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Pkr vs tkr ?

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kimberlyann

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Hi, and first of all thank you to everyone who participates in this forum. You have helped me so much (as a lurker), now I am going joining the ranks of the posters. I was scheduled today for knee replacements. He will do the right in October and the left about 6 weeks later. My OS has great hopes that I will be a fit for partials because of my age (45). I have so many concerns about this, especially after reading here and noticing that even Josephine doesn't really favor them.

On October 12, he will perform surgery and have both options available- partial and full. He will decide when he gets in. He really feels that the Oxford partial replacement is a good choice for me because it is "bone sparing". He is concerned that I may outlive the 2 total replacements they offer in my lifetime. Well, as my son says, "would you rather be in a wheelchair at 45 or 75?"

Here is my main concern, I have moderate arthritis behind my kneecaps and my OS says that the new English research has shown that it does not matter. I suppose they used to think it did matter enough to do a study.
I have a pretty aggressive osteoarthritis throughout my body, and I am really skeptical that the arthritis of my knees is contained to just my inner compartments. And, if so, what prevents it from going to my outer compartments next month? The inners have collapsed really badly, really quickly. He says that he will not do a partial if he sees arthritis in the exterior compartments, but he seems really almost so bent on a partial, that I am concerned he will anyway. Probably just me being paranoid.
Also, I am overweight by 50 lbs, and he used to mention it to me about a year ago, when we weren't even talking about surgery, but he hasn't recently. I also thought that being overweight was a reason not to do a partial. Ok, I am fat and paranoid.:hehe:

I trust him, and he is a wonderful doctor. He has spent a great deal of time with my husband and me answering questions. He is my 3rd OS, and came recommended to me by my rheumatologist. He did my rheumatologist's dad's knee replacement. That is a good reference. He does about 4 or 5 knees per week, so that is a good number.

So, I would love to hear happy PKR stories. I am a pharmacist and cannot work right now. I can't stand up for more than 15 minutes without being in bad pain. If I am standing, my only thought is, " when can I sit down?" They don't let us have recliners behind the counter at Walgreen's. :pray:

I also have kids from ages 3 to 26 and several grandkids. I have lots of playing I need to get to. I wanna squat and tie shoes, and run after them. Right now I am worthless.

Thanks again for your support, I feel like my brain has fallen out and I am kind of in shock. I have prayed for a solution for my pain, and surgery is hopefully it, I just want the right one!!

Sincerely, Kimberly
 
Kimberly I want to welcome you to a great place. I'm glad you stopped lurking and joined us.
I can only offer the little I have been told by my wonderful hip/knee surgeon. I had a knee scope and microfracture surgery in Dec. I have osteoarthritis confined to the knee cap area. I had asked my doc about a partial replacement. He told me for me, he would not recommend it as I am too active. He was sure it would become loose in a short amount of time (a few years) and then would have to be converted to a full replacement. He said they are more for couch potatoe types .
Is your outer as you refer to it area totally free of arthritis???

Others will be by to help you out, I have very limited experience in the knee dept.
judy
 
Welcome KA!!! First of all...you are hurting, NOT" worthless" so let's get THAT straight! I'm a hippie, know nothing about knees, but for what it's worth,,I just don't understand partials! Of course you want to outlive your replacement(s).....just to go through this surgery again (possibly)..at a later date, just doesn't seem feasible to me...but like I said, that's only MY opinion! The most important thing is to trust your OS, and since you do, go with THAT! Pretty soon you will be feeling sooo much better and at the end of the day....THAT'S what it's ALL about! Look forward to hearing from you again! ((:0)
 
Kimberly,
Welcome to BoneSmart. I too am 45 and almost 8 weeks ago I had 2 total knee replacements done. The age thing does not mean a thing anymore. They used to say years and years ago that replacements last 5 years. Well, now with all the research and new knees they can last for about 20 years. I was at the point that I looked horrible when I walked or shall I say waddled. My Dad hated to watch me walk because he could see the pain I was in.

Now with my 2 new knees, I'm walking better than I have in 10 years. I'm not bowlegged at all, and most of I WALK STRAIGHT!!!:wahey:I don't know hardly anything about partial knee replacement but my thinking...if they're going to open you up, might as well go all the way. My ROM is better now then it was before my surgery. Already I feel I can do more, I'm taking walks now, so don't worry about missing out on playing with the children. You will feel like a new woman after it's all done.

Best of Luck!
 
Hi Kimberly Welcome

Like Cindy said, if they are going to open you up why not do the Total replacement.

