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Rheumatoid arthritis, knee replacement surgery - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Arthritis
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1722 Questions
Doctor :   Hi
User :   My mother has a knee prob
Doctor :   I understand
User :   It seems to be the case of TKR
Doctor :   Yes sure
User :   Is what the doctor says
Doctor :   May I know your mother's age?
User :   Can you help me with details
User :   of the same
Doctor :   ok
Doctor :   Let me tell you a few things first
User :   58
User :   sure
Doctor :   Total knee replacement is usually done in people whose knees are completely worn out due to wear and tear
Doctor :   There is very less or no bone left in the joint
Doctor :   That is called Sclerosis of the joint
Doctor :   SO, the mineral density or the calcium in the bone is very less
User :   ok
Doctor :   Hence the person cannot do minimal physical activity also
Doctor :   There is severe pain on mild exertion
User :   Ok
Doctor :   It occurs after 50 years of age
Doctor :   The treatment options include partial or total knee replacement surgeries
Doctor :   For very weak joints, total replacement is done
Doctor :   Are you following what I am saying?
Doctor :   If not you can ask me again
User :   ok
Doctor :   ok
User :   yes i am
Doctor :   So, Based on the X-ray and MRI findings of the knee joints, surgeons decide on which procedure to do on the patient
Doctor :   ok
Do you have any of the reports
Doctor :   of X-ray or MRI
Doctor :   ok
User :   correct.. this is what has happened..
Doctor :   Can you say me the reports?
User :   yes i do
Doctor :   sure
User :   xray reports
User :   sure.. gimme a min
Doctor :   Yes
User :   the report says..
Doctor :   ok
Doctor :   Is there anything else?
Doctor :   ok
User :   Osteophyte formation is seen in the upper end of tibia
User :   and patella. the joint space
User :   is reduced with
Doctor :   ok
User :   sub-articular sclerosismore
User :   on left side.
Doctor :   ok
Doctor :   ok
User :   Articular surface are smooth
User :   Articular surfaces are smooth
Doctor :   ok
User :   Mild soft tissue swelling is noted around the knee.
Doctor :   I understood
User :   Impression: Osteroarthritic changes are seen in the knee joint.
Doctor :   Fine
Doctor :   Did you get an MRI done to your mom?
User :   This is what the report says... for the plain xray of both knees
Doctor :   ok
Doctor :   Is that all the report says?
User :   Not as of now...
Doctor :   How is the general health of your mother?
Doctor :   Ok
Doctor :   Can you tell me the report?
User :   We have also done a plain xray of lumbosacral
User :   spine
Doctor :   Are you there?
Doctor :   ok
User :   Osteophyte formation is seen in the lumbar vertebrae. Bony alignment and mineralisation of the lumber vertebrae are normal. Disc spaces are well maintained. Pedicals, spinoul processes and
User :   laminae are normal. Inter-pedicular distances are normal. Lumbar canal dimensions are within normal limits.
Doctor :   good
User :   pre and para vertibral soft tissues are normal.
Doctor :   ok
Doctor :   ok
User :   conclusion: Plain xray of lumbosacral spine shows changes of spondylosis.
Doctor :   Is there any other investigation that is done?
User :   This is what the 2nd report says
Doctor :   Do you want to know what it means?
User :   This is absolutely greek and latin.. Can you decode this for me :)
Doctor :   I mean you want to know what the report means?
User :   Nothing at all :(
Doctor :   ok
User :   Yes I do
Doctor :   The report of the lumbo sacral spine is very much normal
Doctor :   It says that your mother's lower back bone is normal
Doctor :   with a mild extra growth, that is osteophyte
User :   ok... but it does mention something about spondylosis
User :   Thats good.
Doctor :   Spondylosis is a clinical diagnosis, it occurs normally in everyone after 50 years
Doctor :   Her Lumbo sacral spine X-ray is absolutely normal
Doctor :   The impacts of spondylosis vary
User :   Okay.. what about its impacts
Doctor :   In minimal changes, there is no much of a problem
Doctor :   Advanced Spondylosis do cause health issues
User :   Okay..
Doctor :   Patients suffer from frequent back pain, inability to do routine work
Doctor :   Cannot bend or do heavy lifting
Doctor :   Cannot do heavy work or exercises
Doctor :   It is usually age related
User :   okay...
User :   ok
Doctor :   But chances of getting it can be reduced by taking calcium supplements
Doctor :   Are you able to follow?
