I had a microfracture done 2 months ago and have degenerative changes in my knee. I am having Hylagan injections. Does anyone know if you get 3 or 5? Also does it last or does it need to be repeated every 6 months to a year. Thanks
Sounds like a not-so-good knee. I can’t recall injecting any of the hyaluronic acid preps so soon after the microfracture but maybe your doc has seen some literature that I have not. Could be an interesting concept.
When Hyalgan first came out a few years ago, it was a series of 5 injections spaced about a week apart. When competing products came out, with only three injections, Hyalgan made whatever changes they needed to and became a similar three injection regimen. There is a product currently available as a single injection but insurance coverage is an issue.
Hey John… I know that Hyalgan is indicated for mild to moderate OA, is there any benefit to using it in a more severely compromised joint? I have full-thickness lesions on both the LFC (most of it) and lateral tibial plateau (about 33%). Also no meniscus. I did have a open-wedge DFO to unload the space this past winter, but b/c of the extent of the damage, no one will give me any further cartilage work or a meniscal transplant. Would the injections provide any benefit at all, in yoor opinion, or would I be wasting my insurance company’s $$.
From your description of the joint, indeed you are not a candidate for a meniscus transplant. Maybe you should make friends with a horse in the neighborhood and transplant one of his knees into you! Seriously though, if you were my patient, our goal would be to see how long we could make the joint last before replacement. That would include “The Talk” about the conclusion of your running career, serious weight control, and whatever medications (injections) that were needed to postpone the need for an artificial joint. I did IM Hawaii in 2004 with a local friend, noted his end stage hip arthritis very shortly thereafter, and his joint replacement is scheduled for the 12th of this month. We got 6 more years out of the joint before the big operation.
In other words, I’m a surgeon…stay away from surgeons as long as you can.
I’ve done a couple blogs on arthritis if you were ever interested in more.
From your description of the joint, indeed you are not a candidate for a meniscus transplant. Maybe you should make friends with a horse in the neighborhood and transplant one of his knees into you! Seriously though, if you were my patient, our goal would be to see how long we could make the joint last before replacement. That would include “The Talk” about the conclusion of your running career, serious weight control, and whatever medications (injections) that were needed to postpone the need for an artificial joint. I did IM Hawaii in 2004 with a local friend, noted his end stage hip arthritis very shortly thereafter, and his joint replacement is scheduled for the 12th of this month. We got 6 more years out of the joint before the big operation.
In other words, I’m a surgeon…stay away from surgeons as long as you can.
I’ve done a couple blogs on arthritis if you were ever interested in more.
Hey John, thanks!
I’ve already seen a lot of surgeons 
5 scopes (including chondroplasties, debridements, partial meniscectomies–ending in a total, and microfracture); and then the distal femoral osteotomy this winter. The DFO was designed to put off replacement and allow me to stay active. No one would do a replacement on me anyway, as I am too young (and I wouldn’t want one).
We are hoping to get at least 10 years out of the DFO, and then look at something like arthrosurface, as opposed to a PKR. My weight is fine–about 135-140, and I only run a few days a week, never consecutively, all short distances, and almost always on non-concrete surfaces (usually dirt). Truthfully, the only reason I decided to do the osteotomy was b/c if I continued doing what i was doing, the damage would spread (it was already showing on the patellar surface). So we off loaded it to buy me a few more years.
I guess my main wondering was would adding the injections to this mix help at all? Is it worth investigating next winter when I resume running?
Well, the short answer is yes. The long answer - the long term answer - is a difficult balancing act of not being a slave to the knee, yet making sensible life choices given your probable future constraints. Here’s one thought, why not become a super swimmer? A number of years ago if you’d told me that I could swim around Manhattan Island I’d have told you that you were nuts. But I’ve done it…and I hardly used my knees! Except to climb back up the ladder to get the heck out of the East River. I’ll bet you can do whatever you set your mind to.
I know I’m resuscitating an old post, but everything in this post is relevant to my current situation, so I will take the risk. My ortho has already had “The Conversation” with me (no more running). I’ve got very advanced patellofemoral wear and a kneecap that is misaligned (it rides too far to the outside; has for as long as I’ve had a kneecap). I’ve only had problems with this knee since last November. Before this point, no problems at all.
To date, I’ve tried cortisone (worked great for 2 months, then the pain and swelling returned), and I’m in the middle of a series of Synvisc injections (though my knee is quite swollen in between shots, so it’s impossible for me to tell the extent to which the shots are helping, because the knee hurts from the swelling). Let’s forget about running for the moment. It pains me deeply to say that, but at present, running is the least of my issues. I cannot swim without pain and swelling (kicking, even very light kicking, hurts like hell and swells the knee), and cannot use an elliptical trainer without pain and swelling (minor pain, major swelling). I can’t cycle much when my knee is swollen, because pushing on the pedals hurts too damned much. Even walking hurts, when it’s this swollen. I refuse to accept a sedentary lifestyle. I’m 49, have been an athlete my entire life, a triathlete for the last 12, and I simply can’t accept having to give up all forms of exercise.
