Bicompartmental knee replacement

[digginit]

There doesn't seem to be a good place on the forums for this discussion, so I chose here.  Anybody who has had or is having two compartments replaced?  My surgery is scheduled for September 30th, with plans to do the patello-femoral joint and the medial compartment, though he'll make the final decision about the medial side in the OR. 

There are a couple prostheses that are made as one piece that resurface both compartments.  ConforMIS makes one and Smith and Nephew makes another.  Not sure if there are others that I don't know about.  We're going the modular route, using Zimmer's Gener Solutions patello-femoral prosthesis that can be coupled with their Uni knee.  I'm pretty well-educated about knee replacement in general, but this is getting outside of my knowledge base.  Wondering if there's any experience here and what it's been.

Thanks!
dig

[moon]

hi there, not sure what you are having,not good with all the medical jargon, i had two partials done in april, yep both at the same time, best thing i ever did, april 14 th, danced like a wild woman at my sons wedding june 21, still no probs, slight swelling  but was told that was normal for a year or so, still and afraid to get on my knees, just feels so weird  i did try it out on the edge of the bed, not to bad, but i have 5 acres of flower gardens that need my attention, on my knees!! so i need to stop being a woosie and give it a try, good luck toyou, denise

[digginit]

It's so encouraging to hear stories like yours.  Glad you're doing so well after surgery on BOTH knees.  Wow.  I'm only having surgery on 1 knee, but expecting to do two compartments, the patello-femoral and medial, though he'll make a final decision on the medial compartment in the OR.  It's uncommon to do bicompartmental replacement, but after lots of discussion, my ortho and I both think that this is preferable to a total knee at this point.

I can only hope to be doing as well as you are so soon after surgery.  You must be working hard.  Sounds weird to say congratulations, but it seems somehow appropriate.

~dig

[amy1]

Are they doing two compartements in the same knee or one in the right and one in the left?

[digginit]

Mine is two compartments (patellofemoral and medial) in the right knee.  Can't imagine having both knees operated on at the same time.  My hat's off to people who are tough enough. 

~dig

[amy1]

I never heard of two compartments being done in one knee.  My doctor said that he would either do a uni compartmental replacement or total

[digginit]

I never heard of two compartments being done in one knee.  My doctor said that he would either do a uni compartmental replacement or total

I had not either.  As my ortho and I were looking at options, we were planning for a total knee, but neither of us was really comfortable with that, mostly due to my age.  He wanted me to get another opinion, and in the meantime I did a lot of research on my own.  I ran across the iDuo by ConforMIS and showed it to the doctor that I went to for a 2nd opinion.  He thought that something like that would be much better for me, and he was also hesitant to recommend a total knee. 

I gave that same info to my ortho and also the information about the bicompartmental prosthesis made by Smith and Nephew.  He did more research and likes what Zimmer offers--two separate prostheses that work together.  He's done both of those individually and is very familiar with the individual surgeries.  He's never done the two compartments at once though, either, though they've recently been approved for use that way. 

These bicompartmental replacements have been being done for about a year in the US, so there's not much history to go on.  Bicompartmental replacements were done in the past with limited success--kinda like the Unis in the past.  Hopefully better prostheses really do make a difference....and I *think* I'm a good candidate.  Some folks would say that these should still be reserved for older folks.  Others think that younger patients benefit more.  I'm just gonna do my best to take care of it.

linz

[amy1]

Good luck!!

[Plumb]

I would just like you to keep in mind .. that if the units fail.. how easy would it be to upgrade you to a total knee with out injuring your bones.

The normal rule of thumb is if you have more than one compartment.  Total knee would be a better fit.. However modular knees are very new and just remember you will be a test puppet for them.

[digginit]

Yep.  That's a big consideration.  We've definitely thought that through and discussed it.  The good thing is that the components that we're using aren't new.   They're good parts.  Using them together is what's new.  Sure, we all know the rule of thumb.  But that's based on what there has been to offer so far.  There is definitely a risk involved.  I'm more comfortable taking that risk with components that we know are good....and the risk being an extension of their typical use into another compartment...than I am with using a system that's completely new. 

