My Doctor says I'm on the way to knee replacements (runs in the family) on both legs and we have a few plans for the future so I've got good medical advice but for now I'm getting depo-medrol shots. It's a first time for me so the effect is great but I expect the come-down to be pretty bad after a few months.
So I'm asking if anyone else has been down this road. I'm leaning to get the surgery done early before too much damage is done from the treatments.

 

My Doctor says I'm on the way to knee replacements (runs in the family) on both legs and we have a few plans for the future so I've got good medical advice but for now I'm getting depo-medrol shots. It's a first time for me so the effect is great but I expect the come-down to be pretty bad after a few months.
So I'm asking if anyone else has been down this road. I'm leaning to get the surgery done early before too much damage is done from the treatments.

While your younger will help in speed of healing. Post surgery getting to your feet, a little exercise goes a long way.

I got my sinus surgery would do it again. By far not knee surgery, one of my friends wife got both done she doesn’t regret it.

kv

 

I got one cortisone shot before going for the knee replacement. A waste of time as far as I am concerned. I had the surgery (on one knee) at 65 and recovered well, was back on the dance floor after 6 weeks.

Forgot to mention: I pre-habbed for about 2 months with a personal trainer. Highly recommended, ask your doctor.

 

I got one cortisone shot before going for the knee replacement. A waste of time as far as I am concerned. I had the surgery (on one knee) at 65 and recovered well, was back on the dance floor after 6 weeks.

Forgot to mention: I pre-habbed for about 2 months with a personal trainer. Highly recommended, ask your doctor.

The doctor has already scheduled pre-hab starting next month. I've got the exercise equipment but haven't been able to use it lately because of bone on bone pain but if I can get maybe 5 weeks from the shots I can tone up a bit. The BP is 105/75 but the pulse is a little high.

 

The doctor has already scheduled pre-hab starting next month. I've got the exercise equipment but haven't been able to use it lately because of bone on bone pain but if I can get maybe 5 weeks from the shots I can tone up a bit. The BP is 105/75 but the pulse is a little high.

I could not do much in pre-hab with the bad knee. It was more for general conditioning which helped compensate for the operated knee in recovery.

I am very happy with my outcome, and only wished I had done it earlier. With both knees needed, though, the recovery would probably be longer. I assume you would do one knee at a time? I would say do it while you still have one semi-good one.

 

I could not do much in pre-hab with the bad knee. It was more for general conditioning which helped compensate for the operated knee in recovery.

I am very happy with my outcome, and only wished I had done it earlier. With both knees needed, though, the recovery would probably be longer. I assume you would do one knee at a time? I would say do it while you still have one semi-good one.

The shot, so far, makes it possible workout, walk more than a few blocks without too much pain and relax. The wife and I are heading out this weekend for a night at the local casino, hotel and pool. That's going to be a fun improvement on the quality of life.

Both are shot and both will be replaced but not at the same time, you should see the x-rays. That's what happens when you have a high threshold for pain. I was pretty good this summer but the cold is a knee killer.

 

My doctor wouldn't operate (total knee replacement) if I'd had a cortisone shot within a year. Something you want to check with your doc if you plan on having the operation soon. I had it done in 2021. Early on with my knee pain, I'd had a cortisone shot. It really did nothing for me. Syn-visc shots had some mild relief for only a few months so I knew replacement was coming. I figured I'd get it done at 57 to have a better shot at a clean recovery.
Post surgery, my motion is much better with far less pain even after pretty rigorous exercise. My only complaint is that there is still fluid buildup in the knee. My doctor hasn't given me any solid advice to get rid of it nor has a 2nd opinion from another orthopedic specialist. I have a brother who has had both knees replaced. He says his knees are great, but his back is now having problems.

 

My doctor wouldn't operate (total knee replacement) if I'd had a cortisone shot within a year. Something you want to check with your doc if you plan on having the operation soon. I had it done in 2021. Early on with my knee pain, I'd had a cortisone shot. It really did nothing for me. Syn-visc shots had some mild relief for only a few months so I knew replacement was coming. I figured I'd get it done at 57 to have a better shot at a clean recovery.
Post surgery, my motion is much better with far less pain even after pretty rigorous exercise. My only complaint is that there is still fluid buildup in the knee. My doctor hasn't given me any solid advice to get rid of it nor has a 2nd opinion from another orthopedic specialist. I have a brother who has had both knees replaced. He says his knees are great, but his back is now having problems.

My doc says three months after the shot. The Syn-visc was the alternative offering. So far cortisone is working for me. Side effects were pretty mild, headache and sleeping for a few days.

 

My only complaint is that there is still fluid buildup in the knee. My doctor hasn't given me any solid advice to get rid of it nor has a 2nd opinion from another orthopedic specialist.

I had this problem myself. The doc had me use compression and NSAIDs for a couple of months, which solved it. It started coming back when I quit. So I started wearing a simple elastic knee sleve during my active hours and all has been well for years. I also find the mild support it gives feels good and gives me more confidence in the knee.

