TKR Which way should I go?

paul01609

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Hi every one new guy here
I had my appointment with knee surgeon the other day the way he was talking was not to go knee replacment but go with osteotomy I’m totally unsure which way to go because of my age,
In the letter it sounds like the option is there for knee replacement
Thanks

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@paul01609 Welcome to BoneSmart!

The first issue is age is not a factor in your decision. We have members younger than you who have had knees replaced.

The letter says you are not keen on the replacement option. Why?

Have a read in the knee recovery forum. Lots of happy members there.
 
I had a PKR 4 months ago and am now beginning to really feel the benefit.
If I were you I would do plenty of research on both options.
PKR surgery can be a good option. The recovery isn't necessarily shorter than a TKR but it can be and I think you often get a more natural feeling knee and more likely ability to kneel. It is less common than TKR surgery - and results do seem to vary according to how frequently your surgeon does PKR as opposed to TKR.
Surgeons who do lots of PKR, perhaps unsurprisingly, get better results. If you are in the UK the National Joint Registry is an excellent way to check your surgeon's figures and results.
Another point. Medial PKR is the commonest PKR and the one surgeons are most familiar with- so results and recovery time are probably better than for lateral and patellofemoral.
I think osteotomy is for leg straightening and pretty painful post- op? I don't know much about that except I think it is used in younger people like you.
My leg was straightened ( previously seriously valgus) as part of my lateral PKR and I am very pleased with that- as it has helped my other joint issues.
 
I would be happy to go knee replacment but the surgeon sort of talked me out of it because of me working.
tio be honest he wasn’t very nice to talk to but as long as he does a good job I’m happy
thanks
 
I can't speak to surgery but I'll note that I've had many steroid injections in both knees over the past going on 8 years to keep them going (doctors in my HMO refused replacement until I get closer to 60 - it doesn't matter how awful they are apparently) and some injections "took" WAY WAY better than others. Some lasted me 8 months or more - some were 2 weeks. I had to hunt around to find someone good at giving those shots because after so many at this point I've realized some doctors/doctor assistants are not as good at giving them. My ortho himself was the worst actually.

I'm just noting that it is possible in some cases that another injection when you're eligible (after 4 months) could in work - or maybe not. At least if it doesn't it gives you even more reason to pursue surgical options IF you're looking for a reason to avoid it. I'm not suggesting you go that route, just sharing my (forced due to no other options) experience with steroid injections. I was around 52 years old when I first had serious issues - FYI. I did have something like your experience happen in my early 40's with one knee and a steroid shot did give me many years of a trouble free knee.
 
Could it be because of your job he wants to try this first? I'm sure you have to be in a squat position most of the time and even kneeling. You can do these easier with a PKR than a total knee. A second opinion would be the way to go. What happens down the road when a PKR is no longer an option? That is what happened to me. Good luck!
 
Guess I could go with a second opinion , spent a lot of today reading about the process of both operation I’m now leaning towards partial knee replacement sound like faster recovery and if I have the osteotomy there’s a chance I still might have to have partial knee replacement
thanks all for your help
 
I’m now leaning towards partial knee replacement sound like faster recovery
Partials are often promoted to be a faster recovery, but often this is not the case. They basically take an average of a full year, for complete healing, just like a total does.
and I think you often get a more natural feeling knee and more likely ability to kneel.
While this can be the case for some, this can also happen with a total.

Try not to get caught up in all the things that are written about partials. None of it came true for me, and we have many members who have gone from PKR to TKR, some in a short time.

The best way to have a good result with a partial is to have a very experienced surgeon who has done a lot of the particular partial you are getting. Surgeons who do lots of totals are not necessarily great with partials, if they don’t do them often enough to get good at them. I found this out the hard way.
 
Found this paper weighing up the pros and cons of PKR versus TKR. If you Google the title you can get the full pdf free and it is not that technically challenging to read.
One of the points of interest is that because PKR are easier to revise the revision rates may be artificially raised and more PKR than TKR are revised even if the Oxford knee score is the same i.e.- people may be told to live with a poor outcome on TKR whereas a surgeon is more likely to attempt a revision of PKR.
Another interesting point is because there are more revisions of PKR there is a perverse incentive to stop doing PKRs - as revision rate is seen as a marker of surgical ability or lack of it. Whereas in fact other outcome measures may be worse with TKR.

Unicompartmental knee arthroplasty: is the glass half full or half empty?​

D W Murray et al. Bone Joint J. 2015 Oct
 
I agree with @Jockette that if you are going down the partial route it is very important to get a surgeon who does lots of them and is very familiar with the surgery.
My surgeon is a great fan of partials and is the second author on the paper above. He thinks for the right patients they are a better option.
Another point. Although partials are rarer the medial partial is the most common and the one surgeons are most familiar with- so I think outcomes may be better than for laterals or patellofemoral partials.
I have definitely read papers that say that surgery for lateral arthritis/ knock- knee is more technically challenging. I had a lateral pkr complicated by severe knock knee which has now been straightened- so I think that has slowed my recovery a bit. My daughter in law's father had a medial about a year ago with a very straight forward recovery and he is back skiing now- although my son says that us pretty gentle skiing!
 
Originally, I was scheduled for a lateral PKR but was told that very are a low percentage of the PKRs done, especially if u have a vagal stance because of the lateral knee forces. Medial PKRs seem to be the vast majority.

In any case, if your future bone health could be in question, your should be able to get some good opinions on if a PKR is the right fit. Good luck on your journey!
 
Have you gone through a course of physical therapy?
 
I’m going back to my gp speak it over with him and maybe ask about a second option,
the knee specialist I have see doesn’t do knee replacments as far as I know I think that’s why he was pushing the osteotomy(might be wrong).
 
He was very rude, I told him I’m starting to get pain in my other knee but I can manage that pain his very sarcastic reply was well your knees were born on the same day weren’t they
 
I have had four surgeries on my knee, including my TKR by three different surgeons and all of them, a different specialty within the knee realm.

I would think if you want straight answers, talk to a knee replacement specialist?
 
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the knee specialist I have see doesn’t do knee replacements as far as I know I think that’s why he was pushing the osteotomy(might be wrong).
Big red flag here! I totally agree with you about seeing your GP for a second opinion referral. You want a surgeon who has done thousands of TKRs.

If you tell me your location and who you have already seen I might be able to help you find someone.
 

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