Meniscus, OA, Osteotomy, Transplant?

[maryo52]

My mom had a PKR that lasted a long time and enabled her to play tennis until her COPD (thank you Chesterfield cigarettes!) put a stop to it at age 82. Hers was done by Gerard Engh at the Anderson Clinic in Virginia, a leading developer of PKR. Are you anywhere near the Anderson Clinic?

When I was seeking a second opinion on my knee, my doctor said get two second opinions. Fortunately the two second opinions were alike. But what if the opinions are different? I would've gotten still another opinion. I know you are trying to navigate a path that salvages your treasured activities. It's not like you're in your 60s or beyond when the effects of aging are really felt and one has to accept some decline in function.

If only there was some really good way to re-establish a healthy meniscus!

 

[CAdesgirl]

As someone who had an osteotomy in 2013 and a TKR 3 1/2 weeks ago, I can tell you that the osteotomy recovery was terribly painful for many months. I had my osteotomy done in conjunction with cartilage replacement in order to put off having a knee replacement due to having the cartilage under my kneecap removed two years prior.

I regret the decision to put off having the TKR because of the fear of having a revision down the road. I ended up having to have the TKR a little over 5 years after the osteotomy anyway.

 

[maryo52]

. . . and as much as any of us doesn't want to have revision, I just had one and it was a piece of cake. It is more "constrained," meaning that the hardware picks up more of the load. But so far it's a better knee than I had. I am also remembering a friend from 1978 who was maybe 30 at the time and had had a hip replacement (due to injury). At the time he was told to limit his activities (which he didn't) lest he need a revision, which would be his last option. However, here it is 40 years later and I'm told that he gets around just fine.

 

[Meniscus]

As someone who had an osteotomy in 2013 and a TKR 3 1/2 weeks ago, I can tell you that the osteotomy recovery was terribly painful for many months. I had my osteotomy done in conjunction with cartilage replacement in order to put off having a knee replacement due to having the cartilage under my kneecap removed two years prior.

I regret the decision to put off having the TKR because of the fear of having a revision down the road. I ended up having to have the TKR a little over 5 years after the osteotomy anyway.

Thanks for the comments. But after the osteotomy healed how did you walk and move around?

Taking s look at your profile it sounds like the osteotomy didn’t heal properly. I’m sorry if that was the case.

How are you moving about post TKR?

 

[Celle]

An osteotomy is rarely a long-tern solution and recovery from one is very painful. I would never have considered having one.
It's much better to go straight to a TKR, which can last for 30+ years, instead of having a short-term, painful "fix".

 

[NavyGunns]

@Meniscus, when I had my last scope done on my knee over 20 yrs ago I was told then that my next procedure would be a TKR. When I met with my new OS a year ago, he took one look at my X-ray and said I was a perfect candidate for PKR. I asked why not a TKR. His response made a lot of sense. I’m relatively young (59), my knee is healthy other than the lateral compartment, I’m physically active and healthy (work out regularly). I still pushed him on why a PKR. His last comments sold me. He looked me straight in the eye and said “If it were my knee, I’d go with the PKR first, why replace what isn’t damaged or broke?” We agreed that if he did find issues once he got the knee opened up he would just go with the TKR. Based on my recovery and the fact that I do everything now (at 9 months) that I did prior to my PKR and have absolutely no pain at all and that I can stand and walk on concrete or other hard surfaces without any pain (which I couldn’t do before), I’m expecting long-term success with this new knee. If situations down the road should change requiring a revision, so be it. I know several people who had TKR only to need a revision several years later so I don’t see much difference. To me, it made more sense to preserve as much of my natural knee as possible.

In the end, your decision will be a personal one that only you can make. Nothing any of us say is 100% guaranteed, they are only based on our personal experience and some general statistics, but that doesn’t mean your experience will be the same. You assess what you’ve been told, what you’ve read, and ultimately what you feel and then decide. My last recommendation, once you decide, DON’T look back! The minute you begin to question your decision, you’ll start seconds guessing everything and you’ll be miserable! Commit to it and move forward with confidence!

 

[CAdesgirl]

The osteotomy healed beautifully. I had an xray at 12 months postop that showed the bone was healed. There were complications with the wound that resulted in infection but I didn't know that until 6 months after the surgery. In my case, I found that 10 weeks of being toe-touch only was brutal and walking on it even after I was cleared at 12 weeks was very painful.

