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Multiple myeloma and knee replacement
My 86 year old mother was in need of a knee replacement when she was diagnosed with multiple myeloma. Her condition has been under control for a couple of months. I say this because her blood tests are acceptable. She is gradually losing the ability to walk and is starting to rely on a wheelchair to get around. This lack of mobility is weakening her physically. Up until now, her doctor has discouraged the knee replacement surgery but she really wants to do it. Is there any information on this subject out there?
Re: Multiple myeloma and knee replacement
I have never seen anything formal written bout this, but I guess there are some basics -- caution, these are blunt.
1) Patients with myeloma on IMiDs (Revlimid or thalidomide) are at higher risk of blood clots (DVTs, PEs), and hence when undergoing joint replacement, it is recommended to move from aspirin prophylaxis straight up to full dose anticoagulation (coumadin with a target INR 2-3 or therapeutic doses of lovenox or equivalent)
2) Patients with low white cell counts, hemoglobin (anemic), or platelets (thrombocytopenic) are in general higher risk for surgery. Hence it would be ideal if the patient could tolerate at least a 1-2 month chemotherapy holiday.
3) You'll want to know more than just if her counts are acceptable. You really need to know that her affected immmunoglobulin or free light chain is getting better. If her counts are normal but the antibody her myeloma cells are producing (aka the affected immunoglobulin) is rising, this is NOT the time to do elective surgery.
1) Patients with myeloma on IMiDs (Revlimid or thalidomide) are at higher risk of blood clots (DVTs, PEs), and hence when undergoing joint replacement, it is recommended to move from aspirin prophylaxis straight up to full dose anticoagulation (coumadin with a target INR 2-3 or therapeutic doses of lovenox or equivalent)
2) Patients with low white cell counts, hemoglobin (anemic), or platelets (thrombocytopenic) are in general higher risk for surgery. Hence it would be ideal if the patient could tolerate at least a 1-2 month chemotherapy holiday.
3) You'll want to know more than just if her counts are acceptable. You really need to know that her affected immmunoglobulin or free light chain is getting better. If her counts are normal but the antibody her myeloma cells are producing (aka the affected immunoglobulin) is rising, this is NOT the time to do elective surgery.
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
Re: Multiple myeloma and knee replacement
I was wondering how come the orthpeadic surgon I saw about my severe knee pain was seeming to stall and not jump right to surgery. Your answer makes sence about not being the time to do an elective surgery...I have not been dxed with multiple myeloma but I have many symptoms including an enchondriod tumor in my left femur that has not been causing symtptoms untill lately. now my left knee and leg are very painful like a toothache type pain deep in the knee and nothing has been helpful and too my right lower shin area is really getting to be painfull too ...I am being monotored closely by both my primary care dr and by an orthopeadic surgon.. with appiontments on monday and wednesday of next week..Nothing helps with the pain just takes the edge off a little...
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slee
Re: Multiple myeloma and knee replacement
I am a 1 year survivor. I have a bad right knee. Docs told me two years ago I needed it replaced and it hurts like he double hockey sticks now. If I was her age I truely dont think I would do it. I know how she feels. I would like to have mine fixed but I have had enough of surgical procedures for a while. Has she looked into something called synvlsis?? Excuse the spelling. It's like a jell they shoot into the knee and gives it some cushion. I did it three times and it helped and I was an avid soccer player at age 50 something. Knee replacement requires serious rehabbing. I surely wouldnt want to do it at her age. But, thats just an opinion from a 54 year old ex-soccer player who tore up his knees pretty good.! Good luck to her and GOD bless..I'll say a prayer for her...
Re: Multiple myeloma and knee replacement
My wife is 68, is 27 months out from her first stem cell transplant, and has just come out of remission. After a year and a half on Revlimid, she developed meniscus tears and arthritis in both knees (at the same time) and developed De Quervain syndrome in both wrists. She had surgery on both wrists to release the tendons, which fixed the problem. Developing these joint and connective tissue problems concurrently while on maintenance chemo seems beyond coincidence to me, but I certainly am not a doc so what do I know. She is not an athletic person so these issues are not lifestyle driven.
