partial knee replacement a good idea?

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Hello,

?A brief history. I saw teh GP in 2012 for knee pain, had physio and then cortisone injections which didn't give a great deal of relief. Went to surgery for arthroscopy and microfracture in 2013 which was not a success - left me in a worse condition. Had the right knee done in 2014 for the same which has worked.  Had more cortisone and hyaloronic (sp?) after for left knee then left knee re-done for arthroscopy and microfracture (surgeon said the first op hadn't worked when he looked) in Jan and was a bit better. I fel tthat I'd gone back to where I was before the first op. )The first op left me in bad pain and a terrible "graunching" when I applied pressure through it (like depressing the clutch in the car) it was also "catching" on something inside. He also cut out a fatty pad(?).

?So forward on to this year and it has deteriorated again. My knee constantly hurts. I take co-codamol which doesn't really do anything also norytryptyline at night to help with nerve ending pains. At night my knee feels like it is on fire and during the day it is a constant grinding ache. I also use Voltarol gel to get some topical relief.

?I went back to the GP who referred me to musculoskeletal clinic as he felt they might be able to offer some more conservative treatment. He felt if he referred me to a consultant they woudl just go for surgery.

?So I went to clinic, had xrays, the Dr there said I'd had a lot of work done already and there wasn't anything he could really do. I have osteoarthritis and he recommends a partial knee replacement. I'm off for MRI and he has referred me to consultant.

?Whilst I don't want a PKR I feel I have to do something to try to get rid of the pain. I'm 53. I have an active job that I need to be able to get up and down off the floor for (I work with disabled children in the community). I have to be able to carry equipment and drive.

?Is this really the only solution? Like I say I don't necessarily want it but I can't see the other options.

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  • Posted

    Sorry should say second op on left knee was Jan 2015
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  • Posted

    Hi Trizwizz,

    ​I suffered from 2010 when my knee pain started, when for various treatments...physio, ICAts, podriatry, steroid injections, durolane injections, more physio, then an arthroscopy​ in 2015 which the consultant then said my knee was in a bad way inside and I would need a knee replacement hopefully partil he said but when i did have the op last year 2016 when my knee was opened up I needed a total replacement as knee was too far gone. It has been a long road but def better than the horrible bone on bone pain. I am only 50 and also have a demanding job...full time teaching assiatant ...on feet 8 and half hour a day with 1/2 hour break. I was off work 5 months as my own GP would not let me back until work could slightly change my working conditions to enable me to sit a little more nd change some of my duties.

    ​I would if you can try and go for total replacement as if have arthritis the rest of your knee could get damaged and you may have to have the other part replaced hence having two surgeries.

    Hope all goes well

    Sue

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    • Posted

      Thank you - your experience sounds similar to mine. I kno wthe TKR is probably inevitable. Apparently the xrays show the arthritis on one side mainly hence the MRI to check it out. Though previously when I had th emri on the right knee the surgeon felt that was worse than the left one but when he went in and looked it wasn't! I thought mri's were supposed to be all singing and dancing but hte surgeon said nothing beats having a look.

      ?Fortunately I work for  a local authority so I do get sick pay - I will feel guilty but that's why I put up with a sometimes crummy job as this is one of the few benefits!!

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  • Posted

    Ive had both knees done , total knee replacement , June/ Sept 2014 / and RTHR JULY 2016/ all is good can be on my feet all day at work and no pain/ recovery to be back to 100% can be 6 months / was worth it for me / good luck
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  • Posted

    I suppose the specialist is the best one to tell you what options you have, but I just don't somehow trust these partial knee replacements.  Seems to me that a few years down the line, you are going to be needing a total knee repacement. . but maybe I'm wrong. Will be interesting to hear from PKR's what their experience has been.  Wish you luck!  it's a hard operation, bt sounds as if in your case it will be worth it in the end.

     

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    • Posted

      Thank you  - for me from my experience of my arthritis - not somethingthat gets better - I can see a TKR in the future anyway. WIll a PKR put that off enough? I don't know. My thought is  - is it better to do this now while I'm relativley young, relatively fit and motivated to do the physio after rather than wait till I'm crippled up with the arthritis ( I know I have it in my feet as well - and probably in my shoulders too)

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    • Posted

      Iand hope all goes well for you! should certainly speak to the doctor about this, and get him to explain if there are advantages to just doing the PKR.  As you are relatively young, obIviously you need to know all the facts about revisions , e.g. second operations, as even the TKR could wear out before you do!  I think they reckon that about twenty years is good going for a prosthesis, so you could need another one.  Not having had a PKR I can't really say much about them, but there must be people on here who have and perhaps you could start a new thread. . . . I would just say don't let them talk you into something you don't feel is right.  . . research,  . . .

