Dec. 27th Left Lateral PKR

[RedRider]

Wow, this is quite an informative thread. Mcirish, a couple questions/comments for you (maybe I missed them in the thread so I apologize).

Hardware: What did you decide on and what is your OS most comfortable with?

Patellarfemoral compartment: Did you OS comment on this? When I spoke with mine, he gave me the impression that there's a preference to do both a lateral or medial resurfacing in conjunction with the patellafemoral (a bicompartmental) since the latter is typically the next compartment to fail. It appears it's somewhat of a preventative maintainence procedure to do while they're in there if there's any question about that compartment.

Monolithic vs modular (ie one piece or two piece hardware): Following up with the second question, was there any talk of a preference your OS has between the two. You may have not gotten this far.

My MD told me 2 weeks was a perfectly obtainable goal as well, you should shoot for it.

I'm excited for you, I think this is going to improve your quality of life on a daily basis. Yeah, you could wait around for a TKR down the road, but my surgeon said it best: "I could tell you to come back in 20 years but 20 years of inactivity could get you heart disease just as well".

Good luck, keep us posted!

 

[mcirish]

I was ACL-Deficient, and I also had a Donjoy brace---then, later on, I also had the neoprene sleeves in an effort to stave off the inevitable---now---no braces; my Baker's Cyst has even disappeared, as my knees are very, very stable now.

Despite my "textbook perfect" recovery there is no way in HELL I couldve gone back to work at 2 weeks out--mostly because I was flat EXHAUSTED every afternoon. Even though I was off opiates and able to meet most of my ADLs and certainly could have drived. (Driven? Drove?)

I was spending probably 18 hours of every day icing and elevating and I could only sleep 4 hours at a stretch on my best nights. I could not have tolerated sitting, driving, standing or walking more than 15-25 minutes at a time, punctuated by HOURS of reclining while icing and elevating.

I am now a few days shy of six weeks out and thinking I can try a few simulated work days at HOME and see how that goes--I'll have to chain myself to my desk and computer, jump up at intervals and stand for 15 minutes, and get extremely aggravated about various things, pretend I am coping with very difficult people, and do all of this from 4PM until midnight. With poor to nonexistent opportunities to ice and elevate. And then go for a 20 minute drive and dodge the deer. Until I think I can really cope with those challenges, my butt is staying at home!

Just sayin'.

Well, I am going to have to fake it then because I can't be out 4 weeks let alone 6 weeks. If I don't do my job, the company's revenue stream starts shrinking, plain and simple. The first week or two back at work I can lounge a bit. I have my own office, close the door, can put my leg up and take breaks when ever I need to, even power nap. My cold machine can sit on the floor. My commute is 20 mins so that's not a problem and if I feel like going home early, done deal, np. I mean, as I start getting close to the 14 day mark, I will know how much I will be capable of doing and what my limits are. I can do this jeano!

 

[kneeper]

Good to hear you can make some accommodations at work during the day.

 

[mcirish]

Wow, this is quite an informative thread. Mcirish, a couple questions/comments for you (maybe I missed them in the thread so I apologize).

Hardware: What did you decide on and what is your OS most comfortable with?

Patellarfemoral compartment: Did you OS comment on this? When I spoke with mine, he gave me the impression that there's a preference to do both a lateral or medial resurfacing in conjunction with the patellafemoral (a bicompartmental) since the latter is typically the next compartment to fail. It appears it's somewhat of a preventative maintainence procedure to do while they're in there if there's any question about that compartment.

Monolithic vs modular (ie one piece or two piece hardware): Following up with the second question, was there any talk of a preference your OS has between the two. You may have not gotten this far.

My MD told me 2 weeks was a perfectly obtainable goal as well, you should shoot for it.

I'm excited for you, I think this is going to improve your quality of life on a daily basis. Yeah, you could wait around for a TKR down the road, but my surgeon said it best: "I could tell you to come back in 20 years but 20 years of inactivity could get you heart disease just as well".

Good luck, keep us posted!

As I mentioned earlier in the thread, I selected my doctor based on the hardware first, then his experience and resume. Sounds kind of strange, but I need to qualify that statement by saying I wasn't going to let some "hack" work on my knee. The OS for me had to be one of the best and use the Smith Nephew hardware. Not to say it is "the best". I personally think their oxinium technology is the best, but it's definitely debatable.

