Building decision for knee surgery

[Jeffntate]

I am hopefully a candidate for a partial knee replacement of the medial compartment. Before I lost 55 pounds, all the doctors were only suggesting a total knee, despite the fact that all my problems are in the medial only compartment (as far as I know based on a 2015 MRI). All my pain is in that compartment, so I have reason to hope this is a viable option.

My question - I was reading about President Bush getting a partial knee replacement by a top surgeon at Rush Memorial Hospital in Chicago, and one of the benefits they mention in this article or another one I read tonight (https://www.nbcchicago.com/blogs/wa...Rush-University-Medical-Center-267020221.html) is that at least in the President's surgery, no muscle, ligament, or tendon was cut.

My question is simple - are all partial knee replacements like the President's, with no cutting of any muscle, ligament, or tendor, or does this Rush Memorial surgeon have such technical skill that he can do what no one else can do?

I'm trying also to decide whether to get my partial knee replacement done here locally or if I should travel to a major medical university like Rush, or closer ones to me like Vanderbilt in Nashville or Emory in Atlanta. What did most of you do for knee surgeon, partial or otherwise, did you go to a in town local doctor, or travel 2-4 or more hours to a top notch major medical university to get a top notch doctor and his staff to work your knee surgery?

Also, they have this local to me: Mako Robotic-Arm Assisted Technology for partial knee replacement. Anyone else had this partial knee by Mako Robotic arm? Are all partial knee replacements done with such robots now?

 

[Roy Gardiner]

IMO the skill of the surgeon outweighs all other considerations for TKR or PKR. Find the best person you can. Personal recommendation is best. People here may be able to help. Again IMO you can't spend too much time or effort in finding the right person.

I don't believe muscles or tendons are cut in modern knee surgery; they are pretty much messed about simply by being shoved out of the way, which is what causes post-op pain. Talk of 'quad-sparing' surgery in particular is marketing hype, *all* modern surgery is quad-sparing!

 

[Jockette]

Talk of 'quad-sparing' surgery in particular is marketing hype, *all* modern surgery is quad-sparing!

I agree with Roy.

Partials don’t usually last as long as totals, so there’s a very good chance you will have to have it converted to a total some years down the road. The recoveries are very similar despite marketing saying it’s a quicker recovery and a more natural feel since only one of the 3 compartments are replaced.

I have a partial, a Patellofemoral. I’ve had a difficult recovery and at 20 months post op I am still very sorry I had it done. Nothing about my knee feels remotely natural. I actually have more limitations now than I did with the “partial arthritis” I had before the surgery. I was not bone on bone.

Second opinions are difficult and often disappointing.

There are some surgeons who won’t even do partials because they don’t believe in them.

On the other hand, some people are happy with theirs. @NavyGunns is happy with his. I think his came about because of an injury long ago, not just “general arthritis” that developed over time.

Going by my experience I will never recommend a partial to anyone.

Navy Guns has a good experience so he does recommend them.

I will also add I believed everything my surgeon told me because I didn’t know any better. I am now an unsuccessful patient and he offers me no help to find out why it hasn’t been successful.

 

[Josephine]

are all partial knee replacements like the President's, with no cutting of any muscle, ligament, or tendon, or does this Rush Memorial surgeon have such technical skill that he can do what no one else can do?

Oh my goodness no! There never has been cases where any vital structures were cut. Perish the thought!

Anyone else had this partial knee by Mako Robotic arm? Are all partial knee replacements done with such robots now?

Not all no. Some surgeons like to use these tools but by far the majority still go free-handed. And generally speaking, even an expert would be hard pressed to tell the difference!

 

[NavyGunns]

@Jeffntate, as @Jockette indicated, I had a PKR of the lateral compartment of my left knee back in April. The procedure was Mako robot assisted (Makoplasty). The incision is only about 4” or so long and hardly visible (surgeon used glue to seal rather than staples or stitches which I think makes a difference). Per my OS, I was a perfect candidate for PKR as the lateral compartment was the only damaged area of my knee from a track injury when I was 16. So far, I’m extremely happy with the results. My expectations are that I will not need any further surgery on this knee for at least 15-20 years based on my physical health and the opinion of my OS.

PKR is not for everyone. It was the perfect choice for me. I asked my OS why not just do a TKR and be done with it. He asked why replace what is not broken? He also stated if it were his knee, PKR is what he would do.

Feel free to read my recovery thread for more insight on what to expect.

NG

 

[Jeffntate]

My medical meniscus was torn as seen during scope job several years ago. My son job shadowed an Orthopedic surgeon who did a form of partial called an "Oxford". Is there any info on this particular unicompartmental being more successful than the lateral or the third compartment, or are all unicompartments about the same success rate? More important for me, since I already take a high dose of opioids, is the pain a good bit less postop from a unicompartment in the medial area?