Understanding knee mechanics somewhat and having an orthopaedist who's very thoughtful about these things, I'm comfortable with this degree of risk for the benefits of a more minimal surgery.  That's just the informed decision that I'm making though.  Not saying it's the RIGHT decision, but it's mine.  Gonna work hard to minimize the risks as much as possible. 

~dig

[amy1]

You stated that your doctor did not want to do a TKR due to your age.  How old are you?

I am 52 and right now trying to put off any additional knee surgery as long as possible.  The past two months, my knee has not been that terrible, then again I am only working about 25 hours a week.  Come September, I will be back to a 45 hour week so who knows what will happen.  My doctor is not pushing me into surgery at all.  We are just trying to discuss all options in case I "hit a wall."  At this point, the doctor and I are discussing TKR or PKR.  My mri indicates that while I am not the "ideal" candidate for a partial, it may still be possible.  When I finally decide to go for a replacement, the doctor would order a bone scan to determine if there are additional hot spots in other compartments.  That would help decide whether I am a candidate for a partial.  If I did go for a partial, the bone scan would be used to create a semi custom orthosis.

[Plumb]

I have a total knee replacement in my right knee. I am really lucky.  I did not have any of the horror story's  that you hear with it.  I will 2 years in Dec.   

[digginit]

I'm 42 years old. 

I have decent moments, but they tend to occur during the weeks following a steroid injection.  Right now I'm 5 weeks out from my last one, and I'm reminded how debilitating knee troubles can be.  Ugh.  I'm glad that my ortho is one who was willing to really look into a lot of options with me.  I feel good about where we are, though the closer it gets, the more nervous I am. 

Sounds like your surgeon is pretty conscientious too.  Good to have a game plan, imho. 

~dig

You stated that your doctor did not want to do a TKR due to your age.  How old are you?

I am 52 and right now trying to put off any additional knee surgery as long as possible.  The past two months, my knee has not been that terrible, then again I am only working about 25 hours a week.  Come September, I will be back to a 45 hour week so who knows what will happen.  My doctor is not pushing me into surgery at all.  We are just trying to discuss all options in case I "hit a wall."  At this point, the doctor and I are discussing TKR or PKR.  My mri indicates that while I am not the "ideal" candidate for a partial, it may still be possible.  When I finally decide to go for a replacement, the doctor would order a bone scan to determine if there are additional hot spots in other compartments.  That would help decide whether I am a candidate for a partial.  If I did go for a partial, the bone scan would be used to create a semi custom orthosis.

[*Tiffany]

Why not just do a total knee? 

I had patella-femoral joint replacement and ended up with total knee just a year later. 

If so much of the joint is in bad shape, I would imagine the lateral side is not so good either. 
I would ask if total knee might be better. 

And as I always recommend... get a second oppinion. 

t

[digginit]

Why not just do a total knee? 

I had patella-femoral joint replacement and ended up with total knee just a year later. 

If so much of the joint is in bad shape, I would imagine the lateral side is not so good either. 
I would ask if total knee might be better. 

And as I always recommend... get a second oppinion. 

t

Thanks!  We're doing a bicompartmental replacement for a number of reasons.  1) less extensive surgery, 2) easier recovery, 3) a more natural knee, 4) the lateral compartment isn't involved AT ALL, 5) there's a possibility that we may not have to do the medial compartment (but my expectation is that we will), and 6) less bone loss.  Right now, recovery time is critical for me...I mean a REALLY big deal.  I've recently completed family practice residency and have just opened a new practice (from scratch).  My time off work right now is gonna hurt, and I need my recovery time to be as short as I can make it.

I have had a second opinion, and he agrees that this is a preferred option for me.  The three of us are in agreement.  I have assisted in a BUNCH of total and partial knees, but never on a bicompartmental replacement.  The difference between the two surgeries (uni vs total knee) is huge.  I'd do a total knee if it were clearly a better choice, but I don't think it is.  It would be nice to have some feedback from some folks who have had bicompartmental replacements though.  I did get some information from one person who had bicompartmental replacement back in November.  He's really pleased.  Recovery wasn't difficult for him.  He's older and less active than me, but I'm prepared to give up some of my activities to protect this knee.