Too young to have a partial knee replacement

[Squashmad]

Before my question a quick update.
Now over 5 weeks post pkr, off pain killers and doing well till I thought I'd give the exercise bike a whirl. Mistake, only did about 20min with little resistance but next day up came the swelling.

Anyhow to my question, I've read so many times "had pkr revised to tkr" but never an explanation of why!!
I'm guessing that revision within a couple of years is an implant failure but what about after longer periods. My OS told me that if I was back to see him again it would be because the other side of the knee had deteriorated not because the pkr was worn out.
I would appreciate some feedback as it will really influence what activity levels I may attempt going forward.
Thanks


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[Squashmad]

By the way my pkr is an Oxford.

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[Celle]

Anyhow to my question, I've read so many times "had pkr revised to tkr" but never an explanation of why!!
I'm guessing that revision within a couple of years is an implant failure but what about after longer periods. My OS told me that if I was back to see him again it would be because the other side of the knee had deteriorated not because the pkr was worn out. I would appreciate some feedback as it will really influence what activity levels I may attempt going forward.
Thanks

Unfortunately, some PKRs do fail early.
Here on BoneSmart, we've also had a couple of people whose PKRs were not aligned properly and never seemed satisfactory.

As your surgeon said, other people need to move to a TKR because osteoarthritis has damaged the other compartments of their knee.

My PKR lasted me for 11 good years. I was told to expect somewhere between 10 and 15 years, so that wasn't too bad. It gave me back my life and I did everything with it that I wanted to. Once my recovery was complete, instead of being a semi-invalid, I traveled extensively. I hardly gave my PKR knee a thought - although I didn't play demanding sports.

Then, one day while i was on holiday in Canada, the plastic spacer between the two metal components of my knee replacement broke suddenly. I had no warning that anything was wrong. My surgeon had retired and I had not had any follow-up appointments for several years.

By the time I got home, found a new surgeon and scheduled an operation date, a couple of months had passed. I had to have a revision to a TKR for two reasons:
1. Oxford had modified the type of PKR that I had and no compatible spacer was available.
2. Since the spacer broke, the metal components of the PKR had rubbed on each other, causing some damage, even though I was on crutches.

If a spacer is seen to be wearing thin, replacing a spacer is a less drastic surgery than having to replace the entire prosthesis.

People with knee replacements can do most sports, although most surgeons recommend against running and singles tennis. I imagine that squash would put similar stresses on your new knee.
However, I think you may find this article encouraging:
Sports after TJR: knee replacements not harmed by most sports

 

[referee54]

One thing that I have seen on my time on the forum is that some OS's have moved away from a A PKR as they eventually turn into a TKR. I have seen it more than a few times while on the forum.

My OS told me that if I was back to see him again it would be because the other side of the knee had deteriorated not because the pkr was worn out.

Arthritis can certainly be an insidious disease, and, while the part of the knee that contains the PKR impant is fine, the other aspect of the joint is now negatively impacted.

As for activities, the only time that I was told that it was OK to run was "for my life" ---as said by my OS. I really do not run anymore, but I do umpire and at times I have to get up the line to cover 3rd base, but my movement is on soft ground.

While I miss running and I certainly miss reffing college basketball, I have really gotten into cycling more and it has become more and more intense for me.

There have been some who have chosen to go back and pursue running and other more high-impact sports, and while many of us have made an alteration in our activities and lifestyle, I guess that the choice is truly up to the individual.

 

[shrdlu]

@Squashmad:

At 5 weeks post PKR, my physical therapist had only just put me on the exercise bike-- and with very little (if any) resistance for 10 minutes. I was told to peddle slowly and evenly. The bike was usually at the end of the physical therapy session and ice/elevation followed. So be kind to your knee-- swelling is your enemy. I have a foam wedge that I elevate the leg on anytime I feel swelling. At 5 weeks, just sitting with the knee bent (such as driving or sitting at a computer desk) still induced swelling. My physical therapist had told me that I was only allowed 30 minutes in a grocery store at that point. I found that to be true (30 minutes to maybe an hour was do-able for a shopping trip without too much swelling-- longer shopping trips meant a swollen knee). About once per week I would push things (doctor appointments out of town that took half a day without elevation...or my daughter had oral surgery and I couldn't elevate most of that day), and I always ended up with 2 days elevation to undo my "bad" day. It took about 2 months after surgery before I saw that my knee was starting to swell significantly less.

