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First Surgical Consult - PKR Recommendation

Discussion in 'Knee Replacement Pre-Op Area' started by JDinCT, Dec 15, 2018.

  1. JDinCT

    JDinCT junior member
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    Had my first surgical consult on 12/13. Surprisingly (at least to me) the OS strongly recommended a PKR for me. My bone-on-bone is medial location. I did like the upsides of quicker recovery and the better control and "feeling" due to ligament preservation.

    I have a second opinion consult on 1/9/19 at HSS in NYC which is my preferred location and with my preferred doctor (at least on paper).

    Ready to make the decision and move forward!!…
     
  2. Celle

    Celle FORUM ADVISOR Forum Advisor

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    I'm sorry to disillusion you, but almost everyone finds that it takes just as long to recover from a PKR as it does from a TKR.

    As to the other comment, I had a PKR initially. Now I have a TKR in both my knees. I no longer have the cruciate ligaments. I've noticed no difference in control or feeling between my PKR and my TKRs.

    It sounds as if your surgeon is a fan of PKRs.

    You should know, before committing to having one, that they seldom last as long as a TKR and that some even have to be revised to a TKR within a year.

    Do consult at least one more surgeon, for a different perspective.
     
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  3. JDinCT

    JDinCT junior member
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    Celle-

    Thank you for your perspective and real world experience. My first OS did state that I could expect the PKR to last between 8-10 years and TKR to last between 15-20 years. This estimate was primarily based upon my activity level. One part of his logic was that I would very likely require revision surgery at some point in the future (whether PKR or TKR performed now) and the PKR would most likely provide a better result at this point in my life due to saving the cruciate ligaments. He did state that he would perform either PKR or TKR based upon my preference. He stated that approximately 10% of his knee replacement surgeries are PKR vs TKR.

    I plan to do more research on PKR and hopefully find a few studies on real rates of revision surgery and time to revision surgery. So far I have a few medical presentations that do indicate return to pre-knee replacement sports type activities are better and quicker with PKR than TKR.

    I have schedule one more surgical consult 1/9/19 and will take that advice into consideration before making a final decision.

    Thanks!
     
    Last edited: Dec 16, 2018
  4. Mutti3

    Mutti3 graduate

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    I will add another voice to this conversation. I had arthritis only at the medial ( inner ) side of the knee. Discussed with my OS was told, same recovery, cutting into bone, and revision likely within 5 years. Had total knee, I can do everything as before surgery. My flexion is normal, walk pain free. Also will add, almost unsure to say this, was told I can jog again by the OS.
     
  5. kneeper

    kneeper FORUM ADVISOR Forum Advisor

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    In a sense those of us whose whole knee was shot had an easier decision. :wink: When one compartment is shot you just don't know when or if the others might go.
     
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  6. Jeffntate

    Jeffntate junior member

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    I'd like to see your presentation as I'm in the same boat. Medial PKR vs total knee.
     
  7. sistersinhim

    sistersinhim FORUM ADVISOR Forum Advisor

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    From my experience on Bonesmart for over 3 years, I would never have a partial done. Arthritis in one area is likely to attack the other area and a revision to a total would be necessary. I want just one recovery!
     
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  8. robert johnson

    robert johnson member

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    Back in 2010 just before my right TKR I asked the OS and his PA if I'd be able to jog again. They both quickly answered, no we don't recommend it.

    I'm not saying it isn't possible things have changed, but if it was me, this is what I'd do. I'd ask a the OS to ask all the other OS in the group (I think there are 7) if they can refer me to one patient of a TKR who is currently jogging. Just one, that's all I'd need, although the more the better. I would give them permission to have him/them call me so I could ask him how long he's been jogging post-op, how far and how often, and how it was going.

    Then I'd sit back and wait. Until I heard from someone, I'd assume jogging was a bad idea after a TKR.

    I've found in the last 9 years there's a lot of anecdotal evidence of miracles after recovery. Usually, they're coming from someone who knows someone whose uncle had a TKR in Florida (wherever). But without fail, anytime I actually meet someone who actually HAD the TKR, his or her activities seem quite a bit less miraculous.

    Til this day I haven't even heard of someone, let alone met him, who resumed jogging. Not in the sense of how we jogged back in the day.
     
  9. robert johnson

    robert johnson member

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    Can someone tell me, does a PTKR retain both the ACL and the PCL?
     
