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PKR Need to decide between PKR and TKR

One new update from my appointment yesterday.... My Dr. is still willing and fully capable to do my partial knee replacement (He has done many) and firmly believes it will provide me relief, however he still believes that a High Tibial Osteotomy (HTO) coupled with cartilage treatment (e.g. OATS), is a better path for me. He believes this for the following reasons: 1) My relatively young age (I'm 43) 2) There is not enough data on the long term survivorship of partial knee replacements using the latest materials. 3) Doing an HTO now will preserve my natural knee for as long as possible until I do eventually need a TKR.
He offered my a referral to another orthopedic surgeon in the area for a second opinion. Coincidentally, the Dr. he recommended seeing is the same Dr. a friend of mine (in the medical field) originally recommended seeing (which I never did)... Anyways, I booked an appointment with this new Dr. for next week. I figure there is no harm in getting a second opinion at this point, since this is such a big decision for me. I am keeping my PKR appointment for now, which is scheduled for 9/10/24.
I already stated my reasons for why I believe a PKR is better for me as compared to an HTO, early on in this post. To summarize, with an HTO, I am worried about the prolonged recovery time/rehab (along w/ muscle atropheid) and I am not fully convinced that an HTO w/ OATs will 100% resolve all my pain issues (where as with a PKR, I am much more confident it will work with much less associated recovery time). Lastly, I've read some absolute horror stories about HTO's on this forum (long term pain & the procedure not working), which quite frankly scare me.
Anyways, I will meet this new Dr. next week and ultimately have to make a decision going forward. If anyone has any input into this matter or specific experience with an HTO performed to relieve osteoarthritis, then please share. It's important to note that my current alignment in my right leg is almost perfect (no varus or valgus deformity)... so an HTO would be performed solely to unload my medial compartment to hopefully provide me some pain relief.
 
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I too am curious about the second opinion.

You've thought long and hard about this and I know you think the partial is your best option. Your current OS is honest in not really wanting to go that route, so hoping you get better clarity about the path forward soon.
 
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I have a PKR in each knee. Right 2018, left 2020. The same surgeon did both. The 2nd one is slightly better than the right one. I think the reasons for the difference are:
1. I did not wait till the Left knee was a train wreck before having it done.
2. I did a Lot better job during recovery of the Left.
I rented a Game Ready ice machine, kept it Iced almost 24/7. With the Game Ready you can adjust a constant temperature. It also has compression.
I did NOT let PT have me work through pain. I went to discomfort, then stopped.
I kept the knee moving between ice treatments.
I did not try to rush recovery.
The only drawbacks are:
1. I can not do a full squat. I have slightly more than 130 deg of movement.
2. Kneeling on my knees does not feel normal. I have gotten to the point that I can with padding or knee pads.

I can run if necessary, I do NOT have any pain from either knee. I walk over 8500 steps every day. If I did not have them done, I would not be functional....
Good luck
 
Rick951 said:
I have a PKR in each knee. Right 2018, left 2020. The same surgeon did both. The 2nd one is slightly better than the right one. I think the reasons for the difference are:
1. I did not wait till the Left knee was a train wreck before having it done.
2. I did a Lot better job during recovery of the Left.
I rented a Game Ready ice machine, kept it Iced almost 24/7. With the Game Ready you can adjust a constant temperature. It also has compression.
I did NOT let PT have me work through pain. I went to discomfort, then stopped.
I kept the knee moving between ice treatments.
I did not try to rush recovery.
The only drawbacks are:
1. I can not do a full squat. I have slightly more than 130 deg of movement.
2. Kneeling on my knees does not feel normal. I have gotten to the point that I can with padding or knee pads.

I can run if necessary, I do NOT have any pain from either knee. I walk over 8500 steps every day. If I did not have them done, I would not be functional....
Good luck
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@Rick951 - thanks for sharing your experiences with PKR. Definitely makes me more confident in proceeding with one. Also, thank you for the tips about icing and not overdoing the PT. I will definitely keep both in mind. Honestly, my only hesitation at this point is my age and not knowing exactly how long the PKR will last.
 
A good surgeon will only do a PKR if the rest of your knee is OK. For both of my surgeries I did not know what I ended up with till I woke up after surgery.
At this point,, other than setting off metal detectors at airports.... I don't even think about my upgraded knee joints.
:) :-) (:
Good Luck!
 
