HA shots are easy to try and should be considered before surgery. I know many people including myself who felt that HA shots worked for 1-2 years in terms of reducing knee soreness after active sports and we are all over the age of 50.
The middle-aged patient and meniscus surgery – surgeons cannot predict which patients will benefit and who will not benefit from meniscus surgery. Flipping a coin would work just as well.
A March 2020 study in the British Journal of Sports Medicine (10) questioned whether experienced orthopedic surgeons could predict who would benefit from surgery for degenerative meniscus tears and who would not.

The researchers set up an experiment. Surgeons participating in this study were given 20 cases to examine. In each case, the surgeon was asked to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy and exercise therapy in middle-aged patients. The surgeons were also asked to predict the beneficial change in knee function in those patients they would recommend to surgery and those patients they would send to physical therapy or an exercise program.

The surgeons combined to examine and predict outcomes in 3880 knees. The results?

  • Overall, 50.0% of the predictions turned out to be correct, the surgeons were able to predict 50% of the time which treatment would be of most benefit before treatment. The researchers of this study however noted – 50% correct would be no better than flipping a coin as it equals the proportion expected by chance.
  • Experienced knee surgeons were not better at predicting outcomes than other orthopaedic surgeons.
  • Conclusions: Surgeons’ criteria for deciding that surgery was indicated did not pass the statistical examination. This was true regardless of a surgeon’s experience. These results suggest that non-surgical management is appropriate as first-line therapy in middle-aged patients with symptomatic non-obstructive meniscal tears.
 

GeoffHYL

Professional
My 65 year old tennis buddy just had his second TKR done a few months ago. The first one was last summer. His movement was pretty limited before the first TKR, much improved afterwards, but limited by the second bad knee. Recovery time was about 4-5 months for the first TKR. He's still in recovery from the second TKR. He did a lot of pre and post surgery PT, almost every day, and it was painful, but worth it in his opinion.
 

socallefty

Legend
The middle-aged patient and meniscus surgery – surgeons cannot predict which patients will benefit and who will not benefit from meniscus surgery. Flipping a coin would work just as well.
Had meniscus surgery three years ago and was part of the 50% of patients for whom it had no impact. HA acid shots worked better for me therapeutically for almost two years.
 

Injured Again

Hall of Fame
Have you tried glucosamine for your meniscus?
I had one popping back in/healing in a couple of weeks and so did a younger coach.
I've been taking glucosamine for the better part of a couple of decades. I started having knee problems in my early 40's and I turn 61 this year.

I think it works. At worse, it doesn't do anything and taking it hasn't impacted my health otherwise.
 

Fintft

Legend
I've been taking glucosamine for the better part of a couple of decades. I started having knee problems in my early 40's and I turn 61 this year.

I think it works. At worse, it doesn't do anything and taking it hasn't impacted my health otherwise.
There are rumors though about gaining weight, similar to insuline effects.
 

Injured Again

Hall of Fame
This coming Friday will be four weeks since my acute injury to my medial knee. I could barely walk for the first week, and the second week was walking with a hobble. This third week has seen some pretty quick progression and I'm able to move at maybe 50-60% of my normal level. I can walk normally and only have a sensation of tightness but no pain in my medial knee. I'm able to squat, do leg extensions, and hamstring curls with no pain and so I've been at the gym practically every day doing resistance training.

Though I have excellent insurance, there's been a holdup in getting the Euflexxa authorized. They apparently need me to have had no benefit from oral or topical NSAIDs, or from a corticosteroid shot. The corticosteroid shot would have included two weeks of very limited exercise afterwards, something which I wasn't willing to do, and also comes with a risk of degenerating what little cartilage and meniscus I already have, something I didn't think was worthwhile to do. The topical (Voltaren) was ineffective and the oral NSAID (naproxen) was only partly effective.

