Bilateral PKR PKR or TKR in California

[CaFireman]

Looking for help and advise.

I am 58, and have severe bilateral (bone on bone) medial meniscus damage in both knees and mild to moderate damage to lateral and patellofemoral portions of my knees (as per recent MRI). In my early college years, I was an elite runner, ran close to a 4 minute mile. 30 plus years later, I have been experiencing degenerating mobility issues for 8 years, currently it is difficult to walk 1/4 mile.

I am searching for a competent Orthopedic, and I am weighing the pros and cons between PKR and TKR, and when is the best time to get them.

I am retired firefighter and currently living and doing volunteer work in southern Ecuador, but I have a home in Encinitas California (North San Diego County) and have Anthem PPO medical insurance. It would make the most sense to get my surgery in Southern California near my home, but I am willing and able to travel (domestic or international) for competent, quality, and personal treatment.

I have consulted with Dr. Stone, Stone Clinic in San Francisco. He recommended PKR both knees, however, he is very expensive (out of network) $21,000 per knee plus’s all the other expenses. Also consulted with Dr Parks, South Orange County Orthopedics. He recommends TKR and much more affordable (in network provider), but I prefer PKR.

I am also considering umbilical stem cell treatment here in Ecuador. However, it is my understanding is that it will only help in the short term.

I think a PKR is a better way to go for me, but I’m not sure. Doing as much internet and YouTube research as possible. I am also having trouble finding Orthopedics willing to to initial consults via ZOOM as I am in Ecuador.

I looking for help and referrals in finding Orthopedics, preferably Southern California who are competent and very experienced with robotic PKR and TKR for active 50-60 year olds.

I don’t want knee replacement, but if I do, I want to do it once and correctly. Any helpful advise would be welcome.

 

[benne68]

Hi @CaFireman and welcome to BoneSmart. We have lots of information to share.

Have you tried our Surgeon Locator (https://bonesmart.org/surgeonlocator/) to look for someone in your area of SoCal?

Since you are at the stage where you 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 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?

Additionally, 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

I'm tagging one of our members, @Irongirl56, who was training for an Ironman before surgery, had a medial PKR last year and has returned to running, biking and swimming. I've tagged her, so I'm sure she will check in with you. In the meantime, you can read some of her story here: https://bonesmart.org/forum/threads/irongirl-pkr-5-months-after.67940/.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

Let us know how else we can help.

 

[Jockette]

have severe bilateral (bone on bone) medial meniscus damage in both knees and mild to moderate damage to lateral and patellofemoral portions of my knees

I don’t want knee replacement, but if I do, I want to do it once and correctly.

Then a TKR is the way to go, as you have damage in all 3 compartments, I can’t imagine a reputable surgeon would do a PKR knowing this.

PKRs normally don’t last as long as TKRs, so with damage in all 3, you’d be back in surgery sometime after the PKR. Recovery takes an average of a full year, for both TKR and PKR. That‘s a lot of recovery time if you have to do it twice.

 

[Roy Gardiner]

to BoneSmart

I don’t want knee replacement, but if I do, I want to do it once and correctly

I agree. It's why I had both done at the same time; one surgery, one recovery. I'd look at this, especially if you're still pretty fit.

very experienced with robotic PKR and TKR for active 50-60 year olds.

Again, agreed. My take, though, is that robotic is not essential - it's the surgeon's skill and experience that counts.

I also consulted with several surgeons before deciding and am certain that's the right way; it means you're sure of your final decision - and it's kind of important!

 

[Hollylyn]

Hi @CaFireman,
I live in North County San Diego and did research before having my RTKR in April. Scripps Encinitas does specialize in the robotic surgery. I elected to have mine done the old fashion way by Dr. Owsley in Escondido, he will do the LTKR in July. My experience at Palomar was great and I am very happy with my new hardware. Good luck!

 

[SF Katie]

I live in the Bay Area, and yes, Dr Stone only accepts direct pay.
You want an excellent surgeon who will accept your insurance, and fortunately all you need to do is cast a wider net. There are excellent surgeons at both the UCSF and UCLA Medical Centers, as well as at Stanford Medical Center in Palo Alto. I am sure you will find a world class surgeon at one of these facilities that will accept your insurance. Best of luck to you.

 

[archie]

Looking for help and advise.

Hi CaFireman,
I am now 65 and have always been in good health and although never an athlete, have always been active. I had Patellofemoral replacements in Canada for both knees, 1 year apart. I ended up having them revised with only a 10 day interval in between May 30 ‘22 and June 8, ‘22.Therefore 2 1/2 years and 1 1/2 years post original surgeries. Reasons stated for revision to a TKR were bilateral aseptic loosening and suspected joint infection.
Having now experienced both types of surgery, I just wanted to let you know there is little to no difference, so far, in pain and recovery. I experienced a bit more bruising with the TKR, but other than that no noticeable differences. Because you stated all 3 compartments were in bad shape, my experience would tell me to go for the TKR. It’s not fun to have to have a revision in a few years after original surgeries. Who wants to go through it twice.
However, this is obviously a personal decision to be arrived at after discussion with your surgeon.
I wish you lots of luck and a speedy recovery!

 

[MaryCat]

@CaFireman - I had my RTKR in Jan at Kerlan Jobe Institute in Santa Monica. They are part of Cedars Sinai but my procedure was done at St Johns Hospital- outpatient, Mako robot.

If SD and OC orthos don’t work out for you I’d give them a look. My doc was Jeffrey Zarin. Good luck!

 

[Frenchi]

@CaFireman

Hello CaFireman,

I am a 71 year old very active individual until my knees started to bother me and could not perform any sports activities without constant pain, and got to the point where enough was enough and decided on PKR. I was a spinning instructor until I was 68 years old (gym closed down due to the pandemic), went to the gym religiously 3 times a week minimum, did all kind of group classes, and in the winter when driving was kind of hazardous, and extreme cold, went down to my basement gym. Played racquetball and so on. The only thing I could not do is run (which I use to before I became bone on bone).

I have gone thru every imaginable procedure to avoid surgery, took Ibuprofen and used ICE when the knees were swollen, Daily Glucosamine for at least 30 years (that also helped me), knee strengthening, and had 3 stem cells procedures, 2 taking bone marrow, and the last one was adipose stem cell, using your body fat. The first one was about 8 years ago and lasted about 4 year (surprisingly), the second one about 2 years and the last one about a year, and that's when I decided to go thru PKR. Stem cell is definitely a temporary relief, and sometimes it might not work at all, I was lucky.

From what you are saying "damage to lateral and patellofemoral portions" beside the medial meniscus suggests that you have problems in two knee compartments which suggests that you are not a good candidate for PKR. I am no doctor, just did a lot of reading on that before deciding on having PKR on my knees (one on June 8th 2022 and the other in about 3 month) and was told that by my surgeon. So you should really check with whoever surgeon you will be using if you are a good candidate for PKR.

I am now 4 weeks after my PKR, able to walk comfortably, go on my spin bike (light spinning for 10-20 minute), go up the steps with no problem (avoiding the the down part for now), and do a lot of PT to get that knee back into shape without overdoing it. My surgeon used the ZUK Uni-Compartment Knee Replacement .

Hope you will make the right decision, and good luck.