Also, I don't think any OS out there is going to give you an "option" for hardware. The will only "be comfortable" with what they use 24/7. If an OS did give me an option to pick from several different makers I would be out the door. No way I would trust that guy.

One thing of note, I keep hearing people say that "your doctor will tell you what's best for you and what he will use"....I just can't go there. Most of the doctors are don't have your best interests in mind. Do your own research, talk to friends or people in forums like this to get opinions. Hit google and do searches for "oxford recall" or "stryker recall". Try to sift through all the junk and noise. It's extra work, but at least you'll know things that will help you make a better decision....hopefully

No, the bi-compartmental option was never brought up. I am essentially asymptomatic in the other 2 compartments. Take that back. On the rarest occasion, I will have an aching pain at the inside edge of my medial compartment which I discussed with Dr. Sisto. He said that when he opens me up he is going to look at everything first. If he needs to and time/conditions allow it, he will "do some work" to the medial compartment, which means debridement, microfracture and possibly paste grafting. Of course, if he sees anything extensive he may have to perform a second surgery, but he said it all depends on what he sees.

Another concern that I have is that once my leg and knee joint is realigned into the proper position will that possibly have a negative effect on my knee??? Problem is that there has been a valgus deformity there to some degree for 20-30 years. The knee got comfortable being loose and tracking incorrectly. New grooves were worn in there. Maybe this is why certain people who get partials need a full soon after? I guess I am willing to take that risk.

 

[mcirish]

Good to hear you can make some accommodations at work during the day.

That was always the plan...in my mind, maybe I just did not express it on the thread. I know rest, nutrition and time is required here. I will probably have to over do it at times, but after 8 surgeries (and plenty of mistakes early on) I know how to be a good patient knowing I will live to fight another day.

 

[skigirl]

McIrish, you remind me of myself six years ago when I first began looking at a tkr. I wanted a partial because I believed I would be more athletic and have better rom (range of motion). I was driven and scared---I am a ski instructor and artist, so both activities require the use of my knees.

I also had a vagus deformity in my knee--which developed because of the arthritis and the degeneration in my knee. I had had an ACL and several meniscus types of surgery--trimming mostly! But the thought of a tkr brought an old lady to my mind---I was not going to spend the rest of my life walking a few miles a day. I was 65 when it became obvious to me that my knee was deteriorating. I did not have terrible pain, but I could feel my knee wobble when i was skiing. I got a Don Joy unloader brace but it was minimally helpful.

I finally went to the "knee guy" in our area---I live in a small town in Montana---I brought my husband, who is a psychiatrist---and we spoke to the OS for about an hour. Somehow I had the idea that they took off the knee and put metal in its place--instead he showed me how they take small amounts of bone and he showed me the replacement he uses---a Stryker Triathelon. I almost fainted when he showed me the "prosthesis" Yikes.

I am pretty athletic---play soccer, hike, bike about 100 miles a week. in the winter, ski, skate cross country, go snowshoeing with a group on Saturday--we hike about 10 miles. To say that I was nervous is a joke. I was full of bluster too--- I was only down for three days with the ACL--I listened on the forum to people's recovery, but I was sure I would sail through as I had done so many other times!! I am very strong and a "good healer"

Jo cautioned me--but I was pretty short with her---she had no idea of how strong and athletic I am. Because of my fear, I could not see anything but Wonder Woman rising from the table and walking down the hall back to my room. My doc told me I could play golf in two or three weeks---so I planned a hike with friends for three weeks out---how much harder is that than golf? I told me bike group--we ride 20 miles every tues and thursday that I would miss one or two weeks.

On the day of surgery, I was a mess--so afraid---what would my life be like after I got my "fake knee" which I basically thought of as an amputation? I woke up in recovery and was very surprised to be in pain. But, they gave me "something" and I drifted off again. When I got back to my room, I got up about two hours after surgery to go to the bathroom. I was surprised that my leg was pretty solid under me. I had to crawl over a "CPM" machine to get out of bed and after bathroom I decided to change my clothing as I did not want to wear a hospital gown. When the nurse came in--she was pretty abrupt---who changed your clothes? I said, that I did. She then told me I was supposed to ring the bell for a nurse when i wanted to get up---How do they expect people to know this stuff? The last time I stayed overnight in a hospital I had a baby!!

