Do I proceed with a TKR?

[Jill M]

Hi all. I have posted under the arthrofibrosis section of this board but I am contemplating a TKR. I am almost 40 years old. I have had multiple operations on my right knee. Of course hindsight is 20/20- I really wish I would have had a TKR from the start but I can't turn back time.
 I started with a sports medicine MD and he advised totally against a TKR. I was 38 when I had a menicus transplant, osteotomy to realign my femur and several other cartilage grafts. To make a long story short, I have had major extension loss and patella issues. My flexion isn't too bad 108 degrees. I can function. My problem is that I still have a significant amount of pain. I do have joint space since the major surgery.
I have had 2- 2nd opinions. One was another sports med/ortho that said that a TKR would help address most of my issues but they wouldn't do the surgery so referred me to another MD. I have travelled to Cincinnati to St. Louis, MO. Yesterday I saw a bone/joint specialist. He said that the TKR may or may not totally fix all my issues. I realize that every case is unique. Mine is especially unique. With the possiblity of it helping one part of me wants to proceed and then the other says no. Does anyone have similar experience? Any feedback would be appreciated.
Thanks,
Jill

[elizabethb]

I am curious about your meniscus transplant - it was from a cadaver?  How long did that last for you?  I ask because my daughter in law had this procedure done 5 years ago.

[Jill M]

Elizabeth,
The meniscus was a cadaver. The worst part about all of this is that all of the cartilage transplants are in good shape and have engrafted well. It's the other stuff that is causing issues.
Jill

[Plumb]

I would think twice .. three times.. before going into a TKR.  See several doctors before plunging into a TKR.
Normally When I think of a TKR I think of no cartlidge left. You mentioned your graft is healthy.

What are the doctors stating your extention issue is from? How close to zero are you?

Your Flex is just over what is considered funtional at  108.   I am sure you know 90 is considered functional however so many strive for more post TKR.   I am fairly certain the doctors have warned you that your flex may never get better and could very well worsen post TKR.   

In your situation.  I would think very long and hard about getting yourself into a worse situation with a TKR. Even if you have to fly out to the hospital for special surgery in NYC and meet with one of those doctors.  Your case is a very delicate situation.   And your very young.. to be handed off a worse situation than your in now.   

I was 36 when I had my TKR in my right knee..  My left knee has issues.. and a looming TKR is needed for it. 

The AF puts you in a different boat.  My two cents is to seek out sound medical perspectives before you go into a TKR.   I would hate to have your expectations high and see you heartbroken after a TKR is placed in and you still have to deal with AF issues.    Once you have AF..   You know your healing nature is not like anyone elses. 

If your getting may or may not responses.. and having doctors refer you out to someone else..  I see a clear indication that the risk of you getting into a worse situation is high.. and they would not want to be that person who puts you in a worse off situation.

You need to seek out only the big gun doctors.. who can give you clear expectations..  on what can be possible ..  and clearly define what a TKR will bring you. ..  and you need to clearly understand that you may have lingering pain issues ... that may not be able to be resolved with an implant.

stay strong..

[Jill M]

Thanks for your reply Plumb. From what I have been told the extension issues is a result of scar tissue in the back of the knee. I am about 10-12 degrees from full extension. I am not worried about flexion, as you stated it is functional. I was told that it would not improve.
I realize that the AF puts me in a different category from others. Thanks for helping me see a clearer picture. I didn't look at the referal to another MD in the same light.
I am taking a long hard look at these things and am not rushing to any decisions. I see now that the knee that I have now may not be so bad after all.