Partial Knee Replacement

There is a long way between a clip of a torn meniscus and a PKR. Can you tell us what else is going on in the joint? How big are your lesions? What grade? Are they limited to the medial side? Which bone(s)?

What are you doing in terms of PT? Core work? Quad work? Do you have a range of motion routine?

How old are you? What caused the tear/the lesions?

Have you discussed other options...microfracture/OATS/AMIC/ACI/Osteotomy/ meniscal transplant etc etc. If your damage is confined to one compartment (or one side and the patellar area is mild to moderate), an osteotomy is something to talk about as well.

I would talk more with your doc, and get all of the particulars and specifics about your case. Then I would get at least a couple more opinions, regardless.

I agree, it has been a long road for a surgery that was suppose to be pretty simple. The Arthritis is a grade 4 in that area. The damage is confined to one compartment. Medial of Left knee. I am not sure which bone has the damage. I have requested my records and films and will pick them up Wednesday.

Both Dr's so far have said PT would not help any. I am doing core work, quad work and range of motion on my own. I do have some weakness and discomfort due to the swelling but almost have a full range of motion. I work the bike, swimming and elipitcal regularly. I run on the treadmill but can accomplish no more than a mile or so. But I have done some 5K's with my 9yr old son, but with pain.

I have discussed options with the 3 dr's I have seen so far but they always suggest leaving it as is or getting the PKR. I just dont want to give up an active lifestyle if there is any hope to still run. They have said that would be the best option. With the grade 4 OA, the Meniscus transplant was ruled out. After doing some more research I will ask again about the Mosaicplasty or OATS.

If the lesion is small enough, then you may still be a candidate for one of the replacement therapies. OTOH, if it isn't, before you look at PKR, look into an osteotomy. It is, by far and away, the better choice for people who want to remain active (not that you CAN'T run on a PKR, but the whole rule of "keeping your good bits for as long as you can" is the best rule to follow).

Also, depending on the extent of the damage in the compartment, you may or may not be able to pair a meniscal transplant and/or cartilage repair with that osteotomy. Some docs will do them together or will do them in two procedures. (My doc does not do cartilage work with an osteotomy--he thinks they should be separate procedures for recovery and rehab purposes. Although that issue was moot for me, as my damage encompassed the entire lateral compartment and repair of any sort was not possible.)

An osteotomy involves cutting the bone across, and then either removing a section to shorten it on one side (closing wedge) or adding a bone graft to lengthen it (open wedge). It can be done on either the proximal tibia or the distal femur. Which procedure/combination you get depends on the side of the leg, the amount of correction needed, and the surgeons preference.

For medial damage, chances are you'd be looking at an HTO (high tibial osteotomy). It has a shorter recovery time than the DFO, is much more common, less chance of error, and a pretty good success rate. KathyG just had oen (I think she also had a TTT as well?).

If you'd like literature on it, I can certainly provide you with some :-)

As far as the pain levels...that, in some cases, is a personal thing. I mean, what you decide to do about it. I was all right with running on mine with pain b/c that was what I was used to, since I had it since I was a kid. Mine only became an issue when the ROM and swelling levels were so bad my daily life was compromised.

Don't know if you are addressing me, but I will give you my .02 in response to that... Everyone is different, even in terms of osteotomy. You may end up with two folks having two different procedures to correct almost the same defect.

That being said, an osteotomy might last you 5 years...or 40. It varies. But the answer is usually somewhere in between. 10-20ish, depending.

For me, when I had mine, I was 33, and looking at a joint that was completely destroyed laterally. I could continue to run on it, and it might last 2 years...or 10, or I could  NOT run on it and it would last 2 or 5 or 10 or 15 years, but eventually, either way, I was going to need a pkr. The osteotomy would buy me at least 5 years, maybe 10, or even mor, of being active on kmy own parts. And that, I think, is the key. My end point is, and has always been, a pkr. The difference is what I want to do in the middle and what I want to put up with.Now, with the osteotomy, the end point is both compartments--b/c barring complications, what "fails" in an osteotomy is the other compartment.

If I run 3 dpw, supplement that with ET and pool running... I'd say my knee has 10+ years. I'd hope it's more (and assuming I'm smart, the "odds" are it may be"), but it could be less. NOTHING is certain. Again, two people can have the same amount of damage, and the same procedure and end up in different places (random example: how far your surgeon chooses to correct--some over correct past zero degrees, others do not. It's a philosophy, and an art...not a science, at least not 100%)

Everything in this situation is a roll of the dice. It really is, and you just have to decide where you are, what you want, and what your risk/reward ratio is. There's no one answer for everyone.

Get one, two, preferably three or more opinions. If one option or the other is right for you, the answer will come out--and come out clearly (although the fine points of that may not be...e.g. femoral or tibial, angle of correction, cartoage work or not, etc.).

For me, it was 100% the best answer. I've had some random set backs and/or complications--which you can have with ANY procedure. But even including that...I do not regret it for one second. My knee, after dealing with pain and swelling and general annoyance for most of my life? It's not an issue. It feels GREAT. The rest of my life may be going to hell in a handbasket, but my lateral left knee is AWESOME. :D Even without complications, it's a longer recovery than a PKR (A DFO, which is what I had), but by far and away worth it.

I had two osteotomys in December. I had 2 bone on bone spots on my medial side and 1 on my patella. My doc did HTO to realign my knee and also a TTO moved part of tibia to avoid the bone on bone spot on my patella.