 

[Roy Gardiner]

I already take a high dose of opioids,

If it's for your knee, here's some Good News. Just weeks or at most a couple of months post-op, you won't need any painkillers at all. Zippo. Zilch. How cool is that?

 

[Celle]

My question is simple - are all partial knee replacements like the President's, with no cutting of any muscle, ligament, or tendor, or does this Rush Memorial surgeon have such technical skill that he can do what no one else can do?

No, all PKRs are not like that and that surgeon does not have some super-skill.

Many PKRs last only a few years and some even have to be replaced within the first year. It doesn't matter whether you go to a big fancy hospital or not. What is important is the skill of your surgeon - he needs to be a specialist in knee replacements and do at least 200 a year.

In spite of what you seem to be thinking, the cutting of muscles and tendons is very infrequently done nowadays - it is old-fashioned and unnecessary.

Don't be misled into thinking that having a PKR will give you a faster and less painful recovery than having a total knee replacement. In almost every case, it won't. Recovery from a PKR takes just as long as recovery from a TKR.
In addition, the maximum life of a PKR is 10-15 years, while a TKR should last for 30+ years.

My medical meniscus was torn as seen during scope job in 2016. My son job shadowed an Orthopedic surgeon who did a form of partial called an "Oxford". Is there any info on this particular unicompartmental being more successful than the lateral or the third compartment, or are all unicompartments about the same success rate? More important for me, since I already take a high dose of opioids, is the pain a good bit less postop from a unicompartment in the medial area?

Don't base your decision on whether to have a PKR or a TKR on an arthroscopy done in 2016. Your knee could have changed a lot since then. You need to have up-to-date X-Rays and probably an MRI as well.

I had an Oxford unicompartmental (medial) mobile-bearing PKR for my first knee replacement. I had an excellent and meticulous surgeon and the PKR lasted for 11 years and then failed, and I had to have it revised to a TKR.

The success rate of PKRs is dependent much more on the skill of the surgeon than on the type of knee replacement. The skill of the surgeon is the most important factor in any knee replacement.
In spite of the publicity and advertising, there is really very little difference between one brand of knee replacement hardware and another. Don't waste your time looking for the perfect hardware - instead, look for the best surgeon.

Why are you taking a high dose of opioids now? You may need help to reduce that dose before surgery. Do you see a pain management doctor now? If so, he/she will be a help after your surgery as well and you should talk to him/her about it now.

No, a PKR is not less painful than TKR. I have had both, and, if anything, my PKR was the most painful and the hardest to recover from. The amount of pain and the recovery time are very similar between a PKR and a TKR.

You seem to think that you will be in terrible pain after your surgery. With modern methods, even though you are now habituated to opiates, your pain can be well controlled - but you do need to talk to your surgeon, anaesthetist and a Pain Management doctor about this before going into surgery.

Having had both a PKR and a TKR on my right knee, I chose to have a TKR when my left knee needed replacing, even though I was offered a PKR. I would not have another PKR.

 

[Gimpy9]

I had a PKR in Oct 2007, still have it, still going strong. If I am out in the cold, damp weather, i.e. snow, and not able to sit down now and then it does ache. I had 8 surgeries on the PKR knee. My surgeon gave me my options, I asked him point blank if this was your knee, knowing my history, what would you do? He said PKR. Having to have the epidural prior to surgery scared me more than the surgery itself.
The recovery time felt like forever. I did all the exercises prior to surgery and after surgery. I went to PT 3 times a week and did all the exercises at home the other 4 days a week. I became frustrated with all the work I was putting in and it would only bend to 95 degrees. This went on for a few weeks. I told my PT about it, he kept saying one day it will just be where its supposed to be. A couple weeks later all my hard work paid off, I could bend it to 120 degrees. I was elated, and released from PT. This was in late Feb 2008.
The pain and frustration prior to surgery doesn't end at surgery. You have to work hard for your knee to be as normal as it can be.
I'm not sure if TKR patients are able to kneel. I am not as my initial injury took out part of my knee cap.
I am scheduled for TKR on the other knee in Dec. Excited and at the same time I know the hard work ahead of me.
I wish you all well, quick healing and great PT.

 

[Celle]

I'm glad that your PKR is doing so well, @Gimpy9 .
Actually, all that hard work at PT isn't really necessary. Your knee, whether you have a TKR or a PKR, will gradually start to bend more as it heals and its swelling goes down. All you need to do is keep your knee moving gently.
If you choose to go to PT, that's fine, but you can also rehab your knee by letting your normal activities of daily living be your exercise. Walking is the best exercise of all, so you can start off by just walking around the house, and gradually increase the length of your walks.