In my case, I knew it was a temporary fix. I heard that it would put off a tkr for 5-10 years and I was so frightened of having a knee replacement, I reacted out of fear. Fear of having artificial parts, fear of having to have a revision... Maybe if it had lasted longer, I'd feel differently.

A month out from my tkr, I'm at a place that took me 3-4 months to get to with the osteotomy as far as mobility and pain.

 

[Meniscus]

I have a small update.

First of all, I want to thank everyone who has been posting on this thread. I really appreciate it.

I got my knee scoped. Luckily, the recovery is better than the first time I had my knee scoped. Seems like medicine has advanced during the last 30 years!

I didn’t get a chance to speak with the doctor, it had been a long day and I was the last surgery. I’ll meet with him and get some more information. But my parents said that the doctor indicated I would need a TKR in maybe 3 or 4 years. Which makes me wonder if both compartments of my knee are bad. I won’t think about it too much, it is what it is.

What I am happy about is that he has good info on the true condition of my knee so we can make an informed decision. He said that usually he would do a knee clean up and osteotomy at the same time but felt it would be better if we separated the procedures.

I’ll update more as I know. Even though I am asking for more than I can offer back to the community, I hope if I document this process maybe it will help someone down the road.

Thanks.

 

[Meniscus]

The osteotomy healed beautifully. I had an xray at 12 months postop that showed the bone was healed. There were complications with the wound that resulted in infection but I didn't know that until 6 months after the surgery. In my case, I found that 10 weeks of being toe-touch only was brutal and walking on it even after I was cleared at 12 weeks was very painful.

In my case, I knew it was a temporary fix. I heard that it would put off a tkr for 5-10 years and I was so frightened of having a knee replacement, I reacted out of fear. Fear of having artificial parts, fear of having to have a revision... Maybe if it had lasted longer, I'd feel differently.

A month out from my tkr, I'm at a place that took me 3-4 months to get to with the osteotomy as far as mobility and pain.

Now that you have done the TKR, are there any lingering issues from the osteotomy? It sounds like you are happy with the TKR. But are you suffering from any osteotomy specific issues? Thanks.

 

[CAdesgirl]

I feel like my gait was never the same after those surgeries. Because I had the muscle flap surgery 5 months later, when I was still healing, I'm not sure why that was the case. Other than that, I would say that I don't think about the osteotomy unless I'm wearing shorts because it looks like I have two knees on that leg.

 

[Celle]

But my parents said that the doctor indicated I would need a TKR in maybe 3 or 4 years. Which makes me wonder if both compartments of my knee are bad. I won’t think about it too much, it is what it is.

What I am happy about is that he has good info on the true condition of my knee so we can make an informed decision. He said that usually he would do a knee clean up and osteotomy at the same time but felt it would be better if we separated the procedures.

I hope that you'll get more information when you see your surgeon.

At 46, you are not too young to have a knee replacement, because those replacements can last for 30+ years. There's no need to fear a revision and you are not "too young" to have one.

Don't consider having an osteotomy. Recovery from one is very painful and they often prove to be only a temporary fix, so you'd need a knee replacement only a few years later. Why have two operations, when one will fix your knee for many years?

 

[Meniscus]

Small update.

Met with my doctor and he thinks the osteotomy isn’t worth doing. Since he got a good look at my knee, he thinks I should plan on getting a TKR down the road.

He and I agreed that technology is constantly improving. So every day I can delay a TKR the better.

I’m not in any regular pain. Once in a while I’ll notice something. Going down stairs isn’t fun. But post surgery I can go up stairs like a champ now.

His plan is to treat with cortisone shots should I feel too much pain.

In the meantime, I really want to find a small discreet unloader brace but they are all big.

Any suggestions?

Thanks.

 

[Celle]

I'm glad your surgeon has decided that doing an osteotomy wouldn't be appropriate. He sounds like a careful surgeon.

Since you currently don't have a lot of pain, it makes sense to try the cortisone shots before progressing to a knee replacement.
When they prove ineffective will be the time to have that TKR.

Usually, the first few cortisone shots work well, but their effect seems to decrease as time goes by. You'll know then that it's time to proceed with surgery.

 

[kneeper]

I think all the unloaders are fairly large but I had a decent DonJoy custom fitted that I could just fit under my slacks if they were a bit loose. It bought me a little time. My complaint was getting it in the right spot and to stay in place more than a couple of hours. :(