I was offered a partial and told him no. I did not want to look at another surgery down the road. So I had the total and I think I am doing fine. After he got in there he said the total was best for me.

Either way you will do fine and you will be so pleased after you have had it done. You will be able to play with those kids with in a few months.

Post any time we are here for you.
 
I was diagnosed with end-stage osteoarthritis/degenerative bone disease... in both knees at age 50. I was offered shots, PKRs or TKRs. I chose the latter, after having one round of shots earlier this year.

It didn't help very much. To me, I had no choice but to do the BTKRs because I could not even walk through a grocery, and had to leave my stand up job in May. I also wanted to be sure I did something while I had insurance, which I know you aren't supposed to do something out of fear, but it is an expensive surgery and I believe in my case it was possibly now or never. I am glad my surgeon gave me options, but I feel like we came up with the best for my condition.

Good luck on whatever path you choose.

BTKR 8/25/09
 
I tried the synvisc and it did nothing.:sct: Went to another doctor and a third. He wants to do a pkr if possible. From the scans everything on top looks good. He said he would scope it first and make sure of the pkr. If it is worse, then he will do a tkr. Scheduled surgery next month. I will be 44 next month.
 
Kimberly,
My OS said that you must be under 200 lbs for a partial. I have an uncle that had two partials done a couple years ago and has done fine, but he is 75 and probably would not be looking at another surgery at some point. I was not a candidate for a partial due to the condition of my knee (and my weight), so I had a TKR. My OS also said that partials were not very popular in the US for many years because a prominent OS with national influence did not believe in them. He said they were more popular in Europe and are becoming more popular now in the US. I would hope that your OS would be more inclined to do a total knee replacement if there was the slightest indication that you would need that in the near future. I am told that revisions are harder to do and who wants to go through the surgery twice. I have a friend who thought he was going to get a partial from my OS and wound up with a total, so I believe my Dr is biased in that direction. Ask lots of questions.
Good Luck,
Doug
 
Hello, KimberlyAnn, and welcome to BoneSmart. Glad you decided to join the family! Always room for more.

Now I'm going to speak honestly to you as that is my practice. I don't believe in sugar-coating things for people over such serious issues as hip and knee replacements. You said this surgeon does 4 or 5 knees a week - well, I'm sorry but that isn't a good number at all. That works out at a mere 200 a year. A good, 'full-time' knee surgeon will do a minimum of 500 a year, probably a great deal more.

As for the partial KR, well say you have 'aggressive' osteo-arthritis and that your medial compartments (inners) have 'collapsed really badly, really quickly'. In which case I would say you are very right to be concerned about it progressing to the rest of your joint in a short time. I've not heard about the arthritis in the patellar compartment not being important and since you have changes there anyway, I would be concerned about his dismissing it. For sure you cannot have a patellar button with a partial.

As for the longevity issues, my latest information is that many surgeons are quietly admitting to revising around 10% of their partials within 2 years and as a result are doing fewer and fewer. Having had one major op, I certainly wouldn't relish the idea of having another about 4 or 5 years down the line.

Now about the longevity issues. It is widely accepted that both TKRs and THRs are tending to last around 15 or more years. Considering those that today are 15 years old, and how much the implant manufacture and surgical techniques have improved over that time period, I wouldn't be at all surprised to find that joints implanted today will be lasting 20 years and maybe even more. There are other issues that can and probably will arise over such a period such as wear on the plastic bearings requiring them to be changed, like changing your car's brake pads!! :wink:

As for the age, I would say that in no way is 45 too young but it does emphasis (to me) that he is not a terribly experienced knee surgeon though he might be a good orthopaedic surgeon. The difference is significant.

And of course, the choice is yours.
 
Hey Kimberly, I would voice my concerns to him because i agree i would hate to see you go thru all this again.but whatever you choose we will support ya and be behind you 150 percent.......good luck to ya Post anytime.......oh sorry welcome!!!!!!!!
 
Thank you everyone for your posts. I cannot tell you how much your replies mean to me. I was especially relieved to hear from those in your 40s who are in similar circumstances.

Josephine, your input is so very important to me, because there is no substitution for experience. What baffles me is that he seems to be considering partials because he truly believes that I will face a future surgery, and a revision after a partial is easier than a revision after a total. And that a partial spares bone, allowing more surface to work with later. Does that argument have merit??

My OS was the one who encouraged me to get online and search about the Oxford partial replacement, and I think that is a good thing. I must say I am not completely impressed with what I have read, but that is ok too.

I know that people with great outcomes are less likely to post about their stories, and folks with troubles get online more often to seek advice. That is normal.

I plan to talk to my surgeon again, and clear up a few things. I have 4 weeks ahead of me for all of my pre-op fun and giggles, and I will bend his ear again about the need for a partial.

Josephine, I am not ignoring the fact that he does not have the 500 knee per year number that you recommended. I will definitely chew on that. My brain fell out when I was going the math and you are so right, that is not 500 per year at all. He is a sports medicine specialist if that matters.

sewell44: I am by no means an athlete, but a (previously) active girl. I also need to be on my feet at least 8 hrs per day to work as a pharmacist. So, I am not sure whether that makes me a couch potato or not!

Judles: Thanks for your opinion, it does matter to me!

cindy88fan: I almost cried when you said you weren't bowlegged anymore. I have gotten so bowlegged, it is awful. I would love to walk straight. My little sister told me about a year ago to "just go do anything to fix them, I hurt looking at you!" Congrats on your recovery, keep up the good work and thanks for sharing.

loggon: I agree that a totalKR sounds reasonable if I am opened anyway. I also find myself nodding my head when the surgeon says partials are great because they are bone sparing, making future revisions easier. Crazy.

cotton1958: Thank you for your reply. I too am possibly facing not having insurance after March of next year. It does matter very much, as you need to take care of what you know is needed while you have coverage. I am sorry you don't feel it helped very much. Hopefully you will continue to heal. Good Luck to you.

shine: We are in the same boat! Same approximate age, same advice, same travel through several docs, same month for surgery. Thanks for replying, and keep us posted of your progress. Best Wishes!

dcdowden: Hi Doug, you know, my OS claimed that partials were growing in popularity too. I am under 200 lbs, but still about 50 lbs over weight for my 5'2" frame. I have a feeling I will wake up with totals, but really don't know. About all I do know is that I am not done asking questions! How is your knee feeling?

Texas: Hi, I am in Houston, where are you? Thanks for your welcome, I am really nervous and talking to you all helps me so much. I agree that I don't want to do this again, but my OS is pretty much promising that this won't be the last set of surgeries for me. Only time will tell, huh? How are you feeling now?
 
Sorry, I meant to say, the shots didn't work. I am still in the 2-3 weeks of healing past my BTKR, so I have no idea where I stand at this point, no pun intended.

Good luck again, Kim.
 
Kimberly
I was shocked to hear you are in Houston and going to a OS with not much experience.

There are great doctors there that do only hip and knee replacements.

I suggest you get a second opinion. Esp. since yours keeps saying you will need more surgery.

There are lots of folks your age that have it or had it done and they will not need a replacement. Or at least they are not told they are going to need surgeries.

I am in an around Austin, but lived in Houston for a while.
There are so many Os there that do this all the time.

Esp. if you are not going to have insurance after March.
 
Well, I must admit that I felt I was at a very experienced OS. I would not have known about the recommended "number" of knees without Josephine.
I am actually on my 3rd surgeon, and feel great about this one, except for the worries about partial/total.
I am a pharmacist and used to work in the med center downtown, so I am very familiar with the health care system here. Yes, there are tons of experienced docs here, and I am with one who is highly recommended and regarded, with a busy practice, but maybe just not a concentration on knees which would definitely be preferred.
I have not found any conflicting information about the life expectancy of the partials or totals. It is published as 15-20 years for each, and if my life expectancy at this time is 83 years of age, then probably at least one revision, if not two, may be necessary.
Of course some folks are lucky enough to make it forever on one surgery, but we must plan for the worst, and hope for the best!
I agree that another opinion may be necessary, but this is a "third" second opinion at this point!
I hope you have great success with your BTKR, the shots did nothing for me either.
 
Kimberly.....there is a HUGE difference between being an excellent and highly regarded surgeon and an excellent and highly regarded KNEE surgeon. Please do seek out an opinion from the latter. The surgeon's skill in a knee or hip replacement is the number one consideration. I know it seems like you've already seen a lot of doctors....but this is the rest of your LIFE you're talking about. You need to see at least one more.

We have had several people on the forum from the Houston area. I know there are excellent knee surgeons available for you.
 
Yes, there are tons of experienced docs here, and I am with one who is highly recommended and regarded, with a busy practice, but maybe just not a concentration on knees which would definitely be preferred.
Exactly - - - busy and highly recommended on what? If he's a sports medicine specialist then he mostly deals with torn ligaments and stress fractures. Arthritic knees don't really come into that a great deal.

I have not found any conflicting information about the life expectancy of the partials or totals. It is published as 15-20 years for each, and if my life expectancy at this time is 83 years of age, then probably at least one revision, if not two, may be necessary.
Of course some folks are lucky enough to make it forever on one surgery, but we must plan for the worst, and hope for the best!
Unlikely a 40 yr old living to over 80 would escape having at least one revision!

Josephine, your input is so very important to me, because there is no substitution for experience. What baffles me is that he seems to be considering partials because he truly believes that I will face a future surgery, and a revision after a partial is easier than a revision after a total. And that a partial spares bone, allowing more surface to work with later. Does that argument have merit??
Well he's not totally wrong but I truly think his logic is flawed. The reason for selecting a partial is because the damage is confined to one compartment (usually the medial or 'inner') and not because of any future surgery. Either it's suitable or it's not. Period.

Having said that, people with limited damage in the medial compartment get along very well with partials. My sil has one which is now 2½ years old and she's very happy. But as my surgeon confided in me, he's very cautious about whom he uses them in and even so his conversion rate is around 10% as I think I mentioned before.

But I want to clear up a misnomer about revisions as some seem to assume the bone needs to be totally recut. This just isn't so. When revising a TKR the already cut bone surfaces usually just need to be freshened up a bit not actually recut. It's already the correct shape and at worst just needs some minor adjustments. I think this issue is a somewhat overplayed but that's just my opinion.

My OS was the one who encouraged me to get online and search about the Oxford partial replacement, and I think that is a good thing. I must say I am not completely impressed with what I have read, but that is ok too.
I know quite a few surgeons who have criticised what is on the manufacturers' websites as not actually telling the whole story and I share their reservations. After all, the objectives of their websites is to sell their product so we should really take what is said with a pinch of salt. That your surgeon advised you to go there for info to reassure you in no way reassures me.

Josephine, I am not ignoring the fact that he does not have the 500 knee per year number that you recommended. I will definitely chew on that. My brain fell out when I was going the math and you are so right, that is not 500 per year at all. He is a sports medicine specialist if that matters.
When working out the numbers, I always do it for around 46 weeks as most surgeons will have about 4 or 6 weeks vacation per year, then there are required conferences and such to keep up to date (a requirement for their reregistration every year) and not to mention periods like Christmas where they may be unable to do much for 1 or even 2 weeks. This 11 TKRs a fortnight actually works out at around 286 a year. What a good friend (surgeon) of mine would refer to as a part-time knee surgeon (meaning knee replacements, of course!). My friend who refers to himself as "not a part-time knee surgeon" actually manages around 700 a year and also manages to squeeze in several cruciate ligament reconstructions as well as numerous other sports-related things. Needless to say, he was the one I choose to do my knee!
 
Hi everyone, just reading the posts about PKR vs TKR...
My surgeon is in Houston, too. A sports medicine Doctor, from Baylor College of Medicine. When we were discussing my possible PKR, he said we need to to a special set of xrays to make sure you get what you really need...to make sure the arthritis is confined to the inner knee only.

He then donned the xray protective gear and personally held my knee certain ways while the xrays were taken. He then xrayed my other (good) knee to see if there was any indication of arthritis there.
After all that , he said I definitely only needed the partial.

I read so much on this site about the skepticism regarding the partials that I am nervous anyway.

Also, is there a rule against referring or mentioning specific Doctor's names.??

One Doctor I tried to get some background information on, in Houston, had several very negative comments and experiences from former patients.

How do you check out Doctors when you don't know anyone who has used one??

This is such a supportive group. Bless the person who started it.

I am truly frightened and unsure of what is coming up..surgery date October 14. In Houston, Methodist Hospital, supposed to be a good one.

Anyone on here in Houston??
thanks, Marquesa:pnc:
 
The Methodist Hospital in Houston is an excellent hospital.

Jo will have to let you know about listing doctors names esp if a bad report.
 
Well, we've only had recommendations of surgeons so far. I think legally it might be dodgy but I'll check it out with the boss - that's Richard Warner.

Richard it was who dreamed of this forum and website. He had a hip replacement about 10 years ago and dreamed of a place where people could get truly inbiased information about things.

I have actually known of one or two people who've had PKRs and been very happy with them. Not to mention a few members on here. It's really the probabilities we're talking about but it sounds like your surgeon has gone the right way about it to ensure that you are suitable for a partial. In that I feel assured he has made a good assessment and therefore a good recommendation.
 
How many have been unhappy with the TKR surgery? Percentages? Because there are fewer PKR done lets base both on percentages. And base it on your experiences. How many out there have had a PKR? Just trying to play devils advocate.
 
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