Having partial knee replacement in March

[alfmandy]

I'm a 37 yr old female having a partial knee replacement done in March. This will be my second surgery on the left knee, I had arthritis scraped out of it and exploratory surgery done about 4 yrs ago to see how bad the damage was. After the surgery I had more pain and the joint has almost completely deterorated. Ortho surgeon has decided that a partial replacement will benefit me and improve my quality of life. I work full time and have 2 teenagers that I don't get to enjoy time with. When I get home I end up in bed resting the leg because of the pain and swelling. I have been on pain killers and also had the injections with barely any relief. They have given me hydoro's and darvecets. More relief out of the hydro's. I'm very anxious and gotta say scared of having surgery again. Any and all information on recovery time and rehab would be appreciated. I just want to be able to enjoy life again and hopefully this surgery will help me do that. I have been told that I will have to take 8 weeks off from work, and that I will be down in bed for about 2 weeks. Not sure if I can handle the down in bed part....be doing enough of that! LOL. Does a partial end up later having to be redone into a complete replacement? What about activities after recovery? Thank you all in advance...

 

[Josephine]

To be perfectly frank, I am somewhat bemused by your history and the fact that your surgeon is doing a partial replacement! You've had a debridement and more deterioration, much pain and swelling. How many opinions did you get? How much do you know about the surgeon you are seeing?

You ask if a partial ends up having to be converted into a total - well, the short answer is yes it will, depending upon your age and activity and .... upon the progress of the arthritis in the rest of your knee.

Arthritis is rarely confide to one part of the knee joint. It's a bit like rust in a car - it might be just in the door sill to start with but you know for sure that even though you get that sorted, it's going to pop up somewhere else sooner or later. Arthritis is the human body's form of rust!

The knee has three compartments, the medial (inner) side, the lateral (outer) side and the space between the knee cap and the femur. You are going to have the medial compartment replaced but the chances of there being arthritis now or very soon in one or both of the other compartments is not just real, it's inevitable. The question is now 'if' but 'when'.

Now to the crux of the matter - your problem has been ongoing for some 4-5 years. The chances of your developing symptoms in either or both of the other compartments within 2-4 years are pretty high in which case you'll need a revision to a total. A total done now could last you as much as 25 years, the partial is extremely unlikely to do that.

You've most likely been told that you are 'too young' to have a total knee replacement done which is nonsense! The condition of your knee is what should determine the appropriateness of the procedure, not your age.

Sorry to pour cold water on your plans but unless you've already gone that route, I strongly suggest you get 2 or even 3 more opinons on this before you undergo any surgery. And make sure you see accredited knee surgeons with a profound experience and commitment to knee joint replacement.

 

[alfmandy]

This is my 3rd dr. The other 2 said that yes I needed a replacment but because of my age they would not do it. The current dr is the head of the ortho dept at the leading hospital in my area. On my list of questions is the option to have a complete replacement due to the fact there is arthritis everywhere. Also have about 4 bone spurs, the newest one showing up behind the kneecap. I have pain even when resting anymore. I have talked with other patients that have seen this dr and have procedures done by him. All has been good. Also have done research on the dr. Again good. I do thank you for the information. I have an appointment in a couple of weeks and will be asking lots of questions.

 

[JenniferG]

I had Bilateral TKR March 18 of last year. I was 39. From alot of what I have read here, many partials eventually end up as completes. The fact that you are so young and active is all the more reason to have a complete and long term remedy. TKRs go 20 years OR MORE. Either way, better to have 20 years of relief before needing surgery again than only 5-10. And being younger may also lend to a easier recovery.

 

[Josephine]

On my list of questions is the option to have a complete replacement due to the fact there is arthritis everywhere. Also have about 4 bone spurs, the newest one showing up behind the kneecap. I have pain even when resting anymore.

These statements alone indicate (to me) that a partial would be an ill-advised option for you with a strong possibility of your not being totally pain-free afterwards.

I have talked with other patients that have seen this dr and have procedures done by him. All has been good. Also have done research on the dr. Again good. I do thank you for the information. I have an appointment in a couple of weeks and will be asking lots of questions.

Nevertheless, I strongly recommend you reconsider. If he insists it's for the best because of your age, find yourself another surgeon. We have members on here a lot younger than you who have had TKRs. Also, consider this - any surgeon has a percentage of good outcomes and of poor outcomes. Usually they run at somehwere between 92%/8% and 98%/2%*. The better the surgeon's expertise at decision making as well as surgery the more likely he is to be somewhere towards to second category. What I am trying to say is that it therefore stands to reason that you can meet around a couple of dozen people who are extremely happy with their outcomes. It does not necessarily mean that for one individual, the decisions made were satisfactory. See what I mean? Personal recommendation is good but shouldn't be seen as a clincher.

Read this post How to choose a surgeon and a prosthesis and take note of the five questions.

Now set yourself some objectives
1. What are the principle outcomes you want from this operation?
2. Are you prepared to accept the presence of still being left with long term pain?
3. Are you prepared to accept the possibility of a revision in two or three years?

Because remember, you will still be only in your early forties and still considered 'young' by a large number of surgeons. And what's more, you will still be facing a revision at around sixty and maybe even another at eighty. Possible.


*guesstimates - not statistically accurate

 

[beachcomber]

Welcome to BoneSmart! You have come to the right place. I wish I had found this forum and had the discussion you are having before my PKR a little over a year ago.

At the time, it seemed like the PKR was the way to go for me. I was 51 and very active with a job that keeps me on my feet for more than 9 hours a day. My arthritis pain was limited to the medial compartment only and was very debilitating with a sudden onset of acute pain due to a torn meniscus. The idea of a partial KR instead of a total was very appealing even though my OS estimated I would probably need a revision to a TKR in 9-10 years.

My surgery was successful and I recovered well, but now the pain and inflammation have spread to the other compartments of my knee. Even the medial compartment is painful, probably due to a generalized inflammatory response. I also have documented OA in my other knee and spine.

My point is that at the time of my PKR we believed that the rest of my knee was healthy so the PKR made sense. In YOUR case you KNOW you have bone spurs under your knee cap. NO WAY would I have a PKR if I were you.

At your age you will probably need 1 or 2 revisions in your life. With each revision the results tend to be less successful and the risks are greater. Although the revision from a PKR to a TKR is easier than TKR to TKR--- you lose the benefit if the PKR doesn't last more than a few years.

Keep looking for more information and get another opinion (or two). PKR is a major major surgery (same as a TKR but just on 1/2 of your knee) and you don't want to have to face a revision soon.

Good luck to you.

Beach

 

[cheryl50]

Hi Guys,
This post caught my I because I am 50 and scheduled for Bilateral pnr on 2/2/09. I have been getting tons of great help from this board and feel very prepared and am looking forward to being free of the constant pain and stiffness and being very active again.

My concern is that my OS never mentioned that the medial arthritis I have would pass into the other sections of my knees anytime soon. He said that my arthritis is all located in the medial compartment and said that the Oxford Partial was the way to go. He has been refered by many patients and several doctors that I know as the best in the Boston area. My X-rays show the bone on bone only in the inside of the joint ( I have copies). He also said that plenty of his patients have had this implant for 20 years.
From the sound of Jo's post, this is not true. I'm feeling very uneasy about this. Is there anyone that has had partials with years of sucess? Jo, should I talk to him about doing totals instead? Thanks so much for your help! Cheryl

 

[Josephine]

Don't be too despondant, Cheryl. alfamndy already has evidence of arthritis showing in the other parts of her knee. It is entirely possible for the problem to be evident only in one compartment but the risk is always there that it might crop up elsewhere.

I suggest you have a talk with your surgeon and ask him what evidence he has a) that the arthritis is confined only to one compartment and b) that it won't develop in the other compartments anytime soon. It may well be that your condition is in its early stages and you would therefore have no cause to worry.

 

[alfmandy]

Thank you everyone for all the wonderful information. I honestly feel that TKR is the only way to go. With all of the arthritis and the known bone spurs, I agree that Jo saying I will probably end up with more surgeries in a shorter amount of time completly turns me toward a TKR now instead of later. I will be having an appointment with the OS and seeing what responses I get from him now that I'm armed with more information. I am so glad that I found this site. The people on here have so much information from their own experiences and are so glad to share. Thank you, thank you!!!!

Mandy

 

[Josephine]

Excellent! That's what we're all about on here!