Worries

[CarolStIves]

Hi
I was told six months ago that I needed a partial knee replacement but have now been told that I may need a total but they don't know this until they open up my knee and have a look.
Also I have an allergy to Zinc and Nickel. My surgeon has told me that this may decrease the chances of the operation being successful. he has told me that I can have it done now and risk the chance of it not working or wait a couple of years to see if there is new technology where no metal is used.
I am also confused as to the longevity of the prosthetic knee. He has told me that it may only last 8 years maximum and I could only have one more replacement after that. I am only 53 and that could mean by the time I am 69 I could have no knee at all. Yet I see on here that people far younger than me are having knee replacements. I am very confused and just don't know what to do.

 

[brs0660]

Welcome to BoneSmart. This is truly a community of folks who will help you along your journey as you consider knee replacement, have a knee replacement and recover. We have all been down a similar road and want nothing more than to answer your questions. We have two very capable moderators who have lots of information at their fingertips that will help you.

The library is an awesome resource. I found this article...just click on the link..about longevity of knee implants.

How long could hip or knee implants last?

Medical science is indeed progressing. Also in the library, I found this article on metal allergy. Metal Allergy

Hope this answers some of your questions. Jo or Jaime should be by soon and my have more information to help you.

 

[Jamie]

Hi, Carol. Welcome to BoneSmart. I'm glad you decided to join our forum. Barb has directed you to an excellent resource, the LIBRARY. You can find the link in the red tool bar at the top of every page. The articles she linked for you are excellent too.

We have many, many people around your age (and younger) getting knee replacements, so I think you should NOT worry about the longevity. Your doctor unfortunately is working under some very old statistics if he thinks they only last about 8 years!! Current statistics are more like 20 years and more.

As for the metal allergy, there are tests that can be performed ahead of time that will pinpoint your allergies and allow a good surgeon to make the proper choice of a prosthetic for you.

I see you are in Great Britain. Our forum nurse, Josephine, is also a Brit and she is VERY knowledgeable about the various hospitals and doctors available there. If you tell her the area where you live, she can make some recommendations on who to see. It does sound to me like you need a more up-to-date doctor! @Josephine:

Please continue to post and let us know how you get along. We'll be here to support you in whatever way you need.

 

[Josephine]

What ever is he talking about? There are coated knees especially for people with metal allergies called the GENESIS II and PROFIX Total Knee Systems

OXINIUM implants also increase the opportunity for patients with an acute allergy to nickel to have knee replacement surgery. Although many metals have traces of nickel in them, this advanced material does not have any detectable amount of nickel.

LINK

For a further explanation of the material used there is this

OXINIUM oxidized zirconium is a proprietary material which has been used in more than 200,000 knee procedures and is proven to reduce wear. It is also the only hypoallergenic metal bearing surface since it contains no detectable amounts of nickel, the element commonly associated with metal allergies.

LINK

Plus he's totally off beam about the longevity. I've never known a knee predicted to only last 8 years! I think nowadays, good surgeons know they last about 20 years and probably even longer than that. Reports are coming in of people still going strong at 30+ years! And one of them was a runner!

So next question - who is this surgeon you saw - which hospital did you go to? I think I could probably put you on to someone whose knowledge and expertise is a little more up to date than his!

 

[Tykey]

Hi Carol, when I read your first post, I wondered about the quality of the advice you have been having, it seems a bit way out of date.

I'm sure Jo's advice is well worth taking, I'd find a new surgeon!!

Also don't worry about having a full TKR instead of a partial, as far as I'm aware the op is no worse, and a full replacement works better lasts far longer, and you are likely to need the partial replacing in time with a full replacement. Was the surgeon still talking about the partial when he said it might only last 8 years? Now that might make more sense, but still not GOOD advice either.