As for sports, I will tell you what my surgeon said versus what my physical therapist said. Surgeon said people with knee replacements can eventually play tennis or similar activities, but he did not recommend high impact activities. He said early knee replacement failures in younger people are usually from the joint becoming loose. (Physical therapist said loose joints are from too much activity too soon, when the bone hasn't had time to grow into the joint.) Surgeon said that the spacer (the plastic-y thing that takes the place of your cartilage) eventually wears down (particles are absorbed by your body), resulting in a revision to a TKR at some point, probably about 10 years after surgery. Physical therapist recommended that all high impact activities be totally avoided so that the knee doesn't wear out faster. Physical therapist said that if it was him, he would also avoid moderate impact activities, as they wear down the knee replacement faster. That included avoiding power walking. Physical therapist only recommended swimming or stationary bike for cardio. Surgeon also said it was not a good idea to do anything that required deep knee bends (squatting fully where the heels touch the behind), as it wasn't good for the implant.

In the end, only you can decide how much you are willing to take on versus your quality of life.

 

[referee54]

At 5 weeks post PKR, my physical therapist had only just put me on the exercise bike-- and with very little (if any) resistance for 10 minutes.

That is interesting---my PT's put me on the exercise bike first before PT to warm up the legs' muscles. Like you, though, in the early days, there was little or no resistance.

 

[MartialKnees]

I am 53 years old and a dodgy right knee. The cartilage is damaged. Last year I had an arthroscopy which improved it slightly. I was a keen jogger when I was younger. However, I can't do lots of the things I used to enjoy such as dancing, tennis. I have been told it is caused by arthritis. I've just had another arthroscopy and microfracture, so am non weight bearing on my right leg for several weeks. My surgeon said after the op that I would need a partial replacement. I was really upset about this because I think I am too young and it is a big operation. I just wondered if there was anyone else out there who is in the same or a similar situation to me! :(. I would like to hear from you for advice.

I am EXACTLY your age. In a few weeks I'll have BTKR. Once arthritis gets unbearable there is no return...no pill or magic cream to fix the problem. Only you will know when it's time.

As far as partial vs full replacement....my surgeon feels only perfect candidates are helped fully by partials. I was not a perfect candidate as I had some arthritis on the lateral side as well. I chose full. IMO I didn't want partials only to repeat a surgery a few years later. It's a personal decision but one to think about....

 

[Lovestoread]

I didn't have partial TKR's, but total TKR's, so I can't speak to them or their recoveries. I have seen so many people here on the forum need to have totals fairly soon after their partials, so I would hesitate, but that's just me. As for your age, I had suffered for years and had arthroscopies on both knees, and three rounds of Synvisc injections that bought me almost two years of relief. My surgeon told me at age 55 that I would have to wait until age 65 for knee replacements. I had already had to cut back on so many activities and was beginning to consider retiring from a job I loved that requires me to be on my feet. I did some research and found a surgeon who didn't question my age....only my quality of life. During the summer of 2013 I had my knees done and haven't looked back. The only downside? I guess I'm not retiring for another 5-7 years!


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[Celle]

I am 53 years old and a dodgy right knee. The cartilage is damaged. Last year I had an arthroscopy which improved it slightly. I was a keen jogger when I was younger. However, I can't do lots of the things I used to enjoy such as dancing, tennis. I have been told it is caused by arthritis. I've just had another arthroscopy and microfracture, so am non weight bearing on my right leg for several weeks. My surgeon said after the op that I would need a partial replacement. I was really upset about this because I think I am too young and it is a big operation.

I started having problems with my right knee when I was 50. I have already said that my surgeon advised me to wait until I was 60 before I had a knee replacement.

Looking back on the nine miserable years I waited, and with the benefit of hindsight, I would jump at the chance of a knee replacement at 53.

 

[DeuceDiamond]

I am 28 and am having a LTKR done in January. If knee pain and immobility are negatively impacting your quality of life, I do not think age should be a deterrent.

 

[referee54]

My doctor initially said "too young" (at age 50)

Neither my referring OS, nor my OS who performed the BTKR surgery, mentioned anything about my age, which was 53 at the time.

 

[newlybionic]

I got the talk from my former OS at age 50 that both my knees would need to be replaced but he would not even consider doing it until I turned 60. Now I'm 61 with one knee done. I was in very bad pain and had stopped doing anything for fun. No sports, no dog walking or anything enjoyable. It also led to muscle atrophy. No I'm fighting an uphill battle to get those muscles back. I think if I was younger I would have been able to have a quicker and less painful recovery.

s far as sports I was told no jogging, no singles tennis, no skiing or snowboarding over moguls or jumps ( like I have my snowboard ready!). I would like to relearn skiing. I would also like to go back to coaching basketball or softball again. I hope everything go well from here on out.