There is an age group tournament at the end of this month that I'd like to play, and then immediately after that my wife and I are heading to the east coast to do what was to be a lot of hiking. I'm working my butt off to try and get to the point where I can do both of these things. If desire and hard work were enough, I'd get there but I'm afraid my body won't cooperate.
 

Injured Again

Hall of Fame
There are rumors though about gaining weight, similar to insuline effects.
I haven't had that - not that I haven't gained weight but I know why it is that I have gained weight, and I've also substantially dropped weight while taking it. As far as insulin kind of effects, my A1C and blood glucose levels are well within normal limits so fingers crossed that those markers will stay there!
 

mmk

Hall of Fame
My wife had no cartilage and tried hyaluronic acid, and as predicted by her ortho it didn't help - you really need some cartilage for synvisc/omnivisc/etc. to work. She has since had both knees replaced and revised, where a revision is basically replacing parts from the original replacement. She's also had her right hip replaced (at 36) and revised (at 44) and both shoulders replaced.
 

Bambooman

Professional
My wife had no cartilage and tried hyaluronic acid, and as predicted by her ortho it didn't help - you really need some cartilage for synvisc/omnivisc/etc. to work. She has since had both knees replaced and revised, where a revision is basically replacing parts from the original replacement. She's also had her right hip replaced (at 36) and revised (at 44) and both shoulders replaced.
What is the reason for so many joints failing at a young age? That seems excessive.
 

mmk

Hall of Fame
What is the reason for so many joints failing at a young age? That seems excessive.
Legg Calve Perthes disease caused her right hip to go bad starting when she was about 12, and her parents sent her to a quack who x-rayed her left hip instead, over her protestations, and told them it was all in her head. Compensating for her right hip over the years led to the other joints going bad.
The hip revision surgery was required due to the plastic interface having been irradiated to sterilize it, but that caused the plastic to disintegrate, and the plastic particles ate away at her pelvis, which cracked and needed freeze-dried bone material packed into it to provide enough bone to do the revision. She gets Prolia treatments to get her bone density up. I'm not clear on what caused the issues with the knee replacements, although getting the right sized parts for the knees contributed.
She's also been told she's eligible for ankle replacement, but she won't do that. Her left hip may need to be replaced in the next few years, but hip replacement surgery is a lot more advanced than it was in 1994 when she had her right hip done the first time.
 

socallefty

Legend
Though I have excellent insurance, there's been a holdup in getting the Euflexxa authorized.
My doctor warned me that my insurance wouldn’t pay for HA shot and so, I didn’t bother trying to get them to approve it.

I got a single injection shot (Durolane) and it cost less than $300. I feel like it helped me for about 2 years during which I played tennis 8-9 times a week and so, it was worth it. After two years, I am starting to get slight soreness again in my knees still playing at the same rate. I have very little cartilage left too and had a meniscus arthroscopic surgery three years ago which didn’t help much.
 

Fintft

Legend
My doctor warned me that my insurance wouldn’t pay for HA shot and so, I didn’t bother trying to get them to approve it.

I got a single injection shot (Durolane) and it cost less than $300. I feel like it helped me for about 2 years during which I played tennis 8-9 times a week and so, it was worth it. After two years, I am starting to get slight soreness again in my knees still playing at the same rate. I have very little cartilage left too and had a meniscus arthroscopic surgery three years ago which didn’t help much.
I forgot, are you playing on clay year around?
Since I've switched my indoor seasons from hc to red clay about 5 years didn't have a single injury (not to jynx myself).
I also replace shoes often and the stock insoles with gel ones with plastic reinforcement in the arch (Dr Scholl's active).
 

socallefty

Legend
I forgot, are you playing on clay year around?
Since I've switched my indoor seasons from hc to red clay about 5 years didn't have a single injury (not to jynx myself).
I also replace shoes often and the stock insoles with gel ones with plastic reinforcement in the arch (Dr Scholl's active).
Hard courts in California.
 

