Has anyone had a TKR with a valgus knee?

[wrappergirl]

I've posted on here before. I have a new question. I'm wondering if any of you had a TKR with a valgus knee? My knee is now at 10 degrees valgus. It has gotten worse in the past year, markedly worse lately. I've read online that there are many things to consider during the TKR surgery when the leg is so valgus, such as:
The valgus knee presents a unique set of problems that must be addressed during total knee arthroplasty. Both bone and soft-tissue deformities complicate restoration of proper alignment, positioning of components, and attainment of joint stability.
I'd love to hear from anyone who has experience with this. I certainly don't want to go through such a huge surgery only to have other knee issues still present. I've had very bad knees since the age of 18 and boy, it is tiring at this point, I'm 47 now and my knees make me feel 80 most days.

 

[Jamie]

Wrapper....since I'm not a medical professional, I'll have to defer to Josephine on your question. But I would guess that most people have some type of misalignment that must be dealt with in knee replacement surgery. I know I did....not a great amount, but when the cartilage on one side disappeared, my knee tilted inward.

 

[wrappergirl]

Thanks Jamie. I'm curious to see if anyone with a badly valgus knee (mine is 10 degrees) had a TKR and if the surgeon had any problems, how it turned out and if their leg is straight now. I would love to finally have a straight leg

 

[Jamie]

I'm betting your surgeon will be able to improve (if not correct) your leg. Jo will know for sure, though....and maybe some others on the forum who have been through it.

 

[Josephine]

It's actually quite common, wrappergirl. But correcting them is not too difficult as most can be corrected with a standard knee prosthesis. In the event there is a lot of medial bone loss, the surgeon can adjust that as well. Just make sure you choose a good surgeon with lots of experience (in excess of 500 primary TKRs per year) and he'll take all of that into consideration. That's what you pay him the big bucks for!

 

[wrappergirl]

Hi Jo, thank you. I don't think there are any knee surgeons in maine that do in excess or close to 500 a year, the most I've heard of is 6 to 7 a week for one practice. How do you find out who does the most in your state?
Thank you

 

[marennorge]

Perhaps you should trek to Boston to see Dr. James Bono at New England Baptist Hospital. He does at least that many each year and is a leading TKR surgeon in the U.S. And, a very likable and personable guy. He did both of mine last summer, and I couldn't be happier.

www.drbono.com

 

[Jamie]

Wrapper, If you haven't done so, you can use a search engine here on BoneSmart to find clinics and surgeons in your general area. The link is as follows:

(broken link removed: https://bonesmart.org/clinic_lookup.php

If you are worried about your particular situation, it might be worth it to travel to a larger hospital in a major city.

 

[Simon]

Wrappergirl

I had serious malalignment issues since I was a teen with multiple surgeries to try and realign them. All these surgeries and biomechanics make a TKR more difficult. What I found to be the critical issue was to find a doctor who uses Computer Assisted Surgery. In this approach the OS uses computer mapping to select the cuts and how to place the "parts" to get a straight outcome. My OS said that he would have never been able to get a good result for me without it. Basically, the process is markers are attached to the leg at various locations and the computer picks up the signal and draws the knee on the screen (I was awake during the surgery and was able to watch it and it was very informative). The OS then uses that map for the surgery rather than relying on visual assessment.

Here is the website for the implants my OS used. I had BTKR in june and they came out fine.

https://www.kneereplacement.com/DePuy/DePuy_technology/cas_knee/

I live in Vermont which has the same problem you do in Maine, not high volume. I found that years of experience can overcome the need to do several operations a week. My OS said depending on the time of the year he might due 2 or 3 a week and sometimes none at all. What was critical to me was that in the 25 years or so he has been in practice he was always learning and pushing for the latest technology. In fact he and his practice were able to get the local hospital (though it is the largest community hospital in Vermont it has only 170 beds) to purchase the computer equipment even though it was very expensive. The practice he is with also does alot of research activity and I think that helps keep them sharp. They are also in ski country so they have a high volume of ski and snow board injuries which also require them to stay on top of their game.

Another advantage was the OS had a TKR done by one of the other surgeons in the practice and they have done replacements for many of their physician friends.