 

[Haze]

Worries,
I have had a PKR on April 22nd of this year. I was also told that I could need a full replacement and the surgeon would not know until he actually opened up the knee area. I was asked to sign for a full replacement if it was necessary.I signed but fortunately a full replacement was not necessary. I think this may be a common proceedure to have the patient OK a full replacement rather than have the surgeon close you up and then go back in again at a later date after he /she asked you if you wanted the full. I could be wrong here but this is how it appeared to me.
I asked ahead of time about the longevity of the "new knee" and was told that he was supposed to tell me that it was 15 years but recent research had proven it to be 23 years.
I don't know anything about the allergy part but I certainly hope things work out for you and I thought this information might prove helpful.

 

[Jamie]

Yes, Haze....what you experienced is the norm. Most surgeons will request authorization to do a full TKR if it is necessary once they get in there and see firsthand what is going on. You just cannot tell everything from an xray.

 

[Tykey]

Jo, how many new knees can we have? Is it true that you can only have two?

 

[CarolStIves]

Thank you all for your replies. It has been helpful and reassuring to hear from people who have had some experience as I don't kmow anyone personally that has had this done. Jo, I will contact you with some details. Thanks again.

 

[Josephine]

Righto, Carol. Will wait on your contact.

Tykey - oh boy! That's like asking the old chestnut 'how long is a piece of string'! It depends upon so many thinks like the condition of the bone, what kind of knee you had before, why you need it revised. With each surgery the area gets a bit more worn and a bit more old scar tissue. I'd hate to even try to put a cover-all number on it.

 

[KM253]

What ever is he talking about? There are coated knees especially for people with metal allergies called the GENESIS II and PROFIX Total Knee Systems

LINK

Carol,

I'm only 53 too. ( I so love to say and hear that! ) I had a Smith and Nephew Genesis II put in around 12 weeks ago. There are advertisements here in the US stating they have a 30 year lifetime. I'm very happy I finally did it and am recovering very well. I'll be having the next one done next spring. From the day after surgery, when I first stood on it, I could feel the difference. Now what was my very bad knee is my good one and the 'not too bad' one feels horrible. Everyone's experience is different, but I found the hardest part was the fear of the unknown.

 

[cikasa]

Hi
I was told six months ago that I needed a partial knee replacement but have now been told that I may need a total but they don't know this until they open up my knee and have a look.

Please please please get a second and third opinion. If you had a CT and the surgeon is saying it, it's one thing, though a CT scan is brief, the views are very telling for the surgeon who may be operating on you; he'll most surely know what your a candidate for.

If all the surgeon is going on is a long-leg and sunrise view radiograph, then that aint enough in my book. If it were me, I'd take a partial over a total any day since both can have similar outcomes with the right implant, right diagnosis, right patient post-op rehab, right activities of daily living (as opposed to high-impact activities), etc. etc. But thats me; preservation of my anatomy, and upgrading when necessary.

But if 6-months ago your a uni, and now your a total candidate, I wouldnt be surprised if you were a total candidate 6-months ago, and perhaps something wasn't considered...who knows. But, our joints have lasted many well into their 50's and 60's and with the very slow progression of wear over that period of time, I'm suspicious as to how you progressed so rapidly over 6-months from one "wear pattern" to another.

The literature is clear that implanted knees can last a long time, but expecting your knee to last 30 years is clearly the exception, not the rule. Good to excellent results in a mid-90's score range is widely thought of as success for both uni-compartmental and tri-compartmental designs.

Point being, there are companies out there that have the materials for your indication and the knee for you. For something as invasive as your anatomy, dont rely on one opinion, though you just might be a total knee candidate, ask around.

 

[Jamie]

Cikasa....hello and welcome to BoneSmart. I'm glad you joined us!

While I do agree that it is advisable to talk to a couple of doctors before making a decision on joint replacement surgery, I do not agree with other things in your post.

People CAN have major changes in a joint in 6 months. I'm a good example. I had arthroscopic surgery for a torn meniscus in February. In March my CT scan and xrays looked fairly good. By June I was bone on bone. Arthritis can do that....especially if a person has had previous knee or hip surgeries or injuries.