At this point she, can't walk more than two hundred yards without being done for the day -- she has to sit and elevate her legs. She is on daily rounds of tramadol and acetaminophen (Tylenol / paracetamol) to try to ease the knee pain and stiffness coupled with balance issues connected to the neuropathy in her feet (chemo induced). Some days require hydrocodone.
Her challenge now is to decide whether to have knee replacements, or put them off pending a decision to have another stem cell transplant possibly next year if the docs cannot get her blood issues contained now that she's back on chemo. Seems doubtful that one could do them all during the same span of time. She has had the gel injections in her knees and cortisone shots. Cortisone did not help at all. The gel injections helped "a little" for about four months before the full pain level was back. FYI - Medicare will only pay for injections every six months. Currently she is getting a second series of the gel injections.
No recommendations for anyone, just a reminder that those of you going through similar circumstances are not alone.
At this point she, can't walk more than two hundred yards without being done for the day -- she has to sit and elevate her legs. She is on daily rounds of tramadol and acetaminophen (Tylenol / paracetamol) to try to ease the knee pain and stiffness coupled with balance issues connected to the neuropathy in her feet (chemo induced). Some days require hydrocodone.
Her challenge now is to decide whether to have knee replacements, or put them off pending a decision to have another stem cell transplant possibly next year if the docs cannot get her blood issues contained now that she's back on chemo. Seems doubtful that one could do them all during the same span of time. She has had the gel injections in her knees and cortisone shots. Cortisone did not help at all. The gel injections helped "a little" for about four months before the full pain level was back. FYI - Medicare will only pay for injections every six months. Currently she is getting a second series of the gel injections.
No recommendations for anyone, just a reminder that those of you going through similar circumstances are not alone.
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Warcun - Name: Warcun
- Who do you know with myeloma?: Spouse
- When were you/they diagnosed?: August 2011
- Age at diagnosis: 65
Re: Multiple myeloma and knee replacement
Diagnosed 5/12/12. Surgery, radiation, etc. Then induction, collection, but no SCT. On maintenance. Not in full remission -- but close. 10 mg Revlimid and Zometa infusions.
I underwent a right total hip in Feb. '14. Went off Revlimid 2 weeks pre-op (aspirin too). Resumed it 2 weeks after OR. (Aspirin too) 54 years young.
Zimmer device. Stainless nail with combo cup (ceramic and nylon). Orthopod and PA both said bone was like concrete -- just no cartilage left / head of femur had worn into an egg, instead of a cue ball. No myeloma lesions.
For coagulation issues, I was placed on Xarelto for 3 weeks. Switched back to Revlimid 10 mg / aspirin 81 grain daily.
Only problem has been bone healing. Revlimid (IMID) acts like a "beat cop" -- swinging a night-stick at teenagers. He chases off the RBC's (teenagers) accumulating around the device, so the bone matrix formation has been very slow to develop around the nail / acetablum. Functionally, I'm doing okay -- albeit, I have not pushed things.
On extra calcium, etc. Zometa, still ( every 3 months, now).
At 6 month check: Great placement of nail, acetablum, screws, etc--but very little bone formation around nail / acetablum. Coming up on 1 yr--in Feb. Hopefully we will then see callous formation/ bone matrixes, bone growth around nail / acetablum.
Pain reduction has been remarkable. Basically Zero. I was out of my office 10 days--began part time then, and was full time by 22 days Post-op. ( Desk job mainly)
Frankly, I put it off a few years too long, and began having significant back issues/ pain. Pain meds couldn't control spasms/ Pain anymore. That is what got me to Surgery.
Stairs (up) are still hard and running is still a no-no.
Yoga--well I wasn't terribly flexible, when younger--so we don't go there.
Still can't play the Piano.
I sleep much better. Probably the best result of the entire process.
I'd say "Go for it", if she is a tough old bird--and has no unusual Anesthesia risks, other than 80+ years old. Knees are a bit harder to do than hips. More tissue, Bone and ligaments to deal with. Compound device(s). Femoral and Tibial components.
If her Internists and Hematologist can control her clotting issues--she will have a rough month, but will be better soon, thereafter.
Major Quality of life improvement. Major surgical risks.
