KNEE ARTHRITIS - Total Knee Replacement :

Facing TKR - what are the other options? - - Posted by bayrab (bayrab), 28 February 2003

I haven't posted here for awhile. In Sept. 2002, OS told me I had no "ACL (something Ive known for awhile).. He recommended ACL repair. I went to another orthopod in December (on my birthday, bad idea)... he said I'm too far gone for anything but a total knee replacement! He said there is not enough cartilege left to work with, and at my age, they don't worry about acl's (51). I asked him about cartilage transplants.. apparently, he does a procedure of removing some cartilage and growing it in a culture and then replacing it... he told me I was too old for that, they only do that on young people!

I know I'm old, but not THAT old, and I'm very active. I'm an endurance rider (horses) and ride at 5 to 7 mph, at least 3 days a week for 2 or more hours at a time. I keep two horses conditioned for competition, and I'm training two more horses.. I do all the farm work.. lifting haybales, cleaning manure piles, etc. I am very busy and active!

But my right knee is a constant source of pain. I'm starting to need narcotics to keep riding. Is there ANY alternative for me besides a TKR? Any thoughts, encouragement? Anyone here do extreme physical activity after a TKR

thanks

chris
Posted by hmaxwell (Heather M.), 28 February 2003

Chris,

Which type of cartilage are you missing?  The articular cartilage that coats the bones and provides a frictionless motion, or the crescent shaped meniscus that acts as a shock absorber?  I'm assuming, since your doc talked about culturing cartilage (ACI or Carticel transplantation) that you are missing the articular cartilage, but please correct me if I'm wrong.

It would be important to know where your damage/lesion is, and how large.  If you are not a good candidate of for ACI/Carticel, what about something called OATS or mosaicplasty?  What about microfracture?

Basically, you need to understand that there are several possible treatