OK - here goes. Hope at least a few of you will bear with this long post.
I've been lurking here for a while and am beyond grateful to all of you for what you've shared about your experiences and your advice to one another. Here's my story - any and all advice will be extremely appreciative of any advice or suggestions.
I'm 59 years old. 5'6", 160 lbs. And I love to play baseball. I mean - really love to play.
At age 40, I was diagnosed with severe osteochondral arthritis in my right knee. At that time I underwent an osteochondral autograft (mosaicplasty). It worked incredibly well and I was back to playing baseball within about 15 months.
At age 54, the other (left) knee became unbearable, and my surgeon said the defect was too big for mosaicplasty. So I had an osteochondral allograft (thanks to the kindheartedness of some grief-stricken family to whom I will always be grateful). That didn't work as well - I suspect based on my surgeon's comments that the graft didn't knit well with my own bone and the interface went, in his words, fibrous. It took a couple of years, but eventually I returned to the ballfield, although my performance is greatly degraded.
(BTW I have also done Synvisc, PRP, and stem cells - all with mediocre results. Recently I've started cortizone injections every two months which help temporarily. When I play I take a hydrocodone before games which also helps.)
Five years on, with continued pain which has now begun to include hip-related issues and nerve pain, along with increasingly bowed legs, I thought it might be time to face the inevitable. I had learned from prior doctor's visits that I might be a good candidate for PKR as my arthritis appears to be only in the medial compartments on both legs. I felt that was good news as I hear they feel more natural, and preserve the cruciate ligaments which I imagine improves stability.
I sought out the best local surgeon I could find for that procedure. It's now scheduled for September 18th - both at the same time because A) he felt that I'd have a good outcome given my level of fitness and strength of ligaments and B) I'd much prefer to avoid two procedures and rehabs. (FWIW he only does Oxford UKRs).
As the date approaches I'm getting cold feet. While my pain is pretty much constant, it's not unbearable. Daily activities are tolerable, though I can't walk my dogs anymore because the destabilization when they pull on the leashes causes me a lot of pain. I am still able to play ball (albeit only with elaborate pre- and post-game routines). A couple of guys on my team have had replacements (TKRs) and seem to be able to play ok, but I know that's not advisable and it's totally possible that I won't be able to play after replacements, which would be pretty devastating for me.
I'm also concerned about the depth of my auto/allografts being an issue in the PKR process. In my one and only consultation with my surgeon back in May, he was kind of cavalier (even though he had my x-rays and MRIs close at hand he chose not to consult them) and just said "Well, if we get in there and it's a problem we'll just do a TKR instead."
I also read that the cementless Oxford UKR had more promising results for active people, but when I contacted his office about that possibility I was advised those are not FDA approved in the US so it's not an option for me.
I'm also considering radiofrequency nerve ablation as a pallative procedure to further extend my baseball playing and defer the inevitable, but haven't been able to find much in the way of unbiased reviews of that procedure.
Given my apprehension I contacted my surgeon's office to schedule a pre-op consultation. (Frankly I was a little surprised that wasn't standard operating procedure, especially since my initial consultation was 4 months before my surgery date.) Today I heard that I *might* be able to get in to see one of his physician assistants before my surgery date, but that seeing the surgeon himself would be impossible given his schedule. Naturally I declined the appointment with the PA and asked that they recheck with the surgeon to see if he could squeeze me in.
Anyway, with all that, I'm currently stuck firmly between postponing and just trying the nerve ablation to see if it would let me play for a while longer, and biting the bullet and just going through with the surgery. Any advice appreciated. A few specific questions in case any of you have any insight:
Is my concern regarding the depth of my auto/allografts a legitimate one? Has anyone had experience with a PKR after auto/allograft?
How worried should I be about the recent development of bowleggedness and hip/nerve involvement?
Do any of you have experience with nerve ablation for osteoarthritis pain relief that you could share?
As I consider postponing replacement, should I be concerned about further erosion of knee joints that might make future replacement surgery more difficult?
While I've seen some success stories regarding return to somewhat vigorous sports activities following TKRs, any testimonials out there re PKRs that might buoy my spirits?
Can anyone confirm or refute the assertion that cementless PKR truly isn't available in the US?
Thanks to any of you that made it this far. And thanks for being a great community and supportive resource.