It is quite common for surgeons to request that you agree to a TKR prior to surgery if he or she deems it necessary once they are in there. This is where you must have trust in your doctor.....that they know their stuff and will do the right thing for your particular situation. To each his own, but I would MUCH rather have ONE surgery and go on with my life if the doctor saw arthritis developing in another compartment in my knee. Sometimes they can ONLY see this firsthand...not from any scan or film.

General consensus is that knee replacements are good for 20+ years these days. It's going to be some time before statistics can prove that for certain because these new knees must be in use for a while longer.

But I really take exception to your suggestion that a majority of TKR patients only achieve in the mid-90's for ROM! That is simply not true and you only need to read the individual success stories here on BoneSmart to see that people routinely get 110, 120 and even more. People go back to an active life that includes some pretty ambitious sports like skiing, hiking, cycling, swimming, dancing and more.

 

[cikasa]

Cikasa....hello and welcome to BoneSmart. I'm glad you joined us!

While I do agree that it is advisable to talk to a couple of doctors before making a decision on joint replacement surgery, I do not agree with other things in your post.

People CAN have major changes in a joint in 6 months. I'm a good example. I had arthroscopic surgery for a torn meniscus in February. In March my CT scan and xrays looked fairly good. By June I was bone on bone. Arthritis can do that....especially if a person has had previous knee or hip surgeries or injuries.

Firstly, there are no absolutes, and I was addressing the OP, to be on-topic. But honestly, having a prior soft-tissue repair case, if there is no post-op trauma involved, it is nearly impossible for the vast majority of those patients all-of-a-sudden, being a candidate for knee replacement resulting from OA (osteoarthritis); the most significant or common diagnosis. The OP, unless I missed it, did not mention prior surgeries or events, but I do understand that much for a minority can change.

So, they having a prior debridement or repair for a meniscal tear is hardly a reason. In other words, a prior surgery, such as repair of a meniscus is 'not' a risk factor for increased cartilage degradation associated with osteoarthritis.

However, trauma can be, and eventhough an x-ray, as I mentioned, might show signs of osteoarthritis, such as more than 80% of people over the age of 50 have some evidence of osteoarthritis on x-ray, but have no symptoms. Much of the time asymptomatic arent operated on for OA just because they show signs.

It is quite common for surgeons to request that you agree to a TKR prior to surgery if he or she deems it necessary once they are in there. This is where you must have trust in your doctor.....that they know their stuff and will do the right thing for your particular situation. To each his own, but I would MUCH rather have ONE surgery and go on with my life if the doctor saw arthritis developing in another compartment in my knee. Sometimes they can ONLY see this firsthand...not from any scan or film.

And this is where consultation comes in. Every surgery you undergo for a TKR remvoves bone (most companies require this) in order for the surgeon to sculpt your anatomy to fit a generic off-the-shelf implant. Regardless of what fancy marketing name the implant has (for most big companies), the end-result is your getting an off-shelf-implant whereby your bone is being removed for proper fit of an implant.

Again, OA is not a bone disease, but a cartilage degenerative disease that has progressed for the vast majority over 50, 60, 70 years of your life-span. This is personal preference when it comes from surgeon consultation to personal decision-making, but personally, since the majority of good to excellent results are 15 years, and that's not me, but the literature, many undergoing a joint replacement have to be resigned to the fact that there will be a revision, even if its the polyethylene insert.

But that revision time of 15-20 years is long enough for me to opt for a partial, while preserving my own natural anatomy, and go for a total way down the road. Again, it doesn't make sense for some, but for me it does.

Because as I said, more bone, or natural anatomy is being removed with a TKR vs a partial. Therefore, there is more of my natural anatomy to work with for a revision to a TKR 15-20 years down the road if I were to be a true partial candidate today, and my knee lasts that long.

