KNEE ARTHRITIS - Total Knee Replacement :

TKR at 39 any experiences? - - Posted by fozzy (fozzy), 21 March 2004

Brief summary:
Tore lateral meniscus in 1989 aged 25, various keyhole arthroscopies 1989,1990,1991,1992.  Continued playing sport regularly til 1997, then sporadically after that.

2002, soreness in knee getting worse, surgeon suggested osteotomy (low femoral), to realign knee joint and load-balance the knee.  Knee was "extremely arthritic" and compared to that of an 80-year-old, although I could walk perfectly on it, I was told that I was around 13 degrees off centre, tibia moving outwards lateral side (bow legged?)

Considered too young, 38 at the time, for TKR.

Sep 2002 : exploratory surgery (5th keyhole operation)

Jan 2003 : low femoral osteotomy, leg supported by metalwork bracketed to lateral side of femur, scar approx 6" in same area.
Result: Femur / knee / tibia now straighter than before from front view, however from side has not aligned properly   and my ROM is somewhere between 13-15 degrees to 100-120 degrees.  Still lots of pain in the joint, but crucially now unable to walk properly because of the ROM and not being able to get below approx 15 degrees is severely hampering things, as well as the joint not being balanced and of course causing me pain.

Nov 2003 : Metalwork removed, due to me being able to feel the screw approx 1cm below surface.  No improvement in mobility.

Because of the problems following the osteotomy, it seems likely that the surgeon will recommend TKR on my left knee.

Does anyone have experience of this either (1) at this age - 39 and (2) following an osteotomy? And (3) what is the ROM, manoeuvrability afterwards?   I have 3 young children to think about, with whom I was able to run round the park 18 months ago!  

Has anyone any comments please?

(Berkshire, UK)

Posted by dm (dm), 22 March 2004

My understanding of a tkr after osteotomy is that it's a technically more complicated operation because of the alignment change and that experienced surgeons can cope with the challenge. Having additional shifting would make you even more of a challenge. I'd inquire about the doc's experience with TKR on knees with an HTO (osteotomy). You definitely need an experienced doc to fix yours.
Posted by fozzy (fozzy), 22 March 2004

Thanks, that was about what i thought. I wonder if anyone on the board has experience of actually going through this?  

By the way I presume HTO is high tibial osteotomy, therefore I am LFO (low femoral), not HTO.

I see a new consultant tomorrow for second opinion before maling the decision, just needed any opinions on TKR after LFO to help me along.

Thanks.
Posted by Sandy_F (Sandy_F), 22 March 2004

I have had a fulkerson procedure done prior to my TKR.  I also had a patellectomy done prior to the TKR too.  Whe the TKR was done, I had a modified fulkerson and a LR done to make sure things were properly aligned.  It can be done but make sure that the surgeon is experienced.  It was the same surgeon that had done all three procedures so he was very familiar with my knee and its mechanics.
Posted by heronak (heronak), 22 March 2004

Hey fozzy,

I have not yet had a TKR, but will in the next year or so (I'm 42).  I've found the greatest source of personal experience to be on the On Our Feet - Joint Replacement Forum:

http://forums.delphiforums.com/onourfeet/messages

All kinds of folks, all ages and situations - you're bound to find some answers and they are just as giving as people here.  All the best,

Heron
Posted by Stevejw (Stevejw), 23 March 2004

Hi Fozzy

I know exactly how you feel - I had to undertake a TKR 18 months back at the age of 37.

I can't comment on the osteotomy aspect as this didn't apply in my case. In terms of ROM, i can squueze out 100 degrees before hitting something akin to a brick wall.

The post op stuff was a little tricky in my case but I would suggest you take it easy - I tried to push things along a little and found myself in trouble and had to be readmitted suffering from a "bleed".

Generally speaking, and after 18 months, I can do many of things that I used to be able to do albeit in a modified way. I go to the gym (no treadmill though - just bikes, & x-trainers) and can mess around with the kids in the garden but without running I'm afraid.

On balance my knee is far less painful and with some planning and realistic setting of expectations you can get you stuff done.

Good luck

Steve

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