 

I had this problem myself. The doc had me use compression and NSAIDs for a couple of months, which solved it. It started coming back when I quit. So I started wearing a simple elastic knee sleve during my active hours and all has been well for years. I also find the mild support it gives feels good and gives me more confidence in the knee.

I used a full length compression sock for the first 6 months. I'm not sure it was tight enough as it kept sliding down and that may have been why it wasn't particularly effective. Since then I've been using a knee sleeve for a few hours during the day especially when I'm doing any exercise. nsaspook you may want to buy a compression sock ahead of time to be sure it fits well and is tight enough. No one told me I needed one so the first week or so I was wrapping the leg in ace bandages for compression. Needless to say, that didn't work well.

My doc says three months after the shot. The Syn-visc was the alternative offering. So far cortisone is working for me. Side effects were pretty mild, headache and sleeping for a few days.

Syn-visc is just a lubricant. I always joked with the doctors about needing a zerk fitting on my knee so they could pump it in on a regular basis. My insurance would only cover one shot per year even though I've heard of people having up to four in a year. Seeing the improvement my brother had convinced me to go for the surgery.

 

Off the juice. The treatment today was https://www.nm.org/conditions-and-care-areas/treatments/genicular-nerve-ablation

When these treatments fail, many patients consider a total joint replacement. However, not everyone is a candidate for this surgery. Instead, genicular nerve ablation may be considered.

Genicular nerve ablation is a method to treat chronic knee pain using controlled radiofrequency energy. Through this treatment, your physician directs heat at specific parts of the knee. The heat “knocks out” the sensory nerves around the knee that send pain signals to the brain.

Combined with mobic for inflammation. So far so good. The pain level is about 2 instead of 7 or 8 on the pain scale for bending exercises. If it lasts 6 months between treatments I will be very happy as insurance is covering most of the costs.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6635137/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6635137/#video1

It's the treatment is painful, so they give you the general happy juice.

 

Ask your doctor, and if you do get approved for the procedure, get the happy juice IV.

 

I'm glad to hear that it is going well and I'm particularly interested in how it goes going forward. I'm probably headed for knee replacement in the not-too-distant future. Even just normal daily activities are painful (some days incredibly so, but I can usually walk without too much discomfort. I'm getting back into competitive shooting and my knees are really limiting my ability to move on the course. I've known lots of folks that have had total knee replacements and every one of them have said "never again" in the first week or two post-surgery and then, after a couple of months, "I sure wish I had done this years earlier."

 

I'm glad to hear that it is going well and I'm particularly interested in how it goes going forward. I'm probably headed for knee replacement in the not-too-distant future. Even just normal daily activities are painful (some days incredibly so, but I can usually walk without too much discomfort. I'm getting back into competitive shooting and my knees are really limiting my ability to move on the course. I've known lots of folks that have had total knee replacements and every one of them have said "never again" in the first week or two post-surgery and then, after a couple of months, "I sure wish I had done this years earlier."

Day #1 has been great, took a walk at the park with little pain. Wonderful.


The knee replacement is still in the future for me but I've got plans for the summer that don't include any 'real' surgery pain and a long rehab. Start getting treatments now. Find a good 'pain' specialist, not a surgeon. if you want to try genicular nerve ablation, it's a long process to get the doctor and insurance to agree to do it and to cover it after other treatments have failed to deliver. Expect a year after the first consultation with a pain specialist as the guide lines required drugs first and drug failure before surgery.

I want to wean off the pain pills before I get addicted, this will let me do that.

 

I wish you well, but fear you will still need surgery in the future. Bone on bone does not get better. The pain may be gone, but the knee is still being damaged. When I had my surgery, I went to the best knee guy in town. He said he wouldn't touch it because it was so deformed. He sent me to the surgeon in Boston that he did his residency with. The new doc, after the successful surgery, said it was the “most ridiculous knee he had ever seen.”.

I guess I was lucky. Nine years now and essentially pain free.

 

I wish you well, but fear you will still need surgery in the future. Bone on bone does not get better. The pain may be gone, but the knee is still being damaged. When I had my surgery, I went to the best knee guy in town. He said he wouldn't touch it because it was so deformed. He sent me to the surgeon in Boston that he did his residency with. The new doc, after the successful surgery, said it was the “most ridiculous knee he had ever seen.”.

I guess I was lucky. Nine years now and essentially pain free.

Thanks for the reply.

No need to fear, I know that and said it in my post above yours. The doctors (some of the best in Portland as I have very good private insurance from working in the semiconductor businesses for the last 30 years) , now, recommend genicular nerve neurotomy before knee replacement surgery today to relieve pos-op knee replacement surgery pain and to improve the rehab performance. This is a delaying tactic approved by the pain doc (feel good pills), my knee surgeon (that started me with shots) and my personal GP (who has me on Mobic) for pre-op knee surgery prep. I'm bad but not so bad as to be ridiculous, yet.

https://ainsworthinstitute.com/genicular-neurotomy/

For those patients where a knee replacement is the only option, genicular nerve neurotomy can offer a number of benefits in the postoperative phase.

