PKR Need to decide between PKR and TKR

[sk44tyler]

If I proceed with a PKR, my goals after surgery are the following:
Minimum Goals (accomplish without pain): take the dog for a walk; walk 1 mile +; hike for a 1 mile +; mow the lawn; play basketball (light) with my son; walk around all day at a park
Stretch Goals: Do some light jogging (I haven’t ran in any form in 10 + years because of pain); go snowboarding

Are any of these goals achievable with a Mako PKR?

I don't think the fact that a PKR is MAKO or not significantly affects the level of activity possible after PKR. It just helps the surgeon to ensure good alignment.
I can walk or hike now for pretty much any distance ( up to 6-7 miles/ day- but probably limited more by my age at 68 now than my knee). I walk around all day with my grandson in the park and it is just general exhaustion, rather than my knee that limits me!
I have been told not to run, but I also have an overstretched MCL and lax ligaments. I can run short distances ( for trains/ buses). I have never skied or snowboarded but I know others here with TKRs who go back to these activities. One of my grandsons other grandparents skis regularly after his medial PKR ( non- MAKO).
I think some of the restrictions were because no one was sure how long PKRs would last in younger people. My surgeon says that mine should easily last 25 years and see me out. My implant ( Oxford fixed lateral) apparently has a manufacturer lifetime guarantee- although not sure what that really means!

Thanks for the info! That’s make me feel more confident in getting a PKR.

 

[EalingGran]

One other consideration ( and I don't know if this applies to HTO) kneeling can be tricky after either a PKR or TKR.
There is a numb patch ( due to the saphenous nerve being cut) which never fully recovers and this makes kneeling feel odd and it can be unpleasant. Some people never are able to kneel comfortably after this surgery.
I can kneel. It took some practice and I use thin knee cushions if I am kneeling for any length of time ( say for exercise classes) but I can kneel briefly on a wooden floor - say to get something from a low cupboard.

 

[sk44tyler]

One other consideration ( and I don't know if this applies to HTO) kneeling can be tricky after either a PKR or TKR.
There is a numb patch ( due to the saphenous nerve being cut) which never fully recovers and this makes kneeling feel odd and it can be unpleasant. Some people never are able to kneel comfortably after this surgery.
I can kneel. It took some practice and I use thin knee cushions if I am kneeling for any length of time ( say for exercise classes) but I can kneel briefly on a wooden floor - say to get something from a low cupboard.

Good to know… however I haven’t been able to really fully kneel since ‘99. After my OCD surgery, I never recovered full ROM so I physically can’t kneel and sit back on my heels.

 

[sk44tyler]

Well I did a CT scan of my right knee today - I already received the results. Here are the highlights from the report:

- Moderate to severe tricompartment degenerative change of the right knee
- Patchy underlying subchondral cystic changes noted within this region (medial femoral condyle)

One unexpected detail on the report: "Chronic loose body is noted along the posterior distal fibula on the right". I had to look this one up ... its my ankle... Honestly, I'm not too surprised given all the ankle injuries I went through playing basketball in my younger years.

Anyways, back to my knee... Granted, I am not a medical doctor, however, given the fact that it states moderate to severe tricompartment degenerative changes, makes me think that a partial knee replacement may no longer be my best course of action. Maybe this suggests I need to be considering a total knee replacement? Any thoughts / opinions on the matter would be appreciated.

I have a followup appointment next Wednesday with my doctor to discuss the results.

 

[EalingGran]

given the fact that it states moderate to severe tricompartment degenerative changes, makes me think that a partial knee replacement may no longer be my best course of action. Maybe this suggests I need to be considering a total knee replacement? Any thoughts / opinions on the matter would be appreciated.

It depends on how severe it is in each compartment. If it is fairly severe in all three, then a partial is pointless and a TKR would be better.
I still have some arthritis in my unoperated compartments, with some crackling( crepitus) noises in the patellofemoral joint and the odd twinge if I do a lot of stairs. It is a balancing act/ judgement call for many of us whether we would be better with a TKR or a PKR.
Many people on the forum prefer TKRs because it " gets it over with" and there is a higher revision rate with PKRs.
I do like my PKR though, as my knee moves very freely ( ROM 150+) and feels totally natural.
You need to have a good conversation with your surgeon over which is the best option for your knee.

