PKR Bias against PKR

bdoates

new member
Joined
Apr 29, 2020
Messages
1
Age
69
Country
United States United States
Gender
Male
New member here. I'll be having PKR soon. L knee. Medial replacement.

60 years old. Very active. Play 3 hours of pickleball 6 days a week year round.

It seems to me some people here encourage Bonesmart members to avoid PKR. They indicate PKR doesn’t last and revision surgery to TKR is very often necessary shortly after PKR.

This is diametrically opposed to the experience of my friends (about 12 of them) who have had PKR. Most of my friends’ PKR knees are doing well 5+ years after the surgery.

In case my anecdotal information from my friends is not accurate, I’d like to hear from more members who have had long term success with PKR.

I would also like to hear statistics on failure/success ratios and a more comprehensive explanation as to why Bonesmart does not advocate PKR.

Thank you
 
Last edited by a moderator:
Hi! I had a PKR that was revised to TKR after two years, and those two years were rough. I feel that my mistake was using a "sports med" surgeon who did not do TKR. When he went in for my PKR, he said it was a lot worse than he expected. Had I been with a different surgeon, that surgeon may have changed course during surgery and done a TKR instead. It was a tough lesson to learn!
 
It seems to me some people here encourage Bonesmart members to avoid PKR. They indicate PKR doesn’t last and revision surgery to TKR is very often necessary shortly after PKR.
If you are hearing this from anyone here on BoneSmart it is because they have had experience. For some PKR does work, for others it doesn't. Your friends' anecdotal information is just that - their experience.
I would also like to hear statistics on failure/success ratios and a more comprehensive explanation as to why Bonesmart does not advocate PKR.
Let's be very clear, BoneSmart does not "encourage members to avoid PKR". Unfortunately the nature of this forum is that many of our members reach out due to problems. But for every member with a problem, there are thousands of members who experience good results and are off living life again. Each and every case is different. You and your surgeon will decide what is best for you given your own medical situation.

No one can predict how you will react and recover from PKR. I hope you see good results post PKR. Is your surgery date soon?
 
@bdoates

This is a wonderful forum.

Having said that, I too was surprised at how much the forum advisors discourage PKR's. But keep in mind that these are folks who personally had unfortunate experiences with PKR's and they are just sharing their experience.

Here's why I try not to let that get to me-

#1. I am doing amazing (knock on wood) thanks to robotics, an amazing surgeon, and diligent pre-hab
#2. Many with TKR's experience complications too, unfortunately.

Good luck and go with your gut after researching both.
 
Last edited:
Welcome! I have had 2 lateral PKRs and so far have been very pleased with them.
I want to retain as much bone and as many tendons as I can for as long as I can, so PKRs are my first choice. Also, a PKR can be replaced with a TKR, but once you have the TKR, you cannot get PKRs. And I have been told that you can have more than one PKR in the same knee (lateral and/or medial and/or kneecap) as the 3 compartments function separately. We are born with 3 knee compartments so changing to a uni/single knee TKR hasn't been my first choice. Neither implant is perfect. Medical knowledge and devices are changing constantly.
Glad to have your input.
 
Best wishes for your PKR @bdoates . I hope it serves you well. Mine lasted for 11 years before it failed, rather dramatically.

One thing to make sure of, though: make sure your surgeon is prepared to go ahead with a TKR instead, if he/she finds any evidence at all of osteoarthritis in the other compartments of your knee. Arthritis spreading to the other knee compartments is one of the main reasons why PKRs have to be revised to a TKR - and sometimes that can happen quite quickly.
We have had several people here on BoneSmart who had to have their PKRs revised to a TKR in less than a year because of that happening.

Do you have a surgery date yet?
 
My surgeon explained that the choice between a pkr and a tkr is to a large extent influenced by age.
The logic was that if you are an old fogie, like me, he was not willing to do a pkr. That's because the likely hood of the remaining half of the knee needing replacing, is in his experience much higher than for young whippersnappers, because the incipient arthritis will probably be ready to spread. Plus I'll be much older when he needs to do a revision, and less able to recover well.
I assume that old knees are damaged by old age. Younger knees might well be damaged by injury, one of mine was.
There are lots of considerations, that's why we rarely compare ourselves to others, there are so many factors to consider. In your case, what ages are your friends? 5 years isn't a long time in the life of a new knee, whether partial or whole.
I'd take the advice from your surgeon as to the best way to go.
Good luck
 
Last edited:
I had one surgeon recommend a PKR simply because of my age. I was 45 at the time, though I had already had 10 knee surgeries between both knees. Based on my previous knee history (7 surgeries on Righty, the bad one), I knew the damage was in all 3 compartments even though I was only 45. He didn't want to even hear of doing a TKR though. For this reason alone, I knew TKR was my only option and he wasn't going to touch me with a 10-foot pole.