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  • Posted

    "The Dr there said I'd had a lot of work done already and there wasn't anything he could really do."

    EXACTLY what my ortho said to me last January.  Lots of work done over the past 15 years with scopes, meds, cortisone, SynVisc.  Doc told me that he could do another set of SynVisc but it would be a very temporary solution.  Nothing left but a TKR.  I have no experience with PKRs so I can't speak to that.

    However, with a knee replacement, this is what the docs won't tell you and what you'll be facing...

    http://patient.info/forums/discuss/the-tkr-experience-or-wish-i-had-another-kidney-stone--524499

    Getting down on my knees again and working at that level...I don't think so.  I'm 10 months post-op so it may get better but I've already bought a set of knee pads so I can at least scrub an occasional floor.  Not easy to get down and up but, then again, my quads are still weak so I may have better news a year from now.

    Sorry.  With the work you and I have had done on our knees over many years, sooner or later you reach the end of the line...the last station...the final roundup...end of the road...  When you pull into that station, the sign will read "Welcome to Knee Replacementville...Have a Nice Day"...except that you won't have a nice day, month or year.

    My ortho told me: "You've got a giant mechanical device implanted in your body.  What do you expect?"  I don't thing the clicking, popping and clunking will ever go away...but at least now I walk without pain.  Not a bad trade...but ya gotta get through it first.

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    • Posted

      Thank you - I shall read through your link properly - it looks very comprehensive - so I shall need time to read it and it's a bit late for me now.

      ?I don't do high impact sports for other reasons. I have swum for many years. (I don't do breast stroke legs  - advised against it by the physio) At my last physio after the last knee op the physio said I  had "swimmers legs" - I took it as a compliment!! Bizarrely my mobility is good - I can bend and rotate my knee. I don't think it's as good as it was - but it's not bad. I can straighten it and have it flat - I continue to do the exercises that were given to me by the physio previously. So, if I were to have surgery, I think i'm in a pretty good position to aid my own recovery 

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    • Posted

      Hi, sorry you've been dragged through so many procedures without resolution. I had left PKR almost 2 1/2 years ago. Recovery was pretty easy but pt was the same. Had right TKR February a year ago. Some weeks the right was better than the left and wished a total had been done. My doc said to let them "heal" together a couple months so they might learn to play well with each other. Ok so some days the right was a pain and the left on others.  Then six weeks ago I began enjoying a nasty nerve (sciatic) pinch in my right hip and groin area. It would come and go but has progressively gotten worse. If it's not screaming in pinched pain, the hip is grinding and clunking ( enough to be heard across the room). Very uncomfortable. Using a cane that I never had to do before. Have an appointment on Friday. So we shall see what we shall see is next. But knee wise, the two have been getting along pretty well. The pesky partial has taken over being the strong one. And the right is rather rebellious due to the stiff, limpy, awkward cane walking. I'm afraid it's suffering some set back due to all this strain. During the night both knees will throb in ways I haven't felt in months. So long story short, don't fear a partial but do discuss having the total done. 

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    • Posted

      Thank you and I hope you get some help at your appt on Friday - sounds dreadful!

      ?I feel happier about talking to the surgeon now. It's 7.30am fo rme at the moment and I've taken painkillers already. Sitting with my knee at right angles is the worst for me - I can feel the deep ache  and know I'm in for a bad day.

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  • Posted

    Hi trizwizz,

    ?I had a partial knee replacement done on 6 Nov 2015 - no problems. I had OA in the medial compartment of the right knee. (Thats the left inside bit of the tibia ). I had no other trace of OA in any other part of my body. The cause of my OA is not genetic/hereditary or of any cause other than I tore my right knee cartilage some 20 odd years ago and the damaged parts were removed., So since then I was walking bone on bone and my skeletal alignment got skewed somewhat which brought about this isolated spot of OA.

    ?My surgeon discussed PKR and TKR and I went for PKR. He agreed - with the caveat that he would only do it if there was no other signs of OA in the top of the tibia. There wasn't. If the OA was more extensive then it would be a TKR.The advantage of a PKR is that as I age should OA return and hit the top of the tibia then I can still have a TKR.

    The only way to truly get rid of the pain is to have the op - if your surgeon is any good he will advise whether a PKR or TKR is appropriate.

    My understanding is the the TKR can only be done once - at least with surgical science as it stands today.

    ?Interestingly, my medical team said an MRI wouldn't show all the stuff the surgeon needs to see. Only an Xray would do that. At no time did I have an MRI - the judgement calls were all made on the basis of Xrays !