 

[benne68]

Hi @sk44tyler. It's really good to have this information to discuss with your surgeon. He/she will likely tell you that it is ultimately your decision whether to do a partial or a total replacement.

EalingGran chose the partial route, I opted for TKRs in both my knees.

The right knee was bone-on-bone in two compartments; the left was bone-on-bone in only one, but there was degeneration in the other. I could probably have gotten away with a partial in my left but decided I didn't want to have to come back for a revision down the road.

I'm sure other members will stop by to share their decision-making process with you. Would you like us to change your thread title to something like "Need to decided between PKR and TKR?" or something like that to attract more replies?

 

[sk44tyler]

@EalingGran - Thanks for the response... Yeah, I'll see what my surgeon has to say - I have an appointment this Wednesday with him. Yes - I am fine with changing the title to "Need to decided between PKR and TKR". Thanks for the suggestion!

 

[Mike61]

I had a partial done April 9. While I have some mild degeneration under my knee cap, the medial was bone on bone. My surgeon felt a partial was best, but said he was always prepared to do a full once he got into the surgery ( I obviously had to give permission for the change, if needed), if things were worse that anticipated. His experience is that if the knee ever had to undergo a revision to a total knee, that it was not a complicated surgery (from his experience). I am having the same surgery for my right knee in July. While it is only 6 weeks out, I am very happy with the results and my activity level at this point.

 

[sk44tyler]

@Mike61 - Thanks for sharing. Its always encouraging to hear someone talk about their positive experiences with a procedure... plus it gives me more confidence that a partial would work for me.

 

[sk44tyler]

Update - I saw my doctor today and he is still recommending a High Tibial Osteotomy (HTO) with some sort of cartilage treatment (e.g. OATS). He asked if I had thought about and considered this option. I told him yes, but I still thought a Partial (uni) Knee replacement was a better option for the following reasons:

1) Effectiveness: The HTO will transfer some of the weight to the lateral side, but not all of it. That coupled with the fact that the OATS procedure is not guaranteed to work has me doubting the effectiveness of this option. I would hate to go through such as serious procedure, along with the associated muscle atrophy and required PT (from being non-weight bearing), just to have it be for nothing and still have pain.

2) Potential for complications: My current alignment in my right leg is perfect. Purposefully putting me out of alignment to address my medial cartilage loss seems like it has the potential to create other problems (e.g. back, hip, etc.). It's pretty safe to assume that down the line, I will need a TKR... I have read some studies that conclude performing a TKR after an HTO has the potential for more complications and in general is a more complicated surgery (as compared to not previously having an HTO).

3) Longevity: I read some studies that an HTO (along with OATS) are not really guaranteed to last. Some studies suggest 8 - 10 years. If I needed a PKR (or TKR) in 10 years, I would rather just do it now.

My doctor listened to all of this and understood what I was saying, however still thought the HTO was the best bet. He definitely is a surgeon with a more conservative view and believes in preserving the joint as long as possible (which I respect). Anyways, he stated "If it were me, I would go with the HTO. However, I respect your decision and if you're comfortable choosing a PKR, then so I am." He expressed confidence in doing the PKR (he has much experience with them and has been an orthopedic surgeon for 30+ years) and assured me it will definitely relieve my pain. In addition, he said in my specific circumstances, a PKR is definitely a better choice than a TKR, and that I would be much happier with a PKR (more natural feeling and better ROM).

So, at the end of the day, I scheduled a Mako PKR (Medial) for August 27th (this is the first available time for me, when considering summer plans, trips, etc.). So wish me luck!

 

[Jockette]

Best wishes moving forward with a PKR!

PKR (more natural feeling and better ROM).

I personally disagree with this statement, yet I see it often. It will all depend on how your body responds to the surgery, and how good your surgeon is. We have many members with TKRs who hardly know it’s not their original knee, and also many PKRs that don’t feel natural. I am in the latter group.

 

[sk44tyler]

@Jockette - I'm sorry you're not happy with your PKR and it doesn't feel natural. I hope I have better luck with mine... one thing my doctor did mention (from his perspective of course) was that PKRs of the patellofemoral are not being performed as much any longer because they weren't having high rates of success with them. He said he only really does medial PKRs which for him have a much better success rate... One doctor's opinion, but interesting none the less...

Just curious - in your case, is it simply the knee doesn't feel natural or are you experiencing pain as well?