My orthopedic surgeon does mostly osteotomys and ACI to deal with specific type of knee issues. He works with younger folks with injuries and 40-60 age of older active athletes who want to avoid knee replacement. He does very specific surgeries and no replacements.

Most orthopedic surgeons don't do osteotomies so you need to look around for one that specializes in it.

Before I got to this ortho, I saw 6 others, 2 other specialists and ended up referred to the ortho I used. Living in Boston we have many sub specialists and I was told by two other knee specialists that he was the doc for me to see.

My time line was torn meniscus and surgery 6/1/2010 and at the time I had normal age appropriate cartilage and both medial and lateral meniscus were trimmed about 15%. Within a year I had 3 bone on bone spots on my knee. No reason was determined why I had such rapid onset of arthritis. It could be scope, could be bad luck, could be Lyme's. I kept asking why but no one had the answer only what to do to fix it. My hope is that lateral side cartilage doesn't go as quickly as medial side.

My doctors goal is to get me atleast 5 years before I knee knee replacement.

Have you tried a medial unloader brace? For me the almost immediate pain relief which was why I wanted the osteotomy.  I also stopped running in May and was surprised how much my knee improved.

I do have an unloader brace and it does help. With work though it is hard to wear, so I wear it alot after I get home and on the weekends.

Do you know of anybody else that had had the surgery like yours and how they are faring now?

Steve Yzerman was an NHL player who returned to action after a DFO. On a smaller scalle, there are several of us on KneeGuru who have since returned  to sport. Weenis on Slowtwitch is back running again, as well.

DFOs are less common than other types of osteotomies...but there are many of us out there, plugging along, if you know where  to look. :-)

One of the items by ortho Dr. brought up was the longevity of the PKR lasting if I continued to run. If you don't mind me asking, how old are you and how long do you think you will continue to be active and run? He told me that it should last almost 20years without running. He told me that it would shorten the live of the appliance if I run.

Thanks

sounds like he maybe advising on the easy option rather than the best option, just remember, not all ortho's are born equal as i have found out. What about a graft from the stone crew or pay steadman a visit? Surely they have some other options for you to get more life out of what you have before introducing machinery into the joint?

Get another opinion. Get several. Seriously. I wouldn't suggest doing an osteotomy or a replacement without at least three opinions. My leg is corrected to neutral--the alignment does not in anyway affect my future for a replacement. Noty evefryone's case, but the case in mine.

If you want some articles on replacement following osteotomy, I have some.

I spoke to my Ortho about if my HTO didn't work would it be harder to have a good knee replacement and his response no I will send you to someone who can do a good job and that outcome of knee replacement would be same with or w/o the HTO.

I agree with Megan get quite a few opinions. Living in Boston we had access to top docs and they are quite good at referring you to the right guy who does specialty surgeries. 

It goes against many our belief system to questions physicians and their ideas. I had to go to many doctors before I found the answer I did. I wasted 6 months of time which my knee got steadily and rapidly worse. I wish I had been a bit more aggressive as it is possible other surgery options like ACI might have been available to me if I had found my doc sooner.

I'm 60 days post op today. I was able to start walking yesterday. Good news I have zero knee pain. I have some discomfort from where the plate was placed where wedge opening was made, but that is steadily getting better.

well, perhaps if i may clarify that statement ... maybe they have forgotten about osteotomies or have other incentives to do different procedures or they have a different skill set, but "they" (we) all learn about osteotomies about the knee (and other parts of the body, for that matter,) the different types and the different indications. it's board-certification testable material and is often tested on the yearly in-training exam for orthopaedic residents.  

to answer one of the OP's other questions - having a realignment osteotomy (assuming you're mechanical axis is off a bit varus/valgus and/or you have a cartilage lesion) doesn't really further complicate an arthroplasty procedure (joint replacement) down the line, if you have a good arthroplasty surgeon.  (i.e. a fellowship-trained one, not a general orthopaedist who only does a handful of arthroplasty procedures each year.)  there are some cases where an osteotomy just won't help you out - if you have a pure cartilage defect but no overall alignment pathology (a good, neutral mechanical axis, without appreciable varus/valgus deformity in your knee from your femur or tibia,) an osteotomy may give you a tilted joint line and would be contraindicated.  in some cases, like people who's knee(s) aren't aligned neutrally along their hip/knee/ankle mechanical axis (predisposing to what starts as unicompartmental arthritis, an osteotomy may be helpful for a future arthroplasty, to give the joint surgeon a neutral mechanical axis with which to work.  

hope this adds to the info for you.  best of luck with your knee!  

Yes :-) You've said it better (as well you should, being a pro and all :-)).

Hello Friends,

This is John here new to this site. After the insertion of an artificial hip or knee joint is increased in the blood vessels for a time the risk of clots. These clots (medical: thrombus) may then be washed away with the blood flow and block at another location in the body of a blood vessel. Most clots but are metabolized by the body so quickly that they do not cause any discomfort. Sometimes, however, occur in the weeks following joint replacement surgery symptomatic "thromboembolism," for example in the lungs and inside of the leg arterial system (known as deep vein). For prevention of thrombosis, leading to discomfort, there are several medications available. Within 12 to 24 hours after kneereplacement surgery After a hip replacement, it should be taken 32 to 38 days after a kneereplacement 10 to 14 days.

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