If I jump the gun and get a total whereby more of my natural anatomy and bone is removed, then at revision time from my Total, more non-natural objects, such as metal plates and inserts have to be sculpted into my anatomy just to restore my knee back to some acceptable level of even-ness so Im not walking lop-sided.

General consensus is that knee replacements are good for 20+ years these days. It's going to be some time before statistics can prove that for certain because these new knees must be in use for a while longer.

But I really take exception to your suggestion that a majority of TKR patients only achieve in the mid-90's for ROM! That is simply not true and you only need to read the individual success stories here on BoneSmart to see that people routinely get 110, 120 and even more. People go back to an active life that includes some pretty ambitious sports like skiing, hiking, cycling, swimming, dancing and more.

The vast majority of significant outcomes are 15 years, and from there, results really dont get better. That's an excellent procedure, and much of it's success has to do with what I mentioned in my first post, including the competence of the surgeon. Levels of competence of surgeons is no better or worse than a plumber, teacher, police officer, secretary, corporate executive, etc. There are different levels with every person.

I did not say anything about 90 degrees in ROM. Please re-read. I said a knee score of mid-90's. Yes, that is very acceptable.

 

[Tykey]

I like a good debate!

Personally if someone offered me a partial knee replacement, I'd try to persuade them to give me a total one. I'd rather have a fully good knee than one half good/one half (probably) not too good.

The danger of only having a partial is that the other half will pack in sooner than 20years+, and I'd be back in surgery sooner than otherwise. I'd rather risk the slightly greater problems of a second TKR in the hope and expectation that I wouldn't need one in any case

The one fact which is truly significant is the expected longevity of new knees, there's no way we can know this until we all get to 30 years from now, and tell each other. That won't bother me because I expect to be in another place by then. I'm working on 25years, and even then technology will make the current procedures look stone-age.

But you pays your money and takes your choice.

 

[Jamie]

Cikasa, we obviously have differing opinions and that's fine.

But if you are not referring to ROM when talking about a "knee score," what is it you are referring to?

 

[CarolStIves]

I think some of you may have misunderstood. I was told 6 months ago that I needed a partial. I haven't had anything done yet. As I had a metal allergy I had to wait to have allergy tests. it turns out I have a mild allergy to Nickel and Zinc. since then i have spoken to my surgeon and that is when he told me the stuff I have already outlined. i hope this clears things up.

 

[Josephine]

Please stay on topic here, folks.

 

[Josephine]

I really thought I'd answered this. So sorry Carol - must have either given someone else a similar answer or posted it in the wrong thread!

My first choice was Plymouth Hospital, Derriford Road, Crownhill, Plymouth, Devon, PL6 8DH
Telephone: 01752 202082. Distance 75 miles, a 1hr 45min drive. Surgeons I saw there were Jonathon Keenan and Helmy Fekry, both of whom seem to be fairly basic kind of chaps but the hospital as a fairly good reputation.

Second choice was the Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW
Tel: 01392 411 611 but I couldn't find any information about specific surgeons but its reputation has been pretty good, it being the place where the Exeter hip was designed, though the surgeon responsible for that is long since retired. Distance 110 miles, a little over 2 hours drive.

Hope this helps.

 

[Haze]

I have not posted for awhile becuase I am recovering from a thyroidectomy done Aug. 17th. I have had more problems with that "simple" surgery than with my PKR. I will not go into those details here.
I am now 4 1/2 months out of my PKR on the right knee. Things are going well at this point. My worst time was the two weeks after the surgery. I found that period painful and challenging. I had posted above
concerning my being asked to sign for a total knee replacement just in case. I believe that it is necessary to make the decision that seems to be the right one for you. I believe I made the right one for myself. I was advised that I was to be told that it would last 15 years but studies showed 23 years. I do not know the manufacturer of the replcement but am not too concerned about that.
This weekIi will be registering for tap dance class. I have danced for seven years but obviously had to stop for awhile. It may be challenging initially but I a am ready for it.