 

[Jockette]

I do agree that the medial PKRs seem to be more successful. We also have members with successful Patellofemorals. Unfortunately, in my inexperience, I most likely choose a surgeon with little experience with the procedure, thus my poor outcome.

I agree with your reasons for choosing a PKR over the HTO. I hope all goes well for you.

 

[EalingGran]

one thing my doctor did mention (from his perspective of course) was that PKRs of the patellofemoral are not being performed as much any longer because they weren't having high rates of success with them. He said he only really does medial PKRs which for him have a much better success rate... One doctor's opinion, but interesting none the less

That is very interesting information. It is certainly true that medial PKRs are massively the most common ( over 90% of all PKRs are medial). I have read that laterals are more complex and challenging surgery because they often involve a valgus ( knock) knee. I hadn't heard about issues with patellofemoral replacements but just from what I have heard on BoneSmart they do seem potentially more challenging.
My own lateral PKR has great ROM and does feel totally natural. I think preservation of the ligaments in PKRs helps with the natural feeling joint movement. Although of course the downside of that is you keep any preexisting problems with the ligaments. I still have a slightly weak stretched MCL ( medial collateral ligament) which I have to keep in shape with lots of quad work.

 

[EalingGran]

Long-term results of compartmental arthroplasties of the knee | Bone & Joint

Long-term results of compartmental arthroplasties of the knee

boneandjoint.org.uk

Just found this article on outcomes of PKRs and it confirms what your surgeon says about patellofemoral replacement being less successful.
I hadn't realised that my lateral was quite as rare ( 1% of surgeries). Medials do seem very successful.This paper says that keeping the ligaments helps gives more natural kinetic movement and a more natural feeling joint with better ROM.

 

[mendogal]

@sk44tyler I think it's a good decision based on sound reasoning and your priorities.
We'll be here to support you during the waiting/prep time and all through recovery.

With your history you probably are pretty accustomed to surgery suite procedures and prepping your home to meet your needs but start asking any questions....

 

[sk44tyler]

@sk44tyler I think it's a good decision based on sound reasoning and your priorities.
We'll be here to support you during the waiting/prep time and all through recovery.

With your history you probably are pretty accustomed to surgery suite procedures and prepping your home to meet your needs but start asking any questions....

Thank you so much... it's reassuring to hear you say that and helps me be confident in my decision.

Yeah - I am pretty accustomed to everything that goes with having a major surgery like this (as is my wife
). Luckily, my wife is a stay at home Mom and can help me out while the kids are at school.

One positive thing I have going for myself, is that I've been very consistently doing strength/weight training for the past 1.5 years... The last time I had open knee surgery (2016 - ACI), I had not been doing weight training consistently and the recovery was very tough for me. I can honestly say I'm in better shape now (than I was then) and my diet/nutrition are way better... I think the combination of these will definitely help in my recovery this time around.

A few questions I can think of right now... 1) Any good recommendations on knee ice packs to purchase? (NOTE: I am very use to icing my knee and I'm looking for something that stays cold for a very long time) 2) Is the Active Microbial worth purchasing? I never used anything like this after my previous surgeries 3) For all of you that have had PKR's, do you think a cane will be good enough to get me around initially or will a walker be necessary? (I have both crutches and a cane sitting in the attic from my previous operations).

I'm very happy I found this forum... all of you have been very helpful and kind. I will keep you guys up to date on how the surgery goes in August.

 

[mendogal]

1) an ice machine! I have the Breg Polar Care Cube. Instead of using ice per its instructions I use four frozen 12-ounce plastic drinking water bottles after putting in the water to the fill line. Keep another several water bottles in your freezer and its easy to swap them out.

 

[sk44tyler]

1) an ice machine! I have the Breg Polar Care Cube. Instead of using ice per its instructions I use four frozen 12-ounce plastic drinking water bottles after putting in the water to the fill line. Keep another several water bottles in your freezer and its easy to swap them out.

I’ll definitely check it out. Thanks for the recommendation!

 

[InkedMarie]

I have the Cryo Cuff motorized by Aircast. I also used the Chattanooga ice packs, available on Amazon. Mine are XL and while they don’t last a long time, I used them under my knee & on top of my shins. I bruised terribly and the ice packs helped.

Good luck!
Marie