Is a TKR in my future?

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Jennlynn

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Hello,
I am 38 yo with a right knee that has some surgical history. In 2000, I had my ACL reconstructed, repaired meniscus and a full "clean out" of debris. In 2002, I again had my meniscus repairs and a cleaning. For the last 6+ months I have been in terrible pain. Last Thursday I had a MRI, which was read by the facility and a separate radiologist 4 hours away. So the results were bothersome and I couldn't get an appointment with a OS until 8/24, so I am hoping someone can help me out. I apologize if this is the wrong area to post such a question. My MRI results are:

Degeneration of the ACL graft
Edema tracking along ACL fibers, but the ACL looks intact
ACL revision advised
High grade chondral disease at the posterior aspect of the lateral tibial plateau
Localized chondromalacia along inferior aspect of the median ridge of the patella
Minimal blunting of the free margin of the posterior horn of medial meniscus
New bone formation along lateral wall of the intercondylar notch

I really appreciate any insight you may have. I have researched treatment options and it all points to TKR. I see a lot of knowledge members in the forum and I am trying to prepare myself before the appointment.

Thank you in advance,
Jenn
 
You've been dealing with knee problems for 16 years now. If the OS thinks that would solve your problems then it just might be your best choice. Make sure that you are comfortable with the OS and you feel you can ask whatever questions you have. Try to write down any questions you have before you go for that appointment.
 
Hi and welcome to BoneSmart. I know it must seem like an eternity to wait until the end of the month to talk with a surgeon, but actually you were able to get in fairly quickly. Some of the surgeons out there make new patients wait months!

It sounds like you could be a candidate for a knee replacement. You have damage to the cartilage in the joint and, if it severe enough to cause you pain, then the most likely treatment will be replacement. What needs to be determined is if your pain is from the meniscus problems or the degeneration of the ACL. If it is the latter, maybe..just maybe another repair (if possible) of the ACL could buy you some time.

The best person to advise you is our forum nurse, @Josephine. I have tagged her to respond to you but it may be a few days as she is on a short medical leave for shoulder surgery. But she will get back with you. In the meantime, please feel free to ask any specific questions you may have and we'll get you the answers you need.
 
Good morning,
Thank you both for your responses. I have been in pain for quite some time now. I try my best to push through and not let it tear me down. I was doing good until last Thursday morning, it all changed. That's why I decided to have the MRI. I am a practice manager for a Rheumatology practice so I am always on my feet and moving. My boss has seen my MRI and agrees I need a ortho consult. The OS that I am seeing is a pioneer in joint preservation but, I know his may sound crazy but I would rather have a TKR then a so called "bandaid" for a few years. I want my knee fixed so I can get back to my life before this pain. I've had three natural child births and this pain chalks up there to them. It came on so fast it seemed, but maybe it was there and I was ignoring it. I tell my co-workers that I'm too busy to deal with pain! Well it's slowing me down. Yesterday alone, I kept a tally of each time my patella locked and by 4:30 pm the count was at 8. I am in a Donjoy knee brace all the time now and I just want my life back. I think the biggest issue I'm going to face is my age, which shouldn't be the case, since my quality of life is decreasing. Just like most people, I'm tired of the constant pain. Anyhoo, I hope everyone has a good day, I'm off to the office.
 
I understand your frustration, being in pain and not being able to live your life due to limitations is no way to live, everyone on this site can relate.

If they tell you that you need a TRK, the first couple of weeks are the roughest, and then you still will need a lot of patience and then even more, this is a long road with may twists and turns, but as far as I am concern it is worth the ride, it will be a while before I get to the finish line, but I no longer have the arthritis pain and I know that there is a light at the end of this tunnel.

Good luck with your doctor's appointment, please keep us posted!!!
 
I hope you get answers that solidify your decisions. When I could no longer live my life and my knee was ruling my activity I knew I had no choice, even though I had never had another procedure or been a patient in a hospital before. The pain from a TKR is different, but it is pain that will diminish while bone on bone pain will not.
 
If age is used as an excuse, find another OS who looks at your medical condition and medical need for TKR.


Jean

RTKR (Stryker Triathlon): 21 June 2016 LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006 Left Knee Arthroscopy: 10 February 2005
 
Good luck with your OS visit.

My first OS blew me off because he said I was too young, but the second saw my current x-rays and how my knee was affecting my life and said I was a candidate for TKR. So don't settle for an OS who looks at your age before your knee.
 
Good morning everyone,

I seen the Ortho's PA yesterday and the news was "at your age"......grrrr. So I nicely as possible said "how about we not even look, think or mention my age any more and listen to me when I clearly say that I would rather have a TKR and need 2 revisions in my lifetime then to go another hour in this agonizing pain." So I got a cortisone shot, a new brace to support and stabilize my patella.