Doctor :   If not do ask me
Doctor :   yes, nothing to worry about the lumbosacral spine
User :   Alright.. so nothing to worry about here... for now atleast
Doctor :   But she does have problem in her knees
Doctor :   I would like to know a few more things about your mother's health
Doctor :   Does she have knee pain often?
Doctor :   I want to know the severity of the pain
User :   Ok
Doctor :   ok
User :   sure
Doctor :   oh, sorry
User :   Yes she does... this is at all times
Doctor :   I am really sorry about that
User :   Extreme
User :   she's in tears... at times
Doctor :   I really understand your concern
Doctor :   'I will help you surely
User :   which is what has made me chat with you... keeping my work aside
User :   so its tough
Doctor :   ok
User :   she has a bad medical history
Doctor :   I understand
User :   operated numerous times.. for different reasons
Doctor :   How is her physical activity?
User :   the last was CABG
User :   There were complications in that as well..
Doctor :   Can you tell me more about her previous medical history?
User :   She is almost bed ridden now
Doctor :   ok
User :   gets up only for natural calls
User :   sure..
User :   so she's a diabetic
User :   had BP probs earlier
Doctor :   ok
Doctor :   ok
User :   and she has undergone... Angiography + plasty (2 stents installed)
User :   12 yrs ago
Doctor :   ok
User :   she was operated for some lesion issue as well
Doctor :   I understand
User :   Somehow.. as part of CABG
User :   Her leg was opened to pull the artery
User :   which could be used for the heart
User :   that got complicated post operation
User :   puss developed all around
Doctor :   ok
User :   and that took a good 6 mths to heal
Doctor :   that is a clue
User :   it is the same leg that has this prob now
User :   not sure if this is the after effect
User :   or a co-incidence
Doctor :   Yes I course, I understand
User :   the area which was opened... is extremely stiff now
User :   you know what I am talking about right!!
User :   This is the incision area
User :   which healed with time
Doctor :   ok
User :   Her Bone densitomitry test results were not favourable either
User :   Pardon me if I am not able to use the medical terms in the right way
User :   or with error
Doctor :   You are telling me good
User :   ok
Doctor :   Sure, tell me
User :   One more imp thing that needs to be known
User :   is she get unconscious
User :   sometimes
User :   for no reason
User :   she jus feels tired and fatigued
Doctor :   May I know her weight?
User :   and it appears as if she sleeping
User :   but she goes unconscious
User :   we try waking her up
User :   she doesnt react
User :   for some time
Doctor :   ok
User :   and then after sprinkling water on her face with force... she gets up
Doctor :   ok
Doctor :   I need to ask a thing
User :   ~75 kgs
User :   5 ft height
Doctor :   CABG was done 12 years back, Am I right?
User :   sure
User :   Nope
User :   12 yrs ago.. angio plasty
User :   CABG was done in 2008
Doctor :   ok
Doctor :   And when did the complication in the leg happen?
Doctor :   ok
User :   immed after the CABG
Doctor :   Fine
User :   it never healed
Doctor :   Shall I suggest a few things?
Doctor :   Is she on BP medications now?
User :   pls do
Doctor :   ok
User :   yes she is
Doctor :   what is her latest BP value?
Doctor :   ok
User :   Sorry.. one most imp thing I forgot to say in this is... She is suffering thru rheumatism
Doctor :   What does it say?
User :   She had CTS last year...
User :   we were supposed to go for surgery... when we thought of tryin homeo
User :   pathy
Doctor :   ok
User :   and it worked... the pain subsided
User :   so this rheumatic issue constantly moves around her body giving some or the other prob
User :   every few days
Doctor :   ok
Doctor :   Fine
User :   which is why we thought this time its the leg which is impacted
Doctor :   Let me tell you a few things
User :   Her current BP value is not known
User :   we havent checked it offlate
Doctor :   Her X-ray of the knee joint does not necessitate her to go in for a TKR
User :   sure
Doctor :   I mean to say, it is not required for her to undergo this procedure
User :   ok
Doctor :   Her knees are fine
Doctor :   Yes, it can be done
User :   it would be great if this can be avoided.. and she gets healed
Doctor :   The pain she is experiencing is due to many causes
User :   ok.. we met a couple of docs who said this...
User :   Good if this can happen with TKR
Doctor :   That is what I want to say also
User :   okay..
Doctor :   She can go without the TKR
User :   i mean... good if this can happen WithOUT TKR
Doctor :   Her Rheumatism is a major cause for the pain
Doctor :   It has not much of treatment in Allopathy
User :   right
User :   ok
Doctor :   I would suggest you to continue Homeopathic treatment for her Rheumatism as the results are excellent with it
User :   Okay..