I had a PKR on my right knee (inside) 12/12/23…no problems with my walking at all. I have absolutely no arthritis or reason to have a full..my doctor suggested the partial. Hope your doc does too…so many want to just get it all done, when in reality you might not need a full! BUT, I am getting a full replacement on my other knee 10/01/24, beating luck & I truly hope you can get “pain free” soon!!! (Both my surgeries were & will be Mako done!….where do you live?? Great Ortho docs at Heartland Orthopedics in Alexandria MN❤️
 
Oh to add I am a busy hair stylist who went back part time after 3 weeks(on the partial replacement) taking 5 weeks with the full…
 
JennJon said:
I had a PKR on my right knee (inside) 12/12/23…no problems with my walking at all. I have absolutely no arthritis or reason to have a full..my doctor suggested the partial. Hope your doc does too…so many want to just get it all done, when in reality you might not need a full! BUT, I am getting a full replacement on my other knee 10/01/24, beating luck & I truly hope you can get “pain free” soon!!! (Both my surgeries were & will be Mako done!….where do you live?? Great Ortho docs at Heartland Orthopedics in Alexandria MN❤️
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Thanks for sharing and your kind words! I'm located in Charleston, SC
 
Update.... So I saw the new doctor to get a second opinion on my best path forward. He said the following: Basically either treatment (HTO or PKR) is a feasible option in my case. If my goal was to run marathons or play competitive basketball again, then HTO would be the better option as it preserves the joint and is better for high impact activities. However, with my goals in mind (quicker recovery without as much muscle atrophied; ability to simply walk/hike > 1 mile without pain; play with my kids; etc.), he believes a PKR is probably the right choice.
That being said, I'm going to proceed with the PKR... my surgery date is in a little over 2 weeks (9/10). I'm both excited but also a bit nervous... I am just hoping the surgeon does a good job and that I am NOT somehow worse off than I was before the surgery. Anyways, just thought I'd give everyone an update. Any last minute advice before the surgery would be appreciated. Here are the things I have ready for post surgery:
  • Ice machine (Ossur cold rush compact)
  • Walker, crutches, and cane
  • Shower seat
  • Wedge to elevate my leg
 
That all sounds good.
It seems your surgeon understands your needs in making the decision between PKR and HTO.
I was lent a special frame to put the compression socks on- but to be honest it really wasn't necessary.
I would stock up on pre-prepared meals/ shopping unless you have someone else to do it all for the first few weeks.
 
Best of luck on your upcoming PKR! As stated I have recovered from 2 PKRs. I did a MUCH better job on the 2nd one.
I was NOT trying to set a recovery record.
I kept it elevated and Iced almost 24/7.
I rented a game ready Ice/compression device. With that device you can set the temperature. That way it is a constant chill. It also does compression, nice touch.
I kept the knee moving, never stuck to a specific routine. Never pushed to pain, but did push to discomfort on a regular basis.
I Also knew there would be setbacks. I did not let that bother me, knowing it was part of the process.
Good Luck!!
 
My advice:

Stay hydrated. Every time you use the restroom, walk around your home. This should be often if you’re staying hydrated,

Find out now what pain meds you will be prescribed, what dosage & how many is the doc prescribing. Then, figure worse case scenario. If it’s 1-2 pills every 4-6 hours, how long will your supply last? Can you get a refill and when.

If you’re sensitive to pain meds, ask for a prescription for Zofran for at home.

Have a laxative or Smooth Move tea at the ready. Have some saltines and Gatorade, Powerade etc handy.

For your trip home, have a plastic grocery store bag in the car. Easier to slide in with it. Ride in the backseat on the way home and ask your driver to bring pillows for you.

Good luck!
Marie
 
Jockette said:
sk44tyler said:
However, with my goals in mind (quicker recovery
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PKR does not guarantee a quicker recovery. Recoveries happen at each body’s healing timeframe. Some TKRs heal faster than some PKRs.
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Understood… I meant quicker recovery as compared to a high tibial osteotomy, which is a very lengthy recovery including a period of non weight bearing, followed by intense PT.
 
sk44tyler said:
I meant quicker recovery as compared to a high tibial osteotomy
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You’re right, I understand that is a long recovery.

I just see so many members come here expecting a quick recovery from a partial, including me when I had mine, and very often, a PKR generally takes as long as a TKR. My unrealistic expectations caused me a lot of stress and frustration during my first year of recovery.

I wish you the best with your PKR!
 
Another thing I wish I had done before my PKR is do the Oxford Joint score before my surgery- so that I could monitor my progress better after the operation.
It would have helped me to see exactly when I moved into "profit".
I would also recommend keeping a good post operation diary - either on the post surgery bit of BoneSmart or just by yourself. It really helps to measure your progress and reassure you that things are getting better.
 
marieltha said:
Good luck! I have PKRs and still love them. Knock on wood abd Hail Marys. Used a dr who had done more than 20k+.
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Thank you! It’s getting close and I’m both excited but a little bit nervous. I just hope the Dr. does a good job and I get some pain relief.
 
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