I don't know what to do...

[ferrous]

I will jump right to my great dillema: I don't know what to do.

I am a 60 year-old female who possibly need a knee replacement. I just found this forum and hope I can find some answers.

Here is the short version of my question:
My surgeon told me I need total knee replacement. I have seen two other surgeons and one recommends partial knee replacement and another said I don't yet need knee replacement and should do injections of lubricant every three months.

HERE IS THE LONG VERSION:

Little history of my right knee:
in 1995 I developed a cyst in my right knee, being scared of any invasive surgery, I decided to have it operated when it was quite large and started interfere with my walking. The surgery went well, a large cyst was removed from the front of my knee. It was embedded inside the joint, but it was all taken out.

Year 2006: I started having problems with the same knee and I went to the doctor. In the end, it was loose cartilage that was removed with arthroscopy. All went well, recovery was very quick.

Year 2009, June: I developed baker's cyst in the back of my right knee, but also I started having pains while walking and while sleeping. I went to the same doctor that performed my arthroscopy. He said I have arthritis on the inside of my right knee and he gave me anti-inflammatory injection to my knee, a standard procedure. Doctor explained this would be the first step, then if it doesn't get better, he could inject the three-time lubricating substance (the substance derived form rooster comb) that could help. The anti-inflammatory injection did not help at all and my pain became more severe.

Year 2009, September: I went back to my orthopedist and he took another set of xrays. Comparing those form 3 months before, he said he could see advancement in the arthritis and at this time he said the injections of the lubricating substance (the substance derived form rooster comb) would not do much. He actually said that there was maybe 5% chance that it would get better with the three injections of the lubricating substance into the knee. The reason being the two bones were already touching each other which causes pain.

The big verdict: total knee replacement. I went for second opinion, the second surgeon said I would need only partial replacement as the outside of my right knee is healthy. My family doctor didn't like the verdict so he sent me for a third opinion (which I felt was unnecessary ) but I went today and the third surgeon said I still have cartilage left and knee replacement would be 5 years away. He recommended the injections of the lubricant into my knee, which means every three months, 4 weekly injections (1 anti-inflammatory, and 3 for the lubricating substance.

END OF THE LONG EXPLANATION:

I also went to my original surgeon today and asked why he feels total replacement is better than partial, he said there are some arthritic changes in my knee cap that cause pain already and partial replacement would not take care of this problem. He assured he considered partial replacement, but he feels for my the total replacement is the way to go.

Today I am more confused and scared than before. I am leaning toward the total knee replacement, I like my original surgeon and I trust him.

I would love if anyone would give me any advise, any pros and cons.

Thank you so much for your help.

 

[Jamie]

Hi, ferrous, and welcome to BoneSmart. We're so glad you found our forum and decided to join in.

Your question is a fairly common one....some doctors prefer to exhaust the conservative approaches (injections) before moving to a knee replacement. In the end, the decision is one only you can make.

If it was me, though, I would probably get the TKR. All the other options MAY offer temporary relief, but they will never restore your joint to it's healthy state. At least with the TKR, it is over and done with and once you get into recovery you are in a healing mode that in almost all cases gives you pain free movement.

If the first surgeon you saw is correct that there is arthritis in the knee cap, he is correct that a partial will not do the trick.

It sounds like you have done well so far getting several opinions (even though they are all different). You need to decide which doctor you trust the most, how much risk for continuing pain you are willing to take if you go with a more conservative approach, and then go for it. Please do be aware that recovery from a partial knee replacement is really much the same as a TKR in terms of pain and length of recovery. So if it didn't work, you might face this major surgery again relatively soon.

Don't feel like you have to decide this immediately. Give yourself time until you are comfortable with the direction you take. You will receive lots of input from folks here....weigh it against your particular situation. Talk to any and all of these doctors again if you need to. In the end, it's YOUR knee and YOUR life, so you need to be at peace with your decision.

We will always be here to discuss any concerns you might have. And again....welcome!!

 

[ship4]

Hi Ferrous (interesting name similar to iron, any connection?)!
Welcome to the forum.
I too had problems with the wearing of the cartilage on my knee caps. This is a huge part of the TKR. I would go with his evaluation as a partial sometimes lasts a long time if no other problems exist. It appears you have some bone on bone within the joint and bone on bone behind the knee cap. I would go with the TKR. I had BTKR and it was a wonderful decision for me.
The operation for the partial is just as severe with the possible need to redo it sooner with a TKR. You need the TKR due to the wear on your knee cap.
So, the sooner you proceed and get it done the sooner you can get on with living your life as you would like to live it without the constant pain of bone on bone and needing shots to just get comfortable never mind enjoying what you would like to do!
I went back to downhill skiing and took up golf this year after the BTKR.
Go for it! JMO

 

[Pat29627]

My partial is 2/3, it includes resurfacing the kneecap and the medial side of the knee. Is it the only brand that does that? It's a Smith and Nephew Journey Deuce. I don't know yet if it's going to be wonderful, . . . still having some pain at six months.