Simon

 

[lisamat]

Hi Wrappergirl,
Your question made me decide to post a response because I was just filled with your same questions several weeks ago. I am 50 years old and had a LTKR 5 weeks ago because of a 22 degree Valgus Deformity. My knee had a bit of a valgus bend all of my life but really started caving in after a scope last summer where my OS had to remove loose cartilage. I went from a 10 degree to a 22 degree bend over the course of several months. My knee became very swollen and it was hard to walk. My doctor finally put me in an off-loader brace for the last two months hoping to slow down the progression of the bend.

I believe that I have had a successful knee replacement now. My Range of Motion is great (0 - 120 degrees) and the x-rays look good. I honestly still have pain and swelling, but I believe that to be normal for 5 weeks post-op. My balance is not great and I still have to use my cane for stability. My OS said that my balance issues are likely caused from the overstretching of the muscles in my lower leg when my leg was so crooked. My leg is getting stronger in physical therapy, it is just not going quite as fast as I was hoping. I am a teacher and I started back to work 1/2 days this week and I plan to teach 1/2 days for another 2 weeks before starting back full time.

During the past several months I read lots of articles online about knee replacements and valgus deformities. My research is what made me decide to look for another OS. My first doctor did all orthopedic surgeries - knees, ankles, hips, etc. The doctor I decided to go with to do my knee replacement only does knees. He typically does 5 replacements a week and told me that 2 or 3 times a year he would work on someone with my level of valgus deformity and had never had a patient with nerve damage. He made me feel confident about the surgery.

I may not be far enough in my recovery to answer all of your questions, but I hope this helps. I know that in my case I didn't have any choice about surgery because my knee was going to continue caving in. Good luck with your knees!

Lisa

 

[1jt@atime]

Hi Wrappergirl, One of my knees was 20 degrees out of alignment but in the other direction. I think the official term is Varus or bowlegged. I wish I had had it replaced years ago but the first OS I saw told me I was too young and to wait as long as I could. I waited until I was 46 when I could hardly walk across the room. I sure couldn't wait much longer at that point.

Now I need my ankle on the same side replaced and I have bad arthritis in my foot. I think the cause is from all the years of not stepping down correctly when I walk because of my crooked knee. These surgeons.... dont they know what they are doing to you when they tell you you are too young? If only I had known.

Don't let this stop you from having your knee replaced but look at it as another reason to get it done sooner rather then later.

Karen

 

[Josephine]

Hi Wrappergirl,
Your question made me decide to post a response because I was just filled with your same questions several weeks ago. I am 50 years old and had a LTKR 5 weeks ago because of a 22 degree Valgus Deformity.

Lisa

Welcome to BoneSmart, Lisa. I'm pleased you decided to join us. You sound like you are really satisfied with your knee thus far but it will take some time to adapt to the knew, normal leg!

These surgeons.... dont they know what they are doing to you when they tell you you are too young? If only I had known.

Don't let this stop you from having your knee replaced but look at it as another reason to get it done sooner rather then later.

Karen

I think we all know the answer to that one, Karen! A big fat NO!

And I like your closer - very well put.

 

[Jamie]

Hi Wrappergirl,
Your question made me decide to post a response because I was just filled with your same questions several weeks ago.
Lisa

Hi, Lisa. Welcome to the forum. Your post was an excellent and supportive one and I hope that you decide to write more as you progress in your recovery.

 

[Gringo]

Valgrus is the opposite of bowlegged, right?

 

[Jamie]

Valgrus is the opposite of bowlegged, right?

VALGUS (knockneed) is the opposite of VARUS (bowleg). When I Googled it, many of the photos were not what you typically think of for either a knockneed or bowlegged person, but I think you were asking this in general, right?

 

[Gringo]

Yep. I was not familiar with those terms. My knees are definitely Varus then.

 

[Jamie]

It was new information for me too, Gringo. I had to Google it to learn!

 

[lisamat]

Josephine and Jamie,
Thank you for the welcoming words. I have been "lurking" on this site for weeks and have received such valuable information. Every time I had a question or concern I would search the old threads and I would always feel relieved to know that someone else had been through what I was experiencing. Thank you to all of the posters who are so supportive and so knowledgeable. I was reticent to post until I saw a question that I knew I could add something to. Now that I've posted once though, it does seem to get easier.

Lisa

 

[Jamie]

Oh, Lisa.....you'll find posting is VERY easy! Everyone here is just like a group of neighbors chatting over the backyard fence! Please join us when you can....even if it's just to say hello and tell us how you're doing today. There are always PLENTY of chats going on over in the Lifestyles forum!