I've been lurking here for a while and am beyond grateful to all of you for what you've shared about your experiences and your advice to one another. Here's my story - any and all advice will be extremely appreciative of any advice or suggestions.
I'm 59 years old. 5'6", 160 lbs. And I love to play baseball. I mean - really love to play.
At age 40, I was diagnosed with severe osteochondral arthritis in my right knee. At that time I underwent an osteochondral autograft (mosaicplasty). It worked incredibly well and I was back to playing baseball within about 15 months.
At age 54, the other (left) knee became unbearable, and my surgeon said the defect was too big for mosaicplasty. So I had an osteochondral allograft (thanks to the kindheartedness of some grief-stricken family to whom I will always be grateful). That didn't work as well - I suspect based on my surgeon's comments that the graft didn't knit well with my own bone and the interface went, in his words, fibrous. It took a couple of years, but eventually I returned to the ballfield, although my performance is greatly degraded.
(BTW I have also done Synvisc, PRP, and stem cells - all with mediocre results. Recently I've started cortizone injections every two months which help temporarily. When I play I take a hydrocodone before games which also helps.)
Five years on, with continued pain which has now begun to include hip-related issues and nerve pain, along with increasingly bowed legs, I thought it might be time to face the inevitable. I had learned from prior doctor's visits that I might be a good candidate for PKR as my arthritis appears to be only in the medial compartments on both legs. I felt that was good news as I hear they feel more natural, and preserve the cruciate ligaments which I imagine improves stability.
I sought out the best local surgeon I could find for that procedure. It's now scheduled for September 18th - both at the same time because A) he felt that I'd have a good outcome given my level of fitness and strength of ligaments and B) I'd much prefer to avoid two procedures and rehabs. (FWIW he only does Oxford UKRs).
As the date approaches I'm getting cold feet. While my pain is pretty much constant, it's not unbearable. Daily activities are tolerable, though I can't walk my dogs anymore because the destabilization when they pull on the leashes causes me a lot of pain. I am still able to play ball (albeit only with elaborate pre- and post-game routines). A couple of guys on my team have had replacements (TKRs) and seem to be able to play ok, but I know that's not advisable and it's totally possible that I won't be able to play after replacements, which would be pretty devastating for me.
I'm also concerned about the depth of my auto/allografts being an issue in the PKR process. In my one and only consultation with my surgeon back in May, he was kind of cavalier (even though he had my x-rays and MRIs close at hand he chose not to consult them) and just said "Well, if we get in there and it's a problem we'll just do a TKR instead."
I also read that the cementless Oxford UKR had more promising results for active people, but when I contacted his office about that possibility I was advised those are not FDA approved in the US so it's not an option for me.
I'm also considering radiofrequency nerve ablation as a pallative procedure to further extend my baseball playing and defer the inevitable, but haven't been able to find much in the way of unbiased reviews of that procedure.
Given my apprehension I contacted my surgeon's office to schedule a pre-op consultation. (Frankly I was a little surprised that wasn't standard operating procedure, especially since my initial consultation was 4 months before my surgery date.) Today I heard that I *might* be able to get in to see one of his physician assistants before my surgery date, but that seeing the surgeon himself would be impossible given his schedule. Naturally I declined the appointment with the PA and asked that they recheck with the surgeon to see if he could squeeze me in.
Anyway, with all that, I'm currently stuck firmly between postponing and just trying the nerve ablation to see if it would let me play for a while longer, and biting the bullet and just going through with the surgery. Any advice appreciated. A few specific questions in case any of you have any insight:
Is my concern regarding the depth of my auto/allografts a legitimate one? Has anyone had experience with a PKR after auto/allograft?
How worried should I be about the recent development of bowleggedness and hip/nerve involvement?
Do any of you have experience with nerve ablation for osteoarthritis pain relief that you could share?
As I consider postponing replacement, should I be concerned about further erosion of knee joints that might make future replacement surgery more difficult?
While I've seen some success stories regarding return to somewhat vigorous sports activities following TKRs, any testimonials out there re PKRs that might buoy my spirits?
Can anyone confirm or refute the assertion that cementless PKR truly isn't available in the US?
Thanks to any of you that made it this far. And thanks for being a great community and supportive resource.