  10. JDinCT

    JDinCT junior member
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    From my research, yes .. all the cruciate ligaments are retained and this is often cited as an advantage to PKR. From my research, retaining the cruciate ligaments are also cited as an advantage to more of a "normal" feel and control of the knee post-op than TKR.

    However, YMMV (Your Mileage May Vary)…. meaning real world results are very individualistic...

    I'm counting down the days to my second surgical consult at HSS in NYC.
     
  11. JDinCT

    JDinCT junior member
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    @Jeffntate, see this link and look for "Sports After PKR versus TKR"... I had a couple other ones I reviewed but cannot locate them quickly... will try to find them and repost....

    https://www.orthogate.org/videos/967-sports-after-pkr-vs-tkr
     
  12. Jeffntate

    Jeffntate junior member

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    Check into pain management plans post op. A lot of new rules in the US go into effect 1/1/2019 that limit you to 7 days depending on your insurance and state.
     
  13. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @JDinCT, I had my lateral compartment PKR back in April. When I had my initial consult with my OS, I was surprised when he recommended PKR over an initial regimen of shots. I was also surprised he didn’t suggest TKR. Since my knee issues were due to a sports injury when in my teens and not due to general OA deterioration, the other two compartments were not affected by arthritis. His opinion was that PKR was the ideal solution.

    I’m now 8 months post op. From my experience, I want to caution the belief that recovery is faster than TKR. In general, it may be somewhat faster, but the experience is very much the same. I will say I was walking without any aids by end of week one. I took my first business trip flight at week 7 or so. I bowled in a tournament at week 10 (but I’m left handed so my left leg is not my slide or post leg). I was also able to golf by week 8 or so. I’m not a runner, so I’ve not tried anything like that and have no intentions to do so.

    So far, my knee implant has not been any limiting factor to anything I want to do, however soft tissue recovery has kept me from really pushing leg exercises until I got to the 6 month mark.

    I still firmly believe that PKR is a viable alternative to TKR depending on the person’s history and reason for knee issues. Just don’t set yourself up for disappointment by having unrealistic expectations.
     
  14. JDinCT

    JDinCT junior member
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    @NavyGunns... thank you for chiming in... I read your complete post-op post and gained a lot of significant insight from your PKR experience... I am now armed with additional information from the Bonesmart community and have a few more questions for my second surgical consult.

    I plan to certainly key in on the health and condition of the remainder of my knee as input to my PKR or TKR decision. I am also now convinced that any shorter recouperation from PKR versus TKR is likely to be minimal and will not play a significant factor in my decision.

    Thanks!
     
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  15. NavyGunns

    NavyGunns FORUM ADVISOR Forum Advisor

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    @JDinCT, glad my feedback was found useful. Being armed with questions AND knowledge will help you significantly with making a decision. I would strongly recommend that your questions include asking your OS their position regarding the purpose or role of PT during recovery. I got lucky that my OS didn’t even bring up PT until week 3 which gave me the chance to share my own concerns. It’s important that your OS understand your personal views so that improper expectations can be avoided.
     
  16. Rick951

    Rick951 junior member

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    I had a PKR on October 3rd of this year. Like you I had done a lot of reading regarding PKR vs. TKR. Before surgery my OS told me the plan was to do a PKR, but, if once he got in there and the other parts of my knee looked marginal, he would do a TKR. He also told me of all the knee replacements he does, only about 10% are PKRs. I am now almost 12 weeks out. I was driving after 4 weeks and back at work after 5. I am lucky enough to work from my desk and Ice when I want to, so that helped. The one mistake I did make was pushing recovery WAY to hard And fast!!!!!! in some ways I am still paying for that! I am happy with my PKR, that is what I wanted, so far so good.
    I wish you the best of LUCK!!!
     
  17. johnnyutah

    johnnyutah new member

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    That's encouraging they told you about jogging. Of all the surgeons I have consulted with, they most say TKR is better than PKR.
     
  18. Vansan

    Vansan junior member

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    I have had 3 opinions. 1 TKR. 1 scope. And 1 PT and rooster shots ?


    Sent from my iPhone using Tapatalk
     
  19. Vansan

    Vansan junior member

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    Did you make the decision?


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  20. ApricotPie

    ApricotPie new member

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    A former coworker had both knees done just so that she could keep playing her beloved tennis. Alas for her, neither knee cooperated and her tennis days are over. The really sad part is she did this I her early 50s, so she may end up needing it again in her 70s or 80s.


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