They were mad at me for strolling around without a walker (ugh, no way was I using a walker) and I left the next day and went home where I was much more comfortable. I took percoset (5/325) pretty much around the clock for the first week. Then, every six hours in the second week--by the third week, I was taking tramadol. I drove at two weeks--but I live in a small town and drive 5 miles to pt.

I was full of water and vinegar--but I was completely SHOCKED at how weak I was. I was exhausted a lot of the time. At two weeks, I could walk a mile or so in the woods with the dog. I carried a crutch with me--and I did have a few spectacular falls---my foot would drag and I tripped over roots. I tried to push hard with recovery--but every time I did my knee would swell. and swell.

Finally, I gave in and stayed in bed for three days--I was shocked at how the swelling went down. and I realized that I was not going to bounce back as fast as I thought I would. Here are some of my dates: golf---3 months- (when I spoke to my OS, he said oh--I thought you could try putting at 3 weeks). I went on a 20 mile bike ride at 8 weeks. In fact, I felt pretty good at 8 weeks. But that was the start of my feeling like myself. I skied at 6 months--frankly I ski better now that my knee is not rolling over all the time. I hiked 10 miles at about 8 or 9 weeks--but I was more than fatigued when I got home.

With my second knee---(a year later) I did not push at all. I laid on the couch for two weeks with my knee propped up with three pillows. By the end of three weeks almost all of the swelling was gone and I began to move more. That knee healed easier and better than the left one. I never think of it, but the left one is not as good. My rom is 150 in both knees. Last year I skied 100 days.

I am still an athletic and strong woman. Last summer I went on a three day hike in the Great Bear wilderness area---I was amazed, the knees were fine. I could not have done that before the surgery. My boss at ski school says that I ski better than I ever have. There are five of us in ski school with fake knees and we are all still skiing.

If you have not died of boredom by now, I will just tell you to take it easy the first two weeks. Lots of rest, protein shakes and a lot of elevation and ice. Don't think you are going to dance through this--but you will have an easier time that folks who are not strong to start with. I wish you well---I have struggled with many of your issues myself. I feel at peace with my knees---!!!! Kelly

 

[mcirish]

Kelly, thanks for that. not boring at all. Loved it. One of the most helpful, warm and interesting posts I have ever received in any forum. Got some questions, but i need to get some sleep first! Chat with you tomorrow.

 

[1ELISEA]

I have a Smith & Nephew. The first OS I interviewed was not willing to perform the surgery because of nickel sensitivities. He recommended another OS that was an instructor, OS, and performed the newest procedures and would use the S&N, a nickel free implant. After blood workup for metal allergies, decided the nickel free was the best for me. Still interviewed several others, but when a third OS said the recommended OS had taught him the surgery, I went with the teacher.

Pre and post op surgery, I always saw the OS, not the PA, he answered all of my questions fully, and had an excellent post op protocol. Before the TKR my leg was bent; now it is straight and within one degree of perfection. Added benefit is a regained almost an inch in height.

It was a difficult decision, my knee was untouched prior to the surgery. And with metal sensitivities and other allergies, I could still react to a myriad of things with a foreign body inside me. But my other choice would have been a wheelchair; now I have my hiking boots and can do a one legged stand on the operated leg for a very long time.

I thanked the first OS for recommending the other OS and a nickel free implant. He was looking out after my best interest and provided great advice. I was limited to a S&N, but still sought out the very best OS. An S&N implant in the hands of a less stellar OS might have had a different result.

Sounds like you have gotten a lot of use out of the knee, what are your plans for after surgery? Are there sports or activities you would like to do that are limited now?

 

[mcirish]

I have a Smith & Nephew. The first OS I interviewed was not willing to perform the surgery because of nickel sensitivities. He recommended another OS that was an instructor, OS, and performed the newest procedures and would use the S&N, a nickel free implant. After blood workup for metal allergies, decided the nickel free was the best for me. Still interviewed several others, but when a third OS said the recommended OS had taught him the surgery, I went with the teacher.