Bambooman

Professional
Legg Calve Perthes disease caused her right hip to go bad starting when she was about 12, and her parents sent her to a quack who x-rayed her left hip instead, over her protestations, and told them it was all in her head. Compensating for her right hip over the years led to the other joints going bad.
The hip revision surgery was required due to the plastic interface having been irradiated to sterilize it, but that caused the plastic to disintegrate, and the plastic particles ate away at her pelvis, which cracked and needed freeze-dried bone material packed into it to provide enough bone to do the revision. She gets Prolia treatments to get her bone density up. I'm not clear on what caused the issues with the knee replacements, although getting the right sized parts for the knees contributed.
She's also been told she's eligible for ankle replacement, but she won't do that. Her left hip may need to be replaced in the next few years, but hip replacement surgery is a lot more advanced than it was in 1994 when she had her right hip done the first time.
Wow. I also had that as a child and refused to wear the Forrest Gump style braces.
I took me years to walk and run properly but I've been generally OK since.
Oddly the part of the world where I was born has one of the higher if not the highest incidences of that disease.
Makes me wonder if Murray's hips and knee disorder have a similar cause, whatever that is.
 

Injured Again

Hall of Fame
My doctor warned me that my insurance wouldn’t pay for HA shot and so, I didn’t bother trying to get them to approve it.

I got a single injection shot (Durolane) and it cost less than $300. I feel like it helped me for about 2 years during which I played tennis 8-9 times a week and so, it was worth it. After two years, I am starting to get slight soreness again in my knees still playing at the same rate. I have very little cartilage left too and had a meniscus arthroscopic surgery three years ago which didn’t help much.
My insurance just requires that two out of the three precursor treatments fail to provide relief and we've met that threshold so the authorization should be forthcoming. But my injury seems to be getting better quite rapidly. I guess it's from a lifetime of always being injured and always needing to heal up something or another. Went for a five mile, mostly flat hike today and only had mild post-exercise soreness in my medial knee.

A couple of my tennis friends recommended an orthopedic surgeon who did several of the joint replacements for players at our club. I'll wait out this week to see where I am and then may go see that guy.

My ortho didn't recommend the single shot HA. He says that most people who benefit get much greater relief from a three shot regimen. I'm glad it worked for you and hopefully if you get another one, it'll give you another two years of relief.
 

mctennis

Legend
I saw the OP statement. I did not read any of the replies so here is my answer. I have been using HA injections since 2004. My physician uses Euflexxa , synthetic HA not made from chickens as most are. I had been getting injections one a year until my knees started aching more then I went to twice a year HA injections ( 6 months apart). My insurance company pays for an injection twice a year. It helps a lot and keeps the pain away. My xrays say I have bone to bone or near bone to bone ( depending on what angle the xrays are taken). My physician says professional athletes use the HA injections a lot more often ( of course they can afford to pay for the HA shots and their jobs depend on them being able to preform). So I would try the injections first. My physician holds off doing any knee/ joint replacements until the pain and movement is really effected.
 

TripleB

Hall of Fame
I appreciate all of the input and experiences you all have shared!!!

Update: 3.5 weeks ago I received my hyaluronic acid injection in my right knee for no cartilage, arthritis, and meniscus torn in two places. No help at all for the first two weeks, then had one day with no pain, then three days with pain again, and then pain free for the last 6 days. Went to the courts today and played a little less than 2 hours. Right now absolutely no pain! Supposed to go back to the doctor the first week in June and discuss how the HA injection has worked out.

TripleB
 

mctennis

Legend
I appreciate all of the input and experiences you all have shared!!!

Update: 3.5 weeks ago I received my hyaluronic acid injection in my right knee for no cartilage, arthritis, and meniscus torn in two places. No help at all for the first two weeks, then had one day with no pain, then three days with pain again, and then pain free for the last 6 days. Went to the courts today and played a little less than 2 hours. Right now absolutely no pain! Supposed to go back to the doctor the first week in June and discuss how the HA injection has worked out.

TripleB
Did you have the three shot series for your HA injections or just one injection?
 
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