Her call.
Good luck.
I underwent a right total hip in Feb. '14. Went off Revlimid 2 weeks pre-op (aspirin too). Resumed it 2 weeks after OR. (Aspirin too) 54 years young.
Zimmer device. Stainless nail with combo cup (ceramic and nylon). Orthopod and PA both said bone was like concrete -- just no cartilage left / head of femur had worn into an egg, instead of a cue ball. No myeloma lesions.
For coagulation issues, I was placed on Xarelto for 3 weeks. Switched back to Revlimid 10 mg / aspirin 81 grain daily.
Only problem has been bone healing. Revlimid (IMID) acts like a "beat cop" -- swinging a night-stick at teenagers. He chases off the RBC's (teenagers) accumulating around the device, so the bone matrix formation has been very slow to develop around the nail / acetablum. Functionally, I'm doing okay -- albeit, I have not pushed things.
On extra calcium, etc. Zometa, still ( every 3 months, now).
At 6 month check: Great placement of nail, acetablum, screws, etc--but very little bone formation around nail / acetablum. Coming up on 1 yr--in Feb. Hopefully we will then see callous formation/ bone matrixes, bone growth around nail / acetablum.
Pain reduction has been remarkable. Basically Zero. I was out of my office 10 days--began part time then, and was full time by 22 days Post-op. ( Desk job mainly)
Frankly, I put it off a few years too long, and began having significant back issues/ pain. Pain meds couldn't control spasms/ Pain anymore. That is what got me to Surgery.
Stairs (up) are still hard and running is still a no-no.
Yoga--well I wasn't terribly flexible, when younger--so we don't go there.
Still can't play the Piano.
I sleep much better. Probably the best result of the entire process.
I'd say "Go for it", if she is a tough old bird--and has no unusual Anesthesia risks, other than 80+ years old. Knees are a bit harder to do than hips. More tissue, Bone and ligaments to deal with. Compound device(s). Femoral and Tibial components.
If her Internists and Hematologist can control her clotting issues--she will have a rough month, but will be better soon, thereafter.
Major Quality of life improvement. Major surgical risks.
Her call.
Good luck.
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Rneb
Re: Multiple myeloma and knee replacement
Warcun-
I had a knee replacement 2 years ago during a time when I had relapsed. I put off starting treatment for the myeloma until I had recovered from the surgery. My surgeon had me on Coumadin for 6 weeks following surgery because of the possible clot problem. Normally he had people on aspirin for clotting, but because of the myeloma he decided to power up the treatment against clots.
My healing was slower than any of my other surgeries for joint replacements, but I healed well. You can barely even see the surgical scar unless you look really closely. I started treatment for my relapse with Revlimid and Dex about 2 months post surgery. I went back to work as a full time physical therapist 3 months post surgery.
If your wife is in so much pain and so limited in what she can do because of the knees, I would suggest going for the surgery now. Many of us with active myeloma have had surgery and have lived to tell about it. As long as the surgeon is aware of the complicating factor and takes extra precautions, there shouldn't be a problem. Your wife will likely be in better condition next year to go through a 2nd stem cell transplant if she isn't worn down by painful, nonfunctioning knees.
Nancy in Phila
I had a knee replacement 2 years ago during a time when I had relapsed. I put off starting treatment for the myeloma until I had recovered from the surgery. My surgeon had me on Coumadin for 6 weeks following surgery because of the possible clot problem. Normally he had people on aspirin for clotting, but because of the myeloma he decided to power up the treatment against clots.
My healing was slower than any of my other surgeries for joint replacements, but I healed well. You can barely even see the surgical scar unless you look really closely. I started treatment for my relapse with Revlimid and Dex about 2 months post surgery. I went back to work as a full time physical therapist 3 months post surgery.
If your wife is in so much pain and so limited in what she can do because of the knees, I would suggest going for the surgery now. Many of us with active myeloma have had surgery and have lived to tell about it. As long as the surgeon is aware of the complicating factor and takes extra precautions, there shouldn't be a problem. Your wife will likely be in better condition next year to go through a 2nd stem cell transplant if she isn't worn down by painful, nonfunctioning knees.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
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