Doctor :   I have seen patients do well with homeopathic treatment
User :   Okay... we tried this for over a year now... with no benefits
User :   she has been suffering thru this for a past 14 mths +
User :   homeopathy was going on for this
Doctor :   ok, i will explain
User :   no
User :   what is this
Doctor :   This is an ayurvedic treatment which really works
Doctor :   Do you want to try this?
User :   hmmm... ayurvedic... not with what you mentioned.. but with a vaid in Dhule
Doctor :   Sure
Doctor :   Where do you stay?
User :   Yes... I would atleast want to know more about it
Doctor :   She is doing good as of now
Doctor :   I do not see a valid reason for undergoing TKR
User :   but tell me how serious is the state of the kneee
Doctor :   It is not right
User :   because one of the doctors has clearly mentioned that this can be done only if we are able to do it in the next 1-2 months
Doctor :   I mean to say relief from pain is not very much appreciable
Doctor :   after the surgery
User :   okay
Doctor :   Rheumatism is a systemic disease
Doctor :   It affects the whole body
Doctor :   Treatment is to be given to the whole body even though the joints are affected more
Doctor :   That is one of the best signs of rheumatism
User :   The flexibility in the joint doesnt seem to be there
Doctor :   Rheumatism causes this to happen
User :   she cannot bend it
User :   whats your take on that
Doctor :   So, the main problem is Rheumatism not within the joint
User :   okay...
Doctor :   I will tell you frankly
Doctor :   TKR is not the treatment option for Rheumatism
User :   I understand that.. but there is some osteo issue that she has right... some amt of damage to the knee
User :   okay...
Doctor :   And the treatment is a strict regimen with strict diet
User :   sure i will..
Doctor :   Not at all
Doctor :   In fact she is doing good
Doctor :   TKR may worsen the disease
User :   okay.. so the reports dont definitely show any urgency of TKR ?
User :   yes... she does follow... so that is not a concern at all
Doctor :   I do not feel TKR should be an option
Doctor :   Instead get her treated for Rheumatism
User :   okay...
Doctor :   Part of it should be resolved
User :   So are you saying... if rheumatism is taken care off... it should resolve the issue?
User :   what is your thought on the unconsciousness thing?
Doctor :   Also, she feels giddy and unconscious due to the rheumatoid activity in her body, also due to blood pressure changes also in severe pain, patients can go into temporary loss of consciousness
User :   okay...
Doctor :   So, in rheumatism the disease activity continues always and lot of chemicals are released in the body
User :   I was scared on the time factor... Thanks for your detailing..
Doctor :   Pleasure is mine
Doctor :   Yes, get your mother treated for Rheumatoid first
User :   Okay... she is a chronic rheumatoid... for years now
Doctor :   Her knees are quiet healthy as I see
User :   and it has worsened with age
Doctor :   ok
Doctor :   I have no idea about this site, I am sorry
User :   okay... somebody just referred me to this site
User :   okay
User :   but then wht abt the unhealthy bone desitometry test reports
Doctor :   You have not told me in detail about this report, still her X-ray shows normal density
Doctor :   As you told me the report
Doctor :   Can you mail me the details of the reports?
User :   okay
User :   details i dont have right now
Doctor :   yes sure
User :   can i share this with you by this evening... once I am home
User :   thru some email or something
Doctor :   You can send it to me
User :   ya sure... pls let me know your email address
Doctor :   I will see through the reports
User :   I will check on the kottakkal option
Doctor :   And I will mail you in detail
Doctor :   Is that fine with you?
User :   sure will
Doctor :   Or we can chat again tomorrow
Doctor :   9 am to 6 pm
User :   Should be absolutely good
User :   yes... either ways
Doctor :   yes
Doctor :   This time
User :   what are your timings
User :   If i need to talk to you
User :   again
User :   i mean chat with you...
User :   i'll try and see if i can make it today
Doctor :   you can send me the reports, i will see them and we can chat tomorrow again
User :   sure..
User :   Are you the only one responding.. I am sure there are others
Doctor :   yes, there are other doctors,as soon as you start the chat
User :   so how do I get in touch with you
User :   ok
Doctor :   I am really sorry, I have no clue on this
Doctor :   Hope her wound has healed completely on the leg, is it so?
Doctor :   good
Doctor :   That is also a cause for her pain
User :   yes... the wound took 6 mths... and got cured
Doctor :   She has no fault within the joint as such
Doctor :   I am with you to help you
User :   O great...
Doctor :   Bye for now
User :   Thanks... Bye
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