Revised PKR to TKR PKR to TKR in 12 months

[Psflash]

Hello, my name is Paul and I wanted to share my story in the event anyone has insight.

I am a 52 years old and have been active my entire life (triathlons, CrossFit, etc.). I am a retired police officer (homicide investigator) now working in corporate security/investigations. I reside about an hour north of NYC.

Knee history:
- 1986 (12 years old) - complex ACL (partial tear), MCL, LCL tears (stay away from skateboards).
- 2004 - OCD fracture on lateral femoral condyle as a result of ACL being loose.

Surgeries:
1/2005 - Arthroscopy to remove bone fragments/microfracture.
5/2005 - Arthroscopy to heat shrink ACL and insert OBI/Trufit plug to attempt cartilage growth (plug failed miserably).
9/2006 - OATS autograft (excellent- gave me 15 good years).
3/2021 - Arthroscopy at HSS (chondroplasty/debridgement to address torn cartilage flaps/degrading OATS plug).
6/2021 - Osteochondral Allograft at HSS (two 2 - 2.5cm cadaver grafts). Okay for about 2 years then disintegrated).
11/2025 - Stryker Mako lateral partial knee replacement (medial/patella-femoral compartments were good).

The first 3 months of recovery post PKR were excellent. Then I plateaued following by a rapid decline and increasing pain. I had a MAVRIC MRI in September (at 10 months post-op) which revealed I was bone on bone in my medial/patella-femoral compartments. X-rays 2 weeks post op show perfect joint space. Recent X-rays show zero joint space in my medial/patella-femoral compartments.

Infection has been ruled out. It does not appear that my knee alignment was overcorrected during the PKR (if so it would be a medial issue, not patella).

I refused cortisone because every time I’ve had it in my knee in the past, I have always subsequently torn more cartilage. My body does not respond well to it.

HA injections provided no relief.

I decided that sacrificing my 50’s to wait to for a TKR (to avoid a TKR revision later in life) is not feasible. I can’t do ANYTHING active so I would be feeble in my 70’s. I was also a 9/11 first responder and have had cancer twice because of this (so tomorrow is not promised for me).

I have decided to move forward with a TKR. I have consulted with a Dr. Schwarzkopf at NYU Langone. I will obtain a second opinion from an HSS complex revision surgeon. Dr. Schwarzkopf will use the Smith & Nephew Cori system with Legion Oxinium implants to avoid any possibility that a metal allergy contributed to my rapid decline post PKR. He will also attempt to use non-cemented implants for longevity (as long as there is enough bone stock after removing my existing implants).

Any insight on rapid failing PKR’s or Oxinium implants would be appreciated.

Thank you.