How to decide whether and when to have a partial knee replacement?

[Jakster]

I’m an athletic 60 yo man who has recently been diagnosed with lateral compartment bone-on-bone OA in my left knee. I believe the OA was precipitated by an ACL tear with meniscus damage (from a skiing accident) that occurred and was repaired in 1999. Basketball is my passion, and after playing a few too many games in January, my knee had significant swelling, prompting me to visit an orthopod and start PT. The doctor, who has worked for the local NFL team, suggested a partial knee replacement could be an option in the future, but recommended that I defer until at least age 65 to reduce risk of the implant requiring replacement after a period of time. His view was that the damage was too extensive for cartilage repair.

I’ve continued to do intense PT for the past few months, with a focus on strengthening muscles around the knee. (I started PT from a solid base, as my pre-diagnosis workouts included squats (225 - 250 lbs) for reps.) I’ve been fitted with an unloader brace and have played basketball multiple times. However, I find that my speed, quickness and jumping abilities are impaired as compared with a few months ago. While my knee is somewhat stiff and can be sore after basketball, I don’t have any issues with walking long distances or other non-athletic activities. No pain while resting or sleeping, but there is definitely crepitus in the knee.

My thinking at this point is to manage by continuing PT and keeping legs strong and to moderate load by playing basketball a bout less frequently and stopping when legs tire. However, I’m also wondering whether it could make sense to bite the bullet and go for a partial replacement now or find amother physician and perhaps take a more aggressive approach with a biological/cartilage repair approach. I’m a little concerned that the brace will shift load to the medial compartment and cause problems there as well.

I’d be interested in others’ perspectives on how to manage. Thank you in advance for sharing perspectives.

 

[EalingGran]

My thoughts as someone who has had a lateral partial knee replacement 7 months ago.
The issue isn't really the longevity of the implant. I have been told my Oxford fixed lateral has a lifetime guarantee and will see me out ( I am 67).
I was also told that lateral arthritis often doesn't have significant pain until very late. I could also walk and sleep without much pain in the knee prior to surgery. I decided to go ahead because I was getting increasingly knock kneed ( over 20 degrees) due to the lateral compartment collapsing. This deformity was causing really severe hip pain and sciatica ( although I also have moderate hip arthritis and lumbar arthritis/ spinal stenosis). My surgeon told me that the hip pain and sciatica would improve significantly with knee surgery- which has proved correct. I also had major swelling ( Bakers cyst/ pes anserine bursa/ supra patellar bursa).
The issue for you is that if you don't have much/ any pain currently then you will likely have more pain post op for a few/ several months. It is only in the last month or so that I have less knee pain than pre- op. Although I was in profit from my surgery much sooner because of it alleviating the excruciating sciatica and hip pain.
The other important consideration is that lateral partials are much rarer than medial ones and the surgery can be more complex if there is valgus deformity. A lot of the quotes about easier/ shorter recovery on surgery websites refer to medial.
It is always important to check that your surgeon has lots of experience but it is especially important with partials and even more important with lateral partials as they are fairly rare. My surgeon has done a lot of the research on partials and does plenty. In the UK you can look up a surgeon's figures on the NJR - National Joint Registry.
I am overall pleased with my surgery as my leg is much straighter and I can walk better and faster than pre-op but I still have some slight MCL pain due to it being overstretched pre-op. I was nowhere near as athletic as you are and my needs/ expectations would not be the same as yours.

 

[Jaycey]

The doctor, who has worked for the local NFL team, suggested a partial knee replacement could be an option in the future, but recommended that I defer until at least age 65 to reduce risk of the implant requiring replacement after a period of time.

This is very old school thinking. Technology is on your side. The longevity of implants has improved significantly. Please don't wait to get back to living again.

His view was that the damage was too extensive for cartilage repair.

Sounds like your knee is well past the condition when any of these less invasive procedures might work.

 

[Peter Mac]

I've always wondered why more biologic options aren't recommended instead of partial knee replacements. If you have healthy cartilage surrounding the damaged area it seems like minced cartilage should be equally considered to hardware.

 

[EalingGran]

I think it is still early days on the biological front and it isn't clear how well they work or will last. I do expect they will get better and may well be the future. I think I am going to need hip replacement/s at some point and hope that things will have developed/ improved by then. I saw on BoneSmart one person who had a very mini cartilage/ joint replacement ( Episealer? I think it was called)- but she was having some problems.

 

[EalingGran]

I think another issue with just replacing worn cartilage is that it won't correct any misalignment that caused the damage in the first place. I was a bit knock kneed and then the lateral arthritis caused that side to collapse and make me even more knock kneed. If I had just had a cartilage graft I would still have had the misalignment and presumably the new cartilage would just have worn away again. My partial replacement also involved straightening my leg and correcting the misalignment.