Pat

 

[Judles]

Welcome Ferrous! Hope whatever you decide......that you are PAIN FREE ASAP!!! :thmb::thmb:

 

[Josephine]

Jamie was correct. And many surgeons are giving up using partials because of their high conversion rate - 10% within 2-3 years. That's a lot. Of course, that means that 80% of their patients are still having satisfactory results for a reasonable period of time but they're not odds I would care to have.

You could opt for the Journey Deuce that Pat mentioned but tbh, I wouldn't bother. It's still major surgery.

I read your notes very carefully and there's nothing there that encourages me to believe that a partial or Synvisc are appropriate.

 

[Texas]

I agree i did all that the scopes shots the whole 9 yards and still ended up the the total repl I think you will be happier with that. Just jump in and get it all taken care of....Good Luck to you and welcome..............)

 

[Nancyo]

Welcome Ferrous~
You have gotten the best possible information already, so I would add only one important thing. That is to research the threads on the knee side of this forum and see what the others have been through with their replacements. It may help you to make your decision.
As Jo, Jamie and the others have already told you, a partial replacement most probably will only put off having a full replacement and you had mentioned that you have had some of the Synvisc injections with results that were not exactly helpful.
I like the fact that you said you had confidence in your first surgeon and you've already gotten a second and third opinion. So when you have the time, do some reading here for more research. You do need to be happy with your decision.
Once again, welcome... we are always excited to have new members and you'll find that you are now on a forum who cares for each other and tries to help in every way possible.
Blessings to you~
Nancyo

 

[abunnybabe]

Ferrous, best of luck to you. I was also given the choice of the lubricating joint injections as a bridge to "buy time" and I am 49 and my doc said I was too young. Well, in just 3 short weeks I'm having a RTKR. I didn't want to waste any more time being in pain and limping along. I am looking forward to just getting it over with and getting on with a painfree life.

 

[marquesa]

Hello, Ferrous,
I, too, have been doing a lot of research and have some interviews with surgeons coming up. I have a list of questions for them, as the first two I went to said I only needed a partial replacement. I haven't been able to interview the next group yet..but have been following the posts here, closely.

One thing that is confusing to me is the terminology I hear a lot..i.e. partial, total, minimally invasive and such..

Some of the research on the web says that a partial replacement has less blood loss,less pain faster recovery, etc. because the tendons and ligaments are not cut.

If this is so, I don't understand why, then, the surgery would "be the same"

Would some of you with direct experience please share what was done during your surgery. Were the tendons cut? was the blood loss less?? Have you had both partial and total replacement and have direct experience of both of them??and if so, how was it different?

It is so hard to know the truth because of all the information available on the web, and not necessarily coming from a good source. meaning many of the websites are published by those profiting from whatever they are suggesting.

The best source is from a good surgeon and those who have had, and undertand exactly what was done during their surgery.

So, it would be helpful to know..are tendons severed? what effect does that have??
and what have your surgeons explained as the differences in the surgeries?

thanks.

 

[kimberlyann]

Hi Ferrous, and welcome to the club. I am a member of the "I am probably getting two partials and I have arthritis behind my kneecap" club.
My surgery is Oct 12 and my surgeon is strongly leaning toward a partial because I am 45 and they are "bone sparing". He says he removes so much less bone when doing a partial, it leaves more bone left for future surgeries. At this age, believing that the life-expectancy of either a partial or total is 15-20 years, I should plan to have one or two revisions. There is a chance it would last forever, but we must plan for it to fail before I die. SO, he is going to go into the OR with both a partial and a total. He has done all of the diagnostics to determine whether or not I am a good candidate for a partial, and I still qualify. He says that only when opening my knee will he be able to tell for sure whether the outer compartment is arthritis-free. If there is arthritis in the outer compartment, I will get a total.

Some folks here strongly disagree with doing a partial because of planning for future surgeries. They say, get it all done now, which sounds fine. BUT, the life expectancy of a FULL replacement is only 15-20 years, and when that is due, a revision is supposedly easier with more bone to work with. That sounds fine too.

We know I have arthritis in my knee cap, and he says that I may still have some pain if he does a partial, but that he firmly believes that the benefits of saving bone by doing a partial outweigh that fact. I am not thrilled about having a surgery and still having any pain, but I understand his thoughts.

This is my third surgeon, and I know your journey has been a frustrating one.
Only you know when you have had enough pain. When you have, you will seek out the surgeon you trust the most and that surgeon will do his best to relieve your pain.

I don't think you can ask too many questions. There are those firmly planted in the anti-partial camp, and some believe they are wonderful.

I will let you know when I wake up next Monday what is in my knee, and how I feel about it!
Please ask any questions here, there is no replacement for people who have been there and done that, and these folks are very generous with their advice.
I had the lubricating injections, Synvisc, and they did not help me, but they do help some people.

So, it seems that your "original surgeon" and mine agree that leaving the kneecap will probably leave some pain. You will need to decide if that would be acceptable to you or not.

Clear as mud??

