Partial Knee Replacement or not?

[calfam04]

I am a 62-year-old very active female who has had knee pain since my 30's. I raced and rode dirt bike motorcycles for about 10 years, played racquetball, did step aerobics, and many other physical activities.

After a while, I learned what I needed to avoid to keep my knee from swelling and become stiff and painful. I could not sit on airplanes without unbending my leg often (aisle seat always). I built raised bed garden boxes so I could work without kneeling. I wore neoprene sleeves with a hole in the kneecap. I tried cortisone and Synvisc.

My ortho who did my thumb surgeries said I was probably not bad enough to warrant TKR so I have suffered on and tried to deal with swelling after I hike or golf and not being able to do any sort of squatting or repetitive movements like normal bicycling.

I recently got a second opinion for a sports med doctor my friend saw and recommended. He ordered a second MRI for my right knee, and I have grade 4 loss of cartilage of the patella and the femur surface below it. My ligaments and other areas look to be in decent shape. I may have small meniscal tears on the outside of each knee but I know the tracking of the patella is what causes my pain.

I want to be able to squat and do lunges at the gym, play golf without suffering afterwards and hike up and down inclines without pain. This new doctor seemed to think that I may be in the small minority of folks who are excellent candidates for a partial knee replacement of the kneecap.

How much does this procedure improve one's mobility? I would like to hear those of you that have been through this procedure and can describe the recovery and their outcome. Thanks.

 

[Jockette]

Hi and Welcome to Bonesmart!

I had a Patellofemoral partial replacement, it will be 2 years in March. While some have good outcomes, I have not. I don’t know what went wrong with my surgery but I have lots more discomfort and limitations now than I did before surgery.

I probably didn’t need surgery, I was told I was not bone on bone, and I didn’t have any swelling or the extent if the pain you mentioned.

It never occurred to me to get more than one opinion, , I trusted the first doctor I saw. I am very sorry I had it done and I am in the process of seeking second opinions and not looking forward to going through a revision.

Partials also take the same recovery time as a total, an average of a year, not the quicker recovery that they are said to be.

 

[Mutti3]

I want to be able to squat and do lunges at the gym, play golf without suffering afterwards and hike up and down inclines without pain.

I can do all except I don’t play golf! I can even sit on my heels! I had an excellent recovery with a total, even though I begged my OS for a partial. My OS doesn’t do them, because same recovery, cutting into bone, and doesn’t last. I only had medial side of knee Bone on bone.

 

[ebungalow]

@calfam04

My OS told me that one of my two replaced knees might be a candidate for a partial replacement. It was just information from him, he didn’t seem to push one way or the other.

I’d been reading BoneSmart for awhile by that time, and I don’t believe I’d personally opt for a partial replacement when I could get a total replacement.

Same pain, recovery time, etc. but with the possibility of needing a revision to a total replacement at some point.

There are some people who’ve been very pleased and very successful with their partial replacements. I’m so happy for them.

I wanted to get a total so that I’d hopefully be done with the joint. But I’ve had other joints replaced too, so there is that - I want to be done done!

I can do anything I care to do with my new joints (exercise, crouch, etc). Well, not with my newest knee yet, but I’m getting there.

Just my two cents.

 

[SusieShoes]

Partials can work for some people. The results are comparable to a TKR; both do the same job of restoring function to a compromised knee. The reason many surgeons hesitate about partial replacement is that very often the other compartments of the knee end up with arthritis anyway, after not many years, necessitating revision to a total replacement. Your surgeon thinks a partial is best for you, which is important to consider.

If you go to the Recovery Area for knees, you can find threads with [Partial KR] as the prefix. Those are people recovering from partial replacements and you can read their experiences. @NavyGunns and @bowhunter8 have both had partial replacements, posted post-op threads, and are happy with their results.

Good results mean near original knee mobility. Running as daily exercise is possible but not encouraged because of wear and tear on the prosthesis. People do return to squats, biking, soccer, swimming, riding horses and motorcycles, and definitely golf.

 

[LLL50]

calfam04, I am in the same situation as you. I met with my Dr. yesterday and both of my knee joints look healthy but I have grade 4 arthritis under my patella and on my trochlear groove. I am opting for a partial only because my joint is healthy. All of my pain/issues are limited to my patellofemoral area. I, too am very active and avoid things that irritate my knee. I want to be active again. I was 100% certain that I wanted the PKR and now after reading some stories on here, I'm starting to second guess myself and my decision. My surgeon is very picky about who he choose for this and he does not routinely perform this surgery although he has done a lot of them with great success. When is your surgery?

 

[jary]

I too am very active even at 73. I hike(not now) because of the knee. Kayak, ATV in summer and ski in winter. Jumped off a 6ft cliff a year & a half ago, boulder climbing and wrecked my knee. The an ATV accident injuring it again Orthopedist is sure that the partial is going to put me back in the game. Same story as yours says he has had great success with this new procedure of the AVATAR knee it is really just a thin piece of metal that caps the surface of the knee where it usually makes contact. Surgery is an hour & half under local anesthesia and a spinal. Home the same day walking and doing stairs the same day. Recovery is using a CPM machine at night and also exercise to keep the new joint mobile. I figure where I am at is a dead end road and I want to be on the race track again. I feel badly for you having this happen at such a young age. Life is short and you have to live it to the fullest. Have to weigh the choices and do allot of research deciding what is best for you. Surgeon says this will last my bones are healthy and strong especially for my age. So with that said stay in touch and let me know how you are doing. Thanks for the reply.

 

[bill 3/20]

I had a partial 2 years ago. My repaired knee now functions very well. I can run up to 6 miles, do squats, lunges, etc. I could walk without a walker immediately after surgery. I didn't really need a cane. Even one week post op, I could fake being normal for a very short period, and could do light tasks around the house and cook simple meals. My limitations are more in degree than absolute. For example, I find it uncomfortable to squat for an extended period; I used to run marathons, now 6 miles is my max before the knee becomes sensitive; in doing single-leg extensions at the gym, I am limited to 50 pounds, so my knee is pretty normal. Even though I have had good results, it took over a year to regain full function, and I worked (and continue working) very hard at rehab/maintenance. I used to golf, but don't anymore, but I have no doubt that I could golf carrying my own bag and walk 18 holes if I wanted to.
Now, my doctor is recommending that I do the other knee. I will probably do it, but I am reluctant just because the rehab was pretty uncomfortable and left me with diminished function for at least 9 months. My repaired knee still wakes me at night sometimes. It isn't like having a real knee.

 

[jary]

Bill, Thanks so much for the reply. Glad that is behind you and you have gained some relief.
Did you have to have PT or exercise at home. Did the dr. put you on the CPM machine 12 hrs nights and 8 hrs daily? If so for how long. What procedure was done for the partial knee?
Hope to hear from you.
jary

 

[bill 3/20]

My doctor used Makoplasty - it's a robotic/computer procedure and is supposed to ensure proper alignment. It was recommended to me by a friend in the local tri club who knew people who had returned to triathalon post replacement. I did not use a CPM machine. My doctor said those are no longer recommended. I looked it up, and it seems like what my surgeon said is consistent with modern medicine. I did get an ice machine, and iced like a demon; it helped with both swelling and pain. I used the ice machine for 3 months. I started PT one week post op. My PT was pretty gentle, but she also knew my goal was to return to running, so she had me doing strength exercises early in the process. I actually started PT a couple of months pre op to build strength. For me building strength before surgery felt helpful.