Pre and post op surgery, I always saw the OS, not the PA, he answered all of my questions fully, and had an excellent post op protocol. Before the TKR my leg was bent; now it is straight and within one degree of perfection. Added benefit is a regained almost an inch in height. Wow! If I can get a half inch that would be

It was a difficult decision, my knee was untouched prior to the surgery. And with metal sensitivities and other allergies, I could still react to a myriad of things with a foreign body inside me. But my other choice would have been a wheelchair; now I have my hiking boots and can do a one legged stand on the operated leg for a very long time.

I thanked the first OS for recommending the other OS and a nickel free implant. He was looking out after my best interest and provided great advice. I was limited to a S&N, but still sought out the very best OS. An S&N implant in the hands of a less stellar OS might have had a different result.

Sounds like you have gotten a lot of use out of the knee, what are your plans for after surgery? Are there sports or activities you would like to do that are limited now?

Sounds like you were as particular as I am, but for different reasons obvious if you read my previous posts lol. Really awesome story with a happy ending. Very happy that everything worked out.

Yes, going to miss running and basketball. Running was the easiest way to release tension and get a great workout. Basketball was what i loved the most when my knee could still tolerate it. No better way to release tension or cleanse the body than playing 3-4 full court games on a weekend. I would just play until I was completely spent/exhausted. I haven't been able to play basketball, aside from a game of h-o-r-s-e, in a couple years. Last time I played competitively at the gym it took my knee about 2 weeks to recover. Going to have to focus on lower impact sports now, hiking, cycling, swimming. But the main reason I am doing this is I want to be able to keep up with my daughter as she grows up.

 

[1ELISEA]

Keeping up with your daughter is the perfect reason to have the surgery!

 

[skigirl]

For many years soccer was my way to release tension--I always felt great after a game. Then it was skiing.

Now, I have hiking and biking and sking as the ways to release tension---you just have to look around you. A long, hard ride on my bike is as much fun as a run!! I have a wonderful carbon fiber bike--Orbea Diva and it is just sitting there waiting for me to hop on and work off some steam. Hopefully you will replace running and basketball with some other fun things. It is important to realize that replacing things with others that are still fun is an important part of being an aging athlete.

I don't think I could run down the field like I used to when I was a midfielder--but I am a pretty good biker . . . everything in its time and season leads to a healthy and happy life. My husband spends time thinking about what he can no longer do----but, I just look around and do what I can when I can.

Today, that is going up and skiing powder all day---oh woe is me, I can't play soccer!!!!

 

[mcirish]

lol poor poor Skigirl. The Plight of The Snowbunnies! Sounds like a good title for a teen movie......I may have to follow suit, but just in different ways. Unfortunately the California Concrete we have in the mountains where I live cannot compare to Montana powder. I will have to settle for hiking in the Santa Susana Mountains behind my home, sitting on a jet ski or perhaps I can even take up longboarding as I used to surf a little in my younger years.....oh I also have a carbon fiber MB...an old Dean Carbore made in CO. Needs a little TLC and a tune up, but she's pretty much gtg. Don't worry. nothing extreme. Just street and trail rides.

Was up late last night. Started thinking about the video I saw on the procedure, lots of drills and saws ....the week before the procedure can be a lonely time.

 

[hbacres]

I am avoiding watching the videos. I have helped in a lot of orthopedic surgeries in horses and I pretty much know what will happen and I don't want to see it before hand! I am all ready nervous enough... can't sleep and my hair is falling out... my surgery is Jan 8th for an Oxford partial. I have to start taking Iron supplements on the 25th, I am not looking forward to that as I heard it can be hard on the stomach.
Robin

 

[mcirish]

I am avoiding watching the videos. I have helped in a lot of orthopedic surgeries in horses and I pretty much know what will happen and I don't want to see it before hand! I am all ready nervous enough... can't sleep and my hair is falling out... my surgery is Jan 8th for an Oxford partial. I have to start taking Iron supplements on the 25th, I am not looking forward to that as I heard it can be hard on the stomach.
Robin

Yes, stupid thing for me to do. Another member got me curious as I did not know how the procedure when exactly, but silly me, I had to look. When I had my last ACL done, I had seen a few partial clips too.....anyway, let's not focus on that. Let's focus on the fact that we are going to, not only be fine, but better off, much better off. I am just focused on post-op being the starting block and the recovery thereafter.....that we will take the The Tortoise Approach...slow and steady wins the race! I am still coordinating, gathering and organizing things for my recovery. Bone growth supplements, a supergreen food called "Health Force Nutritionals Vitamineral Green 500g". We also make our own keifer at home, which is a great source of protein, calcium, other nutrients and also boosts your immune system tremendously. Should be getting the CPM today and I am looking into electro stim therapy, hopefully not contraindicated for my recovery.....which reminds me, I have not received any communication from the surg coordinator about the cooling unit. Gotta do that.