My surgeon doesn't allow any PT at all for the first month after a knee replacement. He says your knee needs that time, to start on its journey of healing. For that month, we rest, ice and elevate our leg, and walk around the house.
After that month, we just go to PT once every 2 weeks, where we are shown a few new exercises to do at home.
His patients all do well and achieve good ROM, as I did, and he hasn't had to do a manipulation to help with ROM for the past 4 years. I think that speaks for itself.

 

[Celle]

I have TKRs in both my knee and I can kneel. It feels strange, but I can do it. Some surgeons prefer their patients don't kneel, but that is up to the individual patient and surgeon.

 

[Jeffntate]

Recommendations for a surgeon in North Alabama?

Added some stuff to my personal information. Posting to see if it shows.

Any other opinions on PKR vs TKR? Looking for any and all input, and for surgeon recommendation.
Here is one type of partial knee replacement they do locally: https://www.oxfordknee.com/oxford.html
Not sure if both fix the medial compartment like my problem or not.

Can someone give me a link to buy one of the recommended elevation wedges in picture #1 or #2? Looks like a good idea to get used to sleeping with pre-op.
https://bonesmart.org/forum/threads/elevation-the-dos-and-donts.7602/

Are all knee replacements "quad sparing" and what will tell you whether a surgeon can do that or not? I was reading this thread and saw it. https://bonesmart.org/forum/threads...using-quad-sparing-tkr-procedure.21720/page-3

 

[Celle]

There's nothing special about quad sparing. In fact, most surgeons do it nowadays. Snipping the quads is considered rather old-fashioned.
I suggest you read this article, especially the part about quad snipping:
Knee replacement surgery types and suggested videos

If you want to know whether a particular surgeon refrains from snipping the quads, I suggest you select a surgeon and then ask him/her. It could be one of the questions you ask, once you have a short list of surgeons.

By the way, the thread you've been looking at is 5 years old. No one has posted on it since December 2013.

It may be that no one here at the moment has personal experience of a surgeon in your town.
Have you tried using the "Find a Clinic" facility in teh blue band at teh top of the page?

If you can't find anyone that way, you could try posting your zip code here and tagging Jamie, who might be able to suggest someone not too far away. You need a surgeon who specialises in knee and hop replacements and who does ab out 500 a year.

Instead of focussing on different implants and techniques, I think you'd be better advised to look for a good surgeon, because your surgeon's skill is the most important factor for success in a knee replacement.

 

[Jeffntate]

Hello, I've been reading a lot of threads on here but this thread is specific to me.

I've been putting off knee replacement with SynVisc and cortisone injections, even bought an electric wheelchair and have multiple braces because of things I heard about knee replacement.

Functionally I can still get around on the knee. It doesn't lock or have true functional issues but the pain has gotten unmanageable and I am living a mostly sedentary lifestyle.

I'm doing the 120 leg lifts a day now but am so afraid of pushing any harder out of fear of making the knee pain skyrocket out of control (hit 9/10 yesterday). It hurts all the time, but gets worse at night, regardless of how much I baby myself. I don't know what to do.

I was told to lose weight and that knee replacement isn't a slam dunk like a hip replacement and some are not satisfied. Then I read that those who have a lot of pre-op pain tend to have more post-op pain even long term. But the knee pain is getting to the point that I can't stand it and I wonder if I should even undergo emergency knee replacement. My anxiety is high about all this.

I fear having the surgery and I fear not having it. One of my rheumatologists said he wears a brace because so many people have bad results, but my other rheumatologist said he had TKR and was back to work in 4 weeks as a doctor. I also read people with osteoarthritis tend to do worse with getting pain relief from knee replacement. Any advice or help is appreciated. I'm trying to take the minimum amount of narcotics but the less I take them the less I can do so not having much luck lowering my dose and usually I have to take more at night.

What besides taking narcotics can I do to make it until knee replacement? Should I try to do cardio which I've not done much of since 2014? My BMI is 26.5

 

[Jeffntate]

Background
The purpose of this study was to compare the patient-reported outcomes regarding joint awareness, function, and satisfaction after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).

Methods
We identified all patients who underwent a UKA or TKA at our institution between September 2011 and March 2014, with a minimum follow-up of 2 years. Propensity score matching was performed for age, gender, body mass index, operation side, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. One hundred UKAs to 100 TKAs were matched. Each knee was evaluated according to the WOMAC score, Forgotten Joint Score (FJS), High Flexion Knee Score (HFKS) and patient's satisfaction at postoperative 2 years.