By performing this procedure preoperatively, there is a decrease in postoperative pain, allowing the patient to begin physical therapy earlier. Thus improving knee strength and leading to a shorter hospital stay. Decrease postoperative pain has also been linked to decreased morbidity in the postoperative phase.

For many patients who have to wait several months for surgery, genicular nerve neurotomy can significantly reduce their pain making the waiting period more tolerable.

My doctors notes of my procedure on the Legacy Health system web. The guy is damn good.
https://www.legacyhealth.org/providers/thomas-schrattenholzer

Procedures
Thomas F Schrattenholzer, MD at 04/17/25 0900
Procedure Orders
1. Procedure - unspecified [610508139] ordered by Schrattenholzer, Thomas F, MD at 04/17/25 1036
Pre and Post Procedure Diagnosis:
Encounter Diagnoses
Code
Name
Primary?
•
M25.561, M25.562, G89.29
Chronic pain of both knees
Yes
•
M17.0
Bilateral primary osteoarthritis of knee


Procedure: Procedure:
Radiofrequency ablation of the superior medial, superior lateral and inferomedial branches of the geniculate nerve of the bilateral knee, under fluoroscopy - 64624

Indication:
Patient is referred to Dr. Estes, orthopedist. Patient has severe bilateral knee osteoarthritis. He is no longer responding to intra-articular knee injections and is working on weight loss currently enrolled in the bariatric program. Has had a positive 1st and 2nd diagnostic bilateral genicular nerve blocks and is here for the RFA. This may buy him enough time to work on weight reduction and proceed to knee replacements.

Sedation:
Received 2 mg midazolam and 50 mcg fentanyl. Start time: 0943 stop time 1025, for procedure related, moderate to severe anxiety.

Medication totals:
1% lidocaine in PFNS x 20 mL
0.5% bupivicaine in PFNS x 10 mL
dexamethasone (Decadron) x 10 mg

Needle size:
18 g 100 mm Stryker Venom RFA needle

Estimated blood loss:
Less then 1 mL

Complications:
None

Procedure in Detail:
Patient presented to the hospital and checked in per protocol. Patient was placed in a gown. Relevant chart notes, images and labs were reviewed and a focused physical exam performed. The planned procedure as well as the pertinent risks, benefits and alternatives were discussed. Informed consent obtained and the side and site of the injection verified and marked over both knees. A peripheral IV started for safety.

Patient was then transferred to the fluoroscopy suite where the time-out protocol was preformed. The patient was placed supine position and pillows were used to pad pressure points to optimize fluoroscopic views. Monitors were placed and the skin prepped and draped in standard sterile fashion. A mixture 10 mg of dexamethasone (Decadron) in 0.5% bupivicaine in PFNS to 6 mL was prepared in 5 mL syringe in standard sterile fashion. Patient was given light sedation, in incremental doses, by a registered nurse under my supervision.

Under AP fluoroscopic views the superior medial branch of the left geniculate nerve was targeted at the junction of left medial distal femoral shaft and medial epicondyle. The skin was marked at this point and subcutaneous tissue anesthetized with 3 mL of 1% lidocaine. The radiofrequency needle was advanced “down the beam” until bony contact was made with the junction of the femur and epicondyle. In the lateral view the needle was about the midpoint of the diameter of the femur. The radiofrequency needle for the left superior lateral branch was placed in a similar manner at the junction of lateral distal femoral shaft and lateral epicondyle. As was the radiofrequency needle for the inferior medial branch which was placed at the confluence of the medial tibial shaft and the tibial flare with the needle tip resting at the midpoint of the tibia in the lateral view.

The needle stylets removed and replaced with individually identified radiofrequency probes. The impedance and motor stimulation tested and documented at 2 Hz and 1 mA for each nerve. Motor stimulation elicited deep focal discomfort but no stimulation of the muscles lower leg or foot. The radiofrequency probes were removed and 1% lidocaine x 1 ml injected at each site. The probes were then replaced and final AP and lateral views taken to assure no change in needle position.

A grouped lesion at 70 degrees celsius for 90 seconds was tolerated. The probes were then removed and 1 mL of the steroid/local anesthetic was placed. A similar process was accomplished for the right side.

The needles were removed, sites cleaned and bandages placed. The patient remained conversive and responsive through out the procedure.

The patient was taken to recovery in stable condition and was monitored per protocol, given an ice pack and oral hydration. There was no evidence of procedure related sensory or motor changes. Patient was given a pain diary to track local anesthetic duration and onset of steroid effect. Instructions were given and they were discharged in stable condition.

It's all part of the process as I've been approved for surgery but decided to wait, get stronger and get off the pain meds before replacements as to minimize the need for pain drugs. I don't like the mental and physical effects of the drugs.
My older brother died of drug abuse far too young so I have a deep emotional association with death and addictive drugs.

Day #2 feel even better after the procedure dope fog dissipated. Pain level near zero. Time for coffee, a short walk when it gets warmer today and some prep for the summer road trip in the RV to Yellowstone with family kids and her friends.

Life is good, don't live it in pain if you have alternatives.