Robin, we are young and mentally strong and we will do fine. Let go of what the doctors are going to do. You are in good hands. They will take care of it. Control what you can control and that is taking care of your health the best you can before the surgery and the recovery afterward. Sounds like you are doing just that. Go hug a loved one and tell them thank you for being there for me. I just did. Wife told me she loves me and will help me with everything and my little one just said "Da Da happy face!" What choice do I have? lol Don't worry, be happy.

 

[mcirish]

Iron supplements.....I am sure you are taking them with a meal? Hmmmm. Can you split the pills up? Take them as a smaller dose? Never had to take them, but hopefully you can find something that helps with that.

 

[jeano]

hbacres we will be knee sisters with the same implant. To both you and McIrish-- I couldnt resist watching the youtube video of the complete procedure before my preop meeting with my OS--he asked me if he'd showed me the implant and I told him I'd watched the video and his eyes got big and he muttered something about that not being a good idea for some people. I told him I especially enjoyed seeing the surgical equivalents of routers, drills, jigs and caulking guns and he relaxed a little and said that he sometimes tried to tell people it was a lot like carpentry. I also reassured him that I'd only screamed a couple of times during the video... perhaps not for the squeamish but it does give one a better understanding of just WHY the knee and the rest of the leg feel the way they do during healing. It is a significant amount of trauma.

 

[mcirish]

hbacres we will be knee sisters with the same implant. To both you and McIrish-- I couldnt resist watching the youtube video of the complete procedure before my preop meeting with my OS--he asked me if he'd showed me the implant and I told him I'd watched the video and his eyes got big and he muttered something about that not being a good idea for some people. I told him I especially enjoyed seeing the surgical equivalents of routers, drills, jigs and caulking guns and he relaxed a little and said that he sometimes tried to tell people it was a lot like carpentry. I also reassured him that I'd only screamed a couple of times during the video... perhaps not for the squeamish but it does give one a better understanding of just WHY the knee and the rest of the leg feel the way they do during healing. It is a significant amount of trauma.

This makes me feel SLIGHTLY better, albeit in a morbid way! I actually had the sound turned down when I watched one of the videos and watched half-horrified and half-chuckling as they manipulated the leg vigorously with a big rod protruding from the joint (one of the guides I think). I kept imagining the OS trying to make shadow puppets on the wall like some bizarre "The Far Side" cartoon. "See here? This is how you make a unicorn. Neighhhh!" I know it's warped, but my mind just goes there, kind of a defense mechanism I guess.

 

[skigirl]

I was so scared that when I went in to meet the pt, she tried to show me a booklet---something like, "Oh My, You are Getting a New Knee". It had a photo of a "prosthesis" and I began to get lightheaded and thought I would throw up!! She put the nifty booklet away!!

 

[referee54]

I also ran a great deal---I loved it, and I loved running in the cold; now, though, I either use my road bike and an indoor trainer or I use an elliptical machine in the bad weather months. In the good weather months, cycling has become an obsession for me. I cycle about 120-15=60 miles a week.

I have three bikes; an aluminum fitness bike, and aluminum road bike, and a carbon fiber road bike, too.

It has replaced running for me in many ways.

 

[mcirish]

I also ran a great deal---I loved it, and I loved running in the cold; now, though, I either use my road bike and an indoor trainer or I use an elliptical machine in the bad weather months. In the good weather months, cycling has become an obsession for me. I cycle about 120-15=60 miles a week.

I have three bikes; an aluminum fitness bike, and aluminum road bike, and a carbon fiber road bike, too.

It has replaced running for me in many ways.

The city I live in is not the most "bike-friendly" community (minimal bike lanes and paths) so I am more inclined to look at trail riding, although I would love to try a road bike. I think I could really get into it.

The OS said that running on treadmills is acceptable, but it's just not the same as running outdoors. I can totally see myself getting into trekking and trail hiking since I live literally in the foothills of the Angeles National Forest. Just have to watch out for the rattlers!