Results
There was no significant difference in WOMAC score at postoperative 2 years between UKA and TKA groups. However, the FJS of the UKA group was significantly higher than that of the TKA group (67.3 ± 19.8 and 60.6 ± 16.6, respectively; P = .011). The HFKS was also significantly higher in the UKA group compared with the TKA group (34.4 ± 6.4 and 31.3 ± 5.2, respectively; P < .001). Eighty-six percent of all patients who underwent UKA were satisfied compared with 71% of those who underwent TKA (P = .027).

Conclusion
Patients who underwent UKA had higher FJS, HFKS, and satisfaction rate when compared with patients who underwent TKA, indicating that UKA facilitated less knee awareness and better function and satisfaction than TKA.
https://www.arthroplastyjournal.org/article/S0883-5403(16)30834-8/abstract


The scores for each subscale are summed up, with a possible score range of 0-20for Pain, 0-8 for Stiffness, and 0-68 for Physical Function. Usually a sum of the scores for all three subscales gives a total WOMAC score, however there are other methods that have been used to combine scores.
WOMAC Osteoarthritis Index - Physiopedia
https://www.physio-pedia.com/WOMAC_Osteoarthritis_Index

 

[Celle]

Jeff, It's plain as day that you need a knee replacement.
In fact, you probably needed it years ago.

Stop frightening yourself with so much research and go ahead with that knee replacement.

You seem to have only read about the negative things associated with knee replacement.
Have you read these stories?
Stories of amazing knee recoveries

Know this: Knee replacement is one of the most successful and the most frequent surgeries carried out nowadays.
@Josephine will confirm that.

As long as you continue to put off having a knee replacement, your knee will continue to get more and more painful and unreliable.

If you have a knee replacement, yes, you will have pain at first, but it can be controlled.
Yes, recovery from a knee replacement is not a walk in the park. It's long and frustrating.

But - and this is the great thing! - your knee will continue to get less painful and more reliable once you have had the surgery.

I've had three knee replacements. The first was a partial that lasted for 11 years before it needed to be revised. That's longer than most partials survive. That PKR saved me from a life of ever-decreasing mobility and increasing pain. It gave me back the life I wanted.

I now have a TKR in each of my knees and I love them. They are more healthy than the rest of my aging body! They fully restored my mobility and activity. At 77, instead of being a rocking-chair granny, I'm independently mobile, I drive everywhere I need to, I travel, I do my own housework and gardening, I play with my grandchildren, and I don't take any medications for my knees.

 

[Celle]

Jeff, you're overthinking all this.

Whether you have a partial or a total knee replacement should not be decided on a presumed pain level after surgery. It is the condition of your knee that should be the deciding factor and with your long-standing knee arthritis, it is unlikely that your knee will be a suitable candidate for a partial anyway.

 

[Jeffntate]

All my pain is in the medial side, and the xrays the local surgeon took about 3 months ago led him to mention a partial knee replacement, but that was after I dropped from a BMI of 36.6 to 26.7. Before when I was at the higher number, 3 different surgeons only mentioned a total knee replacement, so I don't know if I am really now a candidate or if he just thinks he can sell me on a partial to get me past the shots and onto the surgery track or not.

 

[Celle]

Don't waste your time and money having a partial. With your knee history and your current pain level, why would you want to go through two surgeries and two recoveries, when one (a TKR) will do the trick?
Especially as partials do not have a good record of longevity. Some even need revising to a total within the first year.

In case you thought differently, and in spite of what you may have been told, recovery from a partial is usually just as long, and just as painful' as recovery from a total.
It takes a full year for complete recovery of all your soft tissues, whether you have a PKR or a TKR, although you will be feeling much better and more mobile long before that.

 

[Josephine]

Not sure if both fix the medial compartment like my problem or not.

Both what? You never said.

Can someone give me a link to buy one of the recommended elevation wedges in picture #1 or #2? Looks like a good idea to get used to sleeping with pre-op.

You actually don't need to buy a wedge because pillows or big cushions will do just as well. However, you can get the Lounge Doctor from Amazon and if you buy via this thread - Recovery Aids: A comprehensive list for hospital and home - (hit "Click Amazon") the you will help for forum by getting us a donation.

Are all knee replacements "quad sparing" and what will tell you whether a surgeon can do that or not?

This was answered earlier and Celle just answered it again. Only old fashioned, out of date surgeons will cut the quads these days. Good surgeons know it's unnecessary.

so I don't know if I am really now a candidate or if he just thinks he can sell me on a partial to get me past the shots and onto the surgery track or not.

He's just a surgeon who is an 'enthusiast' about partials. Some surgeons are. Your key option is to make sure the surgeon also does totals and that he will be prepared to 'jump ship' and do a total if he thinks it necessary because not all knees are 100% suitable for a partial and very often they won't know that until they actually eyeball the inside of the knee.