should I or shouldn't I

[fcrist]

hello.i have been told by os that my oa is not terrible in my lateral aand bilateral compartment,but i have terrible oa of the kneecap. he does not like pkr and is leaning toward tkr .i don't know if this is right .should i wait until total knee is shot? i have had a second opion and that os said a pkr is in order. help i am confused

[JBL]

Hi Fcrist,

I have RPKR and LTKR so have a little insite into both..  It's a difficult call when it comes to OA in the kneecap only and the other compartments are good.  I still have my own kneecaps with the KR's and have some OA in the RKneecap my OS said when it becomes a difficult problem for me he would put what they call a button on the kneecap ..

Did you ask your OS if a button could be done on your kneecap and no replacement needed could this be done ?  It seems a shame to replace the whole knee when the kneecap is the problem.  Personally for me I would opt for a TKR I find it better than the PKR.

If you have any further questions let us know, we are all here to help.

Till next time, have a good day 

Gayle..

[knee deep in Goo]

I would strongly suggest going to a third OS and see what he thinks.   Some OS's are simply more skilled at  PKR than others so they may avoid it.
Another thing is if you have OA in more than one compartment I would say TKR is the better route to go.

The should I or shouldnt I question is one many of us go through. It was really apparent in my situation that I needed a long term solution.  I had a scope in Jan 06 . My OS started treatments to hold off TKR in June 06 - TKR  done dec 06   So I gave it a good year of everything under the sun.

The day after my surgery I was up and walking to a chair.  I used a walker for like 10 days and than back to my crutches to go outside.  At a month I totally ditched all aids and was working on my gait not to limp.

[fcrist]

Thank you for the help. I want to clarify  that i have had 2 scopes first a partial lateral miniscectomy.My second scope was partia later and partial bi later minisectomy along with a partial synovectomy. I now have some degree of pain (ache to excruciating) evryday, especially my kneecap witch tends to go down to the shin. recently i am pain in the back of the knee ( is this normal OA symptom). I am currently waiting for an appt. with a 3rd OS. Again thanks so much for the help.

[JBL]

Hi Fcrist,

Sorry cannot comment on your knee pain as everyone is different, I  had pain from front to back on both knees and my LK would collapse without warning or lock up, my RK would lock up while sleeping, since surgery the LK rarely goes out but I compare it to like a slip on the plastic insert on the replacement but it does not hurt like it did before surgery and the RK has at times locked up but it is a rare occurence possibly 4 times in nearly 20 months. before surgery it was like every day.

With both your kneecaps it would be better to wait and see what the 3rd OS has to say, something new may have arrived everday the drs seem to have other new data information being updated.

After visiting this site you would have a tonne of questions to ask the OS...

Let us know how you get on..Take care...

Till next time. Gayle

[lajama]

you may want to ask about Smith & Nephew's new oxinium component that replaces the patellofemoral groove and the complete under side of your patella.  This surgery is called a patellofemoral arthroplasty, is this what your OS is considering?  If your problems are only with the patella this may be a great way to go.

[Janet]

I had the exact same dilemma as you did...the lateral and medial compartments were fine, but the back of the patella was in bad shape. My OS said he could do either a PFJR or a TKR, but would lean toward the TKR. I saw two other surgeons who both said they didn't like the PFJR because too many of the patients ended up with a total knee within two years. They also explained why they didn't like the PFJR....it was technical and I don't remember it well enough to repeat it. (I also saw a workers comp OS who said I didn't need a TKR, but  he also agreed that the PFJR is not a good surgery.) However, all agreed that it also depended on the patient's age. If you are in your 30s, they'd do the partial. If you are in your 60s, there's no question but to do the TKR. I was 49, right in the middle.

I decided to go ahead and have the TKR. Why mess with a PFJR if there is a chance that it would need to be revised to a TKR in a couple of years? Interestingly, my OS found that the patella was even worse than he expected, and that I had a meniscal tear that didn't show on the MRI. I have had some complications and a rather hard time with the TKR recovery, but am making progress and still expect a very good outcome. I still think it was the right decision for me.

Janet

[fcrist]

thanks for all the imput,Janet my OS said he is not a big fan of pkr,so if he does anything it will be tkr.as i said previously my 2nd opinion was saying pkr. maybe it's best i wtihstand the pain until OA bad enough all around. thanks again all.  Frank
 

[fcrist]

Sorry i forgot to mention my age  i'll be 54 this year thanks again

[L. Thomas.net]

Although I do not consider myself in that "TKA is the best thing I have ever done" Club yet, I will have to say I don't have that OA pain at all.  I guess I just need to give it some time.  I still have problems knowing when to stop.  I just do to much and pay for it.

[knee deep in Goo]

Although I do not consider myself in that "TKA is the best thing I have ever done" Club yet, I will have to say I don't have that OA pain at all.  I guess I just need to give it some time.  I still have problems knowing when to stop.  I just do to much and pay for it.

Do you feel you where more mobile prior to the TKA ?    For me I knew from those first hard steps that life could only get better. I am sorry to hear you feel that way.  Have you tried Lidocaine patches yet?  I know when I over do it my hip hurts but still I feel I got the better end of the deal because my daily pain is just not the same.  Knowing this surgery may not take away all the pain.  I just hate to see you write about being discouraged when it is still pretty early in your recovery.



I think that is why you have to weigh should I or shouldn't I pretty darn well.   You have to know that  it will be a pretty long recovery and this is the surgery of last resort to restore mobility to a pretty disabled existence.  That way you know when you go for it you know it may be a year or two before everything heels.  Perhaps that is the difference that helps you make your decision. That way you are motivated during that post surgery period.  Also there is a risk that things may not get better but worse for a small number of people.  I am sure those cases are in the elderly age bracket and not posting there recovery on the internet. 

[L. Thomas.net]

I remember when I couldn’t make up my mind about the surgery..even when I was having debridement and the OS said “How about TKA” while I was on the table.  I still wasn’t ready.  Then I went to a seminar on TKA.  When I told the OS I wasn’t sure it would increase the quality of my life he wanted to know what was one thing I really wanted out of the surgery.  I said “to be able to get off the toilet”.  Half of the room laughed (the OS didn’t) and all I could think was “YOU AINT THERE YET!”

A girl that spoke about her TKA came over to reassure that I would be able to do lots of things.  That is when I said “Yes, I know it is about time to do something because when I go to the bathroom and there is someone in the handicapped stall, I wait until it is empty.”  She didn’t blink and eye and  stone-faced replied, “Handicapped, that ougth to tell you something”.  I called and got an appointment as soon as the OS office opened.

I guess I would tell you that you will have a “light bulb moment”.  I don’t know if you will wait for it or not. I do know that this is a long slow process.  You really have to be motivated to do what you need to do after the surgery.