I personally found 4 opinions from 4 different surgeons. It's truly amazing and frustrating how the opinions can vary. :yikes: I went with what I knew about my own knee, plus the advice of a Reconstruction/Revision specialist who had 20+ yrs of experience with the wacky, weird, and unusual. That is me and my knees unfortunately, so I trusted him most. He was the ONLY one who didn't want me suffering 10 more years simply because of my age.

You have to do what's best for you based on the knowledge you have. Everyone here wants a good outcome for you, so please know we support your decision regardless of what it is. :) Best of luck to you.
 
@Rockgirl4 That is absurd that any surgeon would suggest a PKR with damage in all components of your knee, regardless of age. That is exactly why it is important to consult with more than 1 OS. I too consulted with 4. The Bonesmart conference speakers yesterday covered some good information regarding PKR vs. TKR and you clearly would not be a candidate for PKR based on their discussion. @bdoates Hopefully, the Bonesmart forum advisors will replace the 2019 videos on this website with yesterday's 2020 conference videos soon and, if you get a chance, you should listen to the information they provide PKR vs. TKR. I found it very interesting.
 
The conference videos will be added to our library of conference material, but it takes 6-8 weeks for the editing and uploading to be done. @partialfixFeb ... I'm glad you felt the information presented there was helpful.
 
@partialfixFeb That's why I left his office and sat in my car texting my husband for 30 minutes. The guy told me so much bad information that I could see through easily. I wanted to tell him I'm not just a pretty face and have a Master's Degree in Geophysics and know my knee better than he did.....but I quickly figured out he was a 70 yr old surgeon, stuck in his ways, and half batty. I kid you not!! The guy actually told me my meniscus must have grown back after 15 yrs, and it's "pain fibers" were the source of my medial femoral pain, instead of the bone on bone pain I knew was there. I had just had an ACI attempted on that area the year before, and I was positive it had failed. :headbang: :tantrum: :yikes: I really just wanted SOMEONE to sue him for malpractice!!!!!!

I only went because I told myself I needed a variety of opinions to get all my info and feel good about my OWN decision to do a TKR. :) I went with the Revision specialist anyway and knew I probably would before I even saw the other 3 opinions. :)
 
Last edited:
Hmmmm. I had PKR 3 weeks ago. Had been considering TKR after two other “ top” surgeons in my area said I needed it. One of them practically invented TKR and may have done more of them than anyone in the world. I had misgivings because he is older and also, did not like the way the practice communicates with patients. Then went to a third dr who was head of ortho at major teaching univ in our city. Others were pleased that I knew and he had great and many recent Google reviews. Might sound silly, but I trust those more than the ones the hospitals show in the bios. When I went for appt and they looked at X-rays, he suggested I’d prob be good candidate for PKR. He said he expected good longevity from the procedure. He also said that on day of surgery I’d be listed as PKR with possible TKR. It actually said that on the board behind me in pre-op. They don’t decide 100 percent until they are doing the procedure and are ready to do either. He does 250 PKR ‘s a year.
Must admit I didn’t do as much due diligence as some ppl on here. I trust my gut.I hope it will work out. I’m three weeks out from surgery.
My knee looks good. Using multi modal pain control. Ice packs, Gabapentin, Tylenol, Tramadol melatonin to help with sleep. They don’t like ice machines. Frost bite worries. My main problem is my ankle and Achilles area. The boot they put your foot in can irritate and injure that area it seems. So, trying to let it rest and avoid aggressive pt.
 
Last edited by a moderator:
My main problem is my ankle and Achilles area. The boot they put your foot in can irritate and injure that area it seems.
Not all surgeons use a boot. In fact, I haven't seen a boot used in any of the knee replacement videos on Youtube.

They don’t like ice machines. Frost bite worries.
You can take precautions against frost bite, by making sure that you have some soft material between the icing medium and your skin.
Have you read this article? Ice to control pain and swelling
 
My main problem is my ankle and Achilles area. The boot they put your foot in can irritate and injure that area it seems. So, trying to let it rest and avoid aggressive pt.
Do you mean a boot used during surgery, or afterwards?

This is all I could find, for use during surgery:
https://www.steris.com/healthcare/p...ccessories/disposable-sterile-tkr-boot-liners

https://www.steris.com/healthcare/products/surgical-table-accessories/leg-supports/tkr-positioner

Not a boot at all, but a device for positioning the foot on the theatre table.

I don't see how that could damage the ankle, but rough handling during the surgery (the knee is bent and extended several times) might do so.
 
@bdoates - This is your thread and we haven't heard from you again. How are you getting on and do you have a date for your surgery?
We'd love to hear how you are.
 

BoneSmart #1 Best Blog

Staff online

Forum statistics

Threads
65,180
Messages
1,597,058
BoneSmarties
39,364
Latest member
All2Gd88
Recent bookmarks
0
Back
Top Bottom