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    • Posted

      Thank you - your information is most useful. The main part of my OA is on the inside of the left knee as well. - but I think at the knee itself rather than the tibia. 

      I had an old injury (fell of pushbike - going too fast downhill!) which I feel may have exacerbated the OA. I am genetically predisposed to OA. I had some surgery on my foot in 2010 and the surgeon said then it took him longer as he had to get rid of the OA first so he could put the pin in.

      ?I know last time the surgeon felt that, at arthroscopy, if he felt there was more OA in the knee cap - right underneath actually in the domed part of the kneecap - sorry don't know proper name - he would stop the arthroscopy and I would have to go back for another procedure. This would involve an open wound rather than keyhole, lifting up the knee cap from the side and scraping the OA out from that. Can't be done keyhole as the dome of the kneecap doesn't allow it - apparently. It didn't need to be done last time he felt.

      My understanind is that you can have more than one TKR so that's interesting.

      ?I agree with you about the MRI - the surgeon said much the same thing too - that nothing beats having a look either. The MRI on my right knee showed it was much worse than the left yet when he went in it wasn't. I asked him about this as I always though MRI s were th ebe all and end all - but he said no they weren't. It is the musculoskeletal clinic who have oreedered this though. Probably worth doing anyway - more information can't hurt. The clinic doctor said the xrays showed the OA.

       

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    • Posted

      I will add one more thing. After both the PKR and the TKR the arthritis pain was GONE! The pain from that point on is the recovery, that is no short or simple process but for me, I felt on the road to a functional recovery.
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    • Posted

      I'm afraid your understanding is completely wrong.  the TKR can be done more than once, and indeed it often is.  OFG on this forum, for example, has unfortunately had to have it done more than once, and so have other members of this forum.  I don't know if the recovery time for a partial is any less than for a TKR, but somehow I doubt it.  I have heard of several people who folowing a PKR have had to have the TKR only a few years later, and if that is the case, then I would prefer to go straight for the TKR, given that yes, you CAN have it done more than once.  Not that I would want to!

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    • Posted

      That's what I want gone - the deep aching pain of the OA - it just never goes away. The post op pain I can deal with I think - mentally I'm in pretty good shape and can see the point of physio etc - understand that physio hurts. But that's all beneficial pain (bit like childbirth!) and mentally I can see that I can cope with that. The pain of the OA I'm not really coping with

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    • Posted

      Thank you the Dr at the clininc did say that more than one TKR could be done - and that was why they wanted to put me off as long as possible - even though more than one can be done each successive surgery is more invasion.

      ?I don't know about recovery time for PKR - like you I would think a very similar time. I shall see. I have another appt at musculosketal clininc on 03.03 (shouldhave had th emri in between time). Then off to the consultant I expect.

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    • Posted

      My recovery was 8 weeks to driving a car again, and 11 weeks to back at work driving a tourist bus and handling passenger baggage, most of it over 15kg. Ticked all my surgeons boxes, pain free, no need to see surgeon for another 4 years. Expected life of implant at least 15 years! Given I was 71 at the time that's gonna put me at 86, given I have other medical conditions associated with the heart it's highly debatable whether I'll be around at 86!If I am I would hope that medical science would have advanced beyond medieval butchery. And I'm still working 30 to 40 hours a week. Job done!

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    • Posted

      Guess I'll have to find another group to com-miserable-ate with. Just got home from seeing orthopod. Guess what? I now need a new hip as it's deteriorating and is bone on bone. Arrrrggggggghhhhh! Oh well, it's said to be an easier recovery than our knees. And this too shall pass...

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    • Posted

      Oh that does sound grim - sorry to hear that. I think that once OA gets its grip then joints start to fail. I am convinced my shoulder is going too now. But the positive is we can have replacments. My granny was crippled with arthritis and didn't leave her room and was confined upstairs as she couldn't get down the stairs fo ryears. This should not happen to our generation thankfully

       

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    • Posted

      Hey Melinda, I had both knees done June Sept 2014, all was good, takes a year to really recover, then beginning of last year my right hip went bad, happened quickly, 6 months post op RTHR, no pain, work all day and walk the dog every day. Welcome to the club, good luck.
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    • Posted

      Hi Dave, I had TKR March 2016, really pleased except cannot improve walking...get really stiff and tight and if walk for more than 15-20 mins struggle. I (and my dog) long for thoses long walks.
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    • Posted

      Hi Dave, I walk 15 mins most days and go on static bike 20 mins five days a week. I still stretch it out whan stiff and am doing strenthening exercises for the oth one to prepare it for the tkr it needs.
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