Today, when I was in my ortho’s office, getting my knee drained and my Synvisc injection, I pressed him on what options I had. Previously he had refused to even discuss surgical options – told me to just stop running and do activities that didn’t hurt it. Today, when I showed him how much it had swelled from only swimming and using an elliptical machine, he was more willing to humor me with a conversation about surgical options. The first option, of course was “sedentary lifestyle.” I told him that wasn’t an option. He offered osteotomy combined with lateral release, but told me it would be at least a year before I would be able to resume regular activities. I’m not completely ruling that out if everything else fails (it’s less than a knee replacement, after all), but I’d be inclined to try a less extreme option, before opting for it. The third option, toward which I am leaning, is an arthroscopic clean-up (remove loose bodies, shave down irregularities in the surface backing my kneecap). He says back to activities in 4 to 8 weeks, but I am guessing it would be less.
My current plan is to see how the Synvisc works (I don’t have high hopes, given how swollen my knee is), and get another cortisone shot if the swelling doesn’t go down soon. Hopefully between the Synvisc and the cortisone, I can get a few months of relief, and can work on my swimming and cycling. I’m signed up for IMNY/NJ in August (signed up long before I developed the knee problem), and hope to swim/bike/walk it. Am headed to Nepal in October for three weeks of trekking (a 50th birthday present to the most beautiful place on Earth). Will get another cortisone shot before the Nepal trip and use trekking poles religiously. Once I am back home in November, I will go in to get the knee scoped/cleaned up/cleaned out, and see whether that provides any kind of relief. No harm in trying, and if it gives me no relief, I can look into the oseotomy/lateral release combo. I’d rather try that than become a couch potato.
Does that plan sound like a reasonable approach? Are there any other options I should be asking surgeons about? I’m going to go get a second opinion, because I hate the idea of working with a surgeon whose first response to knee pain is “adopt a sedentary lifestyle.” I am trying to be realistic (my running days are likely over, but I ought to be able to swim, cycle, walk, and use an elliptical trainer without my knee blowing up).
I had TTO and HTO surgery 12/5. TTO is what I assume he was suggesting to you.
You sound similar to me. Last November I turned 50 and was hoping to do my 5th IM but had to pull out of IMLP. My knee was scoped 6/10 and has gone down hill since then. I have some type of synovium inflammation that docs can’t figure out. I did FL last year and did walk a mile/run 30" and finished but it was ugly. Still happy I did it.
If you go the TTO route get an expert that does a lot of them. I went to Brigham and Women’s arthritis center after seeing 5 other orthos, 3 different orthos told me the doc I was using was the guy to do it.
I’m signed up to do IMFL in November. I’m almost 6 months out from surgery. I have been able to bike and swim for months. He originally said I could run at 6 months. I see him for my 6 week follow up next week. I have some other inflammatory issues going on and walking is painful so I’m not sure IMFL with walk plan will be possible. The osteotomys fixed the knee pain and the pain I have is different.
If you’d like to chat about my experience PM me and we can talk.
Eileen, I know it doesn’t do much good but you have a lot of company in this setting unfortunately. As important as triathlon is, your ability to simply walk in 5-10 years should take a higher priority. My brother’s been to Nepal and tells me about the “one breath per one step” method of hiking. Sounds pretty difficult. And his knees are sound. If there’s any chance that your knee would act up when you are a million miles from no where…well, use your best judgement. As far as the potential for a clean up scope, the literature has shown repeatedly that they do not offer long term help except for those with a mechanical problem like a torn meniscus.
And, as far as osteotomies go, make sure that if/when you do, that the orthopedist does lots of them as it’s a hard operation to get right consistently.
Lastly, at 49, please don’t consider a replacement as anything other than the last option, a salvage procedure. The “Well I’ll get it replaced and start racing again” mentality, is just very short term thinking and the owner pays for it in the future. Sometimes it’s a hefty price, and I’m not talking about money. Best of luck.
John
Thanks for your response. I’ve been to Nepal before, so know what I’m getting into. And yes, I’m clear that my triathlon career is over, at least as far as triathlon involves running. I hope to keep the competitive itch scratched with OWS races and aqua bikes. My question is, other than cortisone, Synvisc, and an arthroscopic cleanup, are there any options I’m failing to consider? Or is an osteotomy likely the only non-replacement option available to me, if those fairly conservative options fail? Right now, I can’t swim, bike, or do much of anything. The knee swells A lot whenever I try.