Severe arthritis under the patella, on the lateral side and a uni replacement has been discussed. I see the OS Wednesday to schedule a arthroscopy to have a lavage and debridement and he is measuring me for my half of a new knee...lol. I have bad spurring of my patella, and she was shocked how much it was popping and cracking during the exam. I'm not fond of the new brace but wearing it faithfully so far. Any input on a uni?
 
@KarriB , Unicompartmental replacement, AKA partial knee replacement (PKR), only covers where the knee is worn, leaving healthy cartilage.

@Jennlynn , Your age should not be a consideration, your pain and how you are functioning should determine if you need a PKR or a TKR, now, not later when you have wasted years in pain when you could have been active and involved in life. Joint replacements are lasting longer and a revision may or may not be in your future. I would caution you, PKR's tend to have a higher failure rate.

Here are some articles for you, fill out the score chart you you and your OS can see how limited your life is NOW.

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

Score Chart: How bad is my arthritic knee?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?


If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?


Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing knee recoveries
 
My doctor has recommended a lateral uni for me. I have moderate-severe arthritis in my lateral tibiofemoral compartment and patellofemoral compartment. He says he doesn't usually resurface the patella so the arthritis there shouldn't be an issue. I have concerns regarding a uni because I have major loss of cartilage in the trochlea (part of femur that patella rides in) that won't be resurfaced in a uni. I was given an unloader brace to unload the lateral compartment and it helps for a while but then it causes increased pain in the medial compartment, which he is worried about. I go back in a few weeks to discuss the matter with him. His preference is a partial (he is very, very confident in his abilities) but said when he gets in there it's possible he may need to do a total.

My problems started with the patellofemoral compartment. I had a scope in 2015 to clean up the patellofemoral joint. A year later my current doctor did a diagnostic scope and the lateral compartment went from some possible areas of grade 1 to severe grade 3. My medial compartment is grade 1. Since my arthritis seems to be progressing very fast I am weary of uni. My good knee isn't that good either.
 
Hello everyone,
I had to leave work early today because of the increased pain and stiffness in my knee. Just sitting at my desk with my leg elevated, I felt my brace getting tighter and tighter. Wouldn't ya know it, my knee looks like a grapefruit! I'm home now, icing it, but my boss said 2% of patients have increased pain after the cortisone injection, which my interpretation of that is you are having a cortisone flare. Well let me tell you, I will never have another shot of any kind, cortisone, Orthovisc, Sinvisc or Monovisc injected into my knee.

I was getting around without crutches, until today. I'm miserable, and scheduled for pre-hab PT tomorrow. I am not thrilled about a PKR as I know they have a low life expectancy compared to a TKR, but that's where "my age" seemed to be a problem, yet she stated that at my age they don't repair meniscus, they remove it. So you want to replace the lateral side of my knee, remove my medial meniscus and fix my spurring, cartridge missing patella? And tell me again why I'm not a candidate for a TKR? I need to see what the OS says on Wednesday, but if a PKR is all He is willing to do, then I will look around. Am I wrong to think a TKR is a better option?

Thank you for the articles, I will be reading them!
 
Fuzzybunny,

I know exactly what you mean when you wear your unloader brace. I'm having the same issue and I want to throw the darn thing at the PA who put me in it. Within 30 minutes of wearing it, I'm screaming with pain in areas of my knee that didn't hurt to start with! My brace includes a patella support dewhicky that doesn't allow full ROM. This to me seems counter productive. Ugh, I just want it fixed and no more band-aids! Shots, braces, PT, is not the solution, its buying them time. I'm all for the replacement, I'm not trying to postpone it like they are. Just cut me open and fix me!
 
I'd spend the afternoon icing and researching new orthos if I was you. Try the find a clinic tab at the top.
 
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I have used the clinic finder. I live on the Eastern Shore of MD, where there are only 2 Ortho practices. I have started the search for OS 3 hours away, in Baltimore and surrounding areas. Thanks for the info.
 
Am I wrong to think a TKR is a better option?
With all the damage you mention, IMO you will need a TKR. Hope you find someone you are comfortable with, it will be worth the drive. Be sure they do a lot of knee replacements,
 
Good morning everyone,

I awoke this morning with less swelling. I was able to hobble down my 15 steps into the kitchen to make my coffee. I'm am going to work, taking my crutches just in case, but I honestly believe the brace is causing the pain more then the arthritis. It could be from the cortisone flare too, but that brace is awful. I know my patella is extremely loose, but, this brace is jamming it in one position and its locking. It was locking a lot prior to the brace. So I will be a good patient and wear it until Wednesday and hopefully the OS will say it's useless! $775 down the drain. I hope everyone has a wonderful, minimal pain-pain free day!
 
Jennlynn,
I did not tolerate an unloading brace either. Ask about having a PT tape your patella, it might help, and is much more comfortable.
I ended up donating my brace so someone else could use it.
 
The statistics on PKR are really not that great. It is a tricky surgery and you need someone who has a lot of experience to do one properly. Maybe someone who does only partials. Otherwise, here, we sometimes call them a two step TKR!
 
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