 

[Jamie]

Kimberly, I went in to my knee surgery just like you did. I had told the doctor to do a partial if at all possible and he agreed that it looked like I might be able to have that. But when he got inside he found so much arthritis he needed to do the TKR. He was prepared for either one on surgery day. This is why it's so important to have a good knee surgeon and to trust them to make the right decision for you.

We can't say it enough here to people facing joint problems. Find a good surgeon who specializes in the joint you are having problems with (knee or hip) and that you trust....then put yourself in their hands totally. In most cases, you will get the best result that way.

Now..."putting yourself in their hands" does NOT mean that you don't get out there and read, study, ask questions, post on BoneSmart and do everything else you can to be an informed patient. It just means you let them make the medical decisions about what you need for your particular situation.

 

[Josephine]

One thing that is confusing to me is the terminology I hear a lot..i.e. partial, total, minimally invasive and such..

~ Partial is a resurfacing of one femoral condyle and the accompanyin tibial condyle.

​

~ Total replacement is putting a cap on the entire femur and tibia

​

~ Minimally Invasive is when very small incisions are made to carry out the surgery. There's a lot of misunderstanding about MIS in knees. MIS in hips is keyhole surgery but in knees it's reduced incision surgery - you got to have an incision big enough the get the implants in! Hip implants are a lot, lot smaller than knees!

...........................TKR scar (7" and mine!) ........................ PKR scar

.........

​

Some of the research on the web says that a partial replacement has less blood loss,less pain faster recovery, etc. because the tendons and ligaments are not cut.

So, it would be helpful to know..are tendons severed? what effect does that have??

The less blood loss rather depends upon the incision. Many partials have smallish incision to one side but some surgeons make the standard incision similar to that for a TKR. My sil has such a scar. Assuming he carried out a reduced incision, then obviously there will be less blood loss and less pain.

Tendons and ligaments are never cut in knee replacement. That would be totally counterproductive to early recovery and rehab.

There is one procedure where a small cut of about an inch is made in the quads muscle to give better access to the joint space but it's a rapidly expiring practice as surgeons acknowledge it hampers recovery with extra and often excessive pain. It hinders the straight leg raise which is the first target for recovery on day 1 or 2.

​

The only ligaments that that are touched are the cruciates if they are poor quality but that's done as part of the bone removal and a specially designed TKR implant is used to take over their function.

What surgeons do during surgery is to go in between the natural planes of muscles in order to reduce any risk of bleeding. But, of course, you cut human tissues, they bleed. It just depends how much and that can be controlled.

It is so hard to know the truth because of all the information available on the web, and not necessarily coming from a good source. meaning many of the websites are published by those profiting from whatever they are suggesting.

You are so right here. People so often do hours of research on the implants and neglect to notice that the websites with glowing references are actually those of the manufacturers! This is why BoneSmart is different because the owner won't allow any rhetoric of glowing testimonials by the manufacturers, only basic information. You can trust this site.

 

[beth1954]

Hi ferrous!

Nothing much more to add except that my daughter is in the medical field. If you know ANYONE that works in a hospital in almost any capacity. Ask them who they would recommend. If you can find a nurse that assists, and anesthesiologist, or some kind of person who assists in sugery, they will tell you a good doctor. That's how I have found several doctors. The people who assist in surgeries KNOW who is good. The best advice I ever had!!

Also, when I had my TKR I didn't lose much blood at all, and my doctor used this device that caught all my blood loss, and not too long after surgery, it was infused back into me!! I thought that was so cool!

Best of luck, and just move forward!!

Beth
:thmb:

 

[Linda2]

My right knee, the one replaced in July, really only had trouble with the knee cap; there was still cartilage on both the medial and lateral sides. My surgeon believed the only real fix was a TKA--I have faith in the surgeon and I went for it. It was the right decision for me. I feel sooooo stable now that I have two new knees.

 

[JudyS]

I am at a bit of a loss as to what happens to the patella component in a knee replacement. Some of you posting with possible partials talk about the knee cap remaining painful. I only have arthritis in the knee cap area . I can assure you it does get painful .
I had a cleaning out of the joint, removal of the synovium and microfracture on the troclear groove. All 9 months ago. It is improved, but not totally pain free. THis was all in the knee cap .
Just adding my 2 cents
judy

 

[Josephine]

Well, there are three compartments in the knee; the medial, the lateral and the femoro-patellar. It is possible to get arthritic changes show up in just one compartment. But the changes are rarely confined to one compartment and if, on a direct visual via arthroscope or even MRI scan, they appear to be so there may yet be minor or even microscopic changes that are a prelude to the advancing O/A.

So if it's the fpc, then it needs addressing but any treatments such a microfracture will likely only be a temporary fix. In the end, there really isn't much of an option other than dealing with the entire joint.

 

[Max Wallace]

Please make sure that the DR. you choose is a knee replacement specialist and not just an ORTHO who does knees. VERY IMPORTANT!!

 

[Josephine]

:amen: :amen: :amen: :amen:

Can't say it enough

:amen: