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Rheumatoid Arthritis and Knee Replacement

Discussion in 'Knee Replacement Pre-Op Area' started by amycrops2, Apr 19, 2017 at 7:16 AM.

  1. amycrops2

    amycrops2 New Member
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    Thanks so much for all the kind comments on my last post. This is along the same lines in trying to decide between TKR and PKR. One of the reasons my physician son is urging me to do a TKR is my having RA and the incidence of degeneration continuing in the other compartments. The ortho surgeon is going to talk to my son so that's going to help a lot with this decision. I also have a call in to my rheumatologist for her advice. I sure wish this had been a no question decision. I guess it is for the surgeon! ;)
     
  2. SusieShoes

    SusieShoes Junior Member

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    Surgeons are decisive, for sure. :) I had a knee specialist for about 10 years, who helped me nurse my deteriorating arthritic (osteoarthritis) knees along with cortisone and synovial injections. He was wonderful and considerate, but when I would ask him, "Should I get knee replacement? Are my knees bad enough?" he would only answer, "That's up to you. You'll know when they're ready." I figured he'd tell me if they were there. Nope.

    When I got fed up with the pain and said, "The heck with this," I went to a surgeon. He presented my options -- injections, cane, walker -- and I thought maybe he was trying to talk me out of doing replacements. I'm always a little afraid I might be making more of things than they are. So I asked, "You don't think I need surgery, do you?"

    "Oh, I think you do." He pointed to my x-rays.

    Ah. Confirmation. Some of us need it more than others. I'm sure you'll get good advice and know what you must do for the best result. :smile2:
     
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  3. sistersinhim

    sistersinhim Forum Advisor

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    I believe that partial replacement usually have to be revised to a total replacement eventually. I would rather get it over with one time, then have to go through the same type of surgery again. But, it is a decision for you to make, along with your family and your doctor.
     
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  4. Celle

    Celle Forum Advisor

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    My first knee replacement was a partial. I've never regretted having it done, because, after 9 painful years with arthritis in my knee, it rescued me from becoming housebound. I regained an active life and travelled the world with that PKR.

    My PKR lasted for 11 years, which is longer than most do. It failed suddenly, and most inconveniently, when I was in Canada on holiday. I had to travel back to New Zealand to have it revised to a TKR. The travelling and the waiting were not pleasant.

    The revision to a TKR wasn't too bad and my recovery was no harder than my recovery from the PKR. However, I chose to go straight to a TKR when my other knee needed replacing.

    Some PKRs fail because the arthritis progresses to other compartments of your knee. That can happen quite quickly for some people.
    Others fail because they were not installed well enough. It takes a particular skill to do a PKR accurately and some surgeons who do them aren't quite as skilled as they need to be. If you choose to have a a PKR, do make sure that your surgeon does a large number of them every year. Ask how many of those he has to revise, and within what time frame.

    For the record, I had a meticulous surgeon, who did a great job of my PKR. The PKR failed because I had unknowingly worn the plastic spacer too thin and one day it just snapped. That is quite a rare occurrence, one that I wouldn't wish on anyone, because it was painful. One minute I could walk and the next I had severe pain and could no longer walk. It was that experience, rather than the revision surgery, that decided me not to have another PKR.
     
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  5. kneeper

    kneeper Forum Advisor

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    Hi @amycrops2 with the RA my guess is the chances are good that the knee will eventually deteriorate totally. The problem is no one can predict if or when. Mine hung on a long time (many years with JRA) but there is no way a pkr would have done the job even though not all compartments were equally bad at the time of my tkrs.
    I think you're wise to have the OS and rheumy weigh in.
     
  6. SuperSnapper

    SuperSnapper Post-Grad

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    It's my understanding that most surgeons who opt for doing a PKR reserve the option of doing a full replacement when the knee is open and they can see the problems inside . I certainly gave my surgeon permission to use his judgment in my case. Not sure that helps much in your case with RA.
     
  7. amycrops2

    amycrops2 New Member
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    He didn't say anything about the possibility of a TKR - just told me I was a good candidate for a partial. Meanwhile my rheumy is deferring to his decision and ortho has yet to call my son. The ortho comes highly recommended by my rheumy and I'm sure both she and he are wondering why I don't just take his advice. Meanwhile I just want to get a surgery date set up and out of this pain!
     
  8. Celle

    Celle Forum Advisor

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    You don't just take his advice because this is your knee and you need to be sure you are having the most appropriate treatment, by the best possible surgeon.

    Having a good surgeon is the most important factor in getting a successful result.
     
  9. SuperSnapper

    SuperSnapper Post-Grad

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    You could ring your ortho and ask if he would do a full replacement should the knee be more damaged than imaging has shown so far.
     
  10. sistersinhim

    sistersinhim Forum Advisor

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    You need to make sure your OS understands that a total replacement is perfectly OK with you if he feels your arthritis will continue in your knee. Why have to go through another knee replacement on the same knee if you don't have to!
     
  11. KarriB

    KarriB Forum Advisor

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    A full replacement can last years. My dad's first TKR will be 18 years old this summer. So it's totally possible you may not need a revision with a full knee replacement.
     
  12. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Only problem with partials is that they have a sneaky tendency to require conversion to TKR after a fairly short time. I have been keeping a log of members who have gone that way. It started in 2011 and so far I have 35 names in the list. I know that's a small proportion generally but as a percentage of this forum, it is significant.

    I was originally offered a partial but I'm awfully glad I changed surgeons and got a total. As it happens, my surgeon told me he used to do partials but stopped because of the high conversion rate.

    If you had a total, I would expect it to last you your lifetime.
     
  13. kneeper

    kneeper Forum Advisor

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    Is your RA under good control? I'd hate for you to go through the PKR which has a very similar recovery period to a tkr and then have to go through another surgery again in a few years. Can you get another opinion from another OS who has a lot of experience with RA patients?
     
  14. KarriB

    KarriB Forum Advisor

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    I agree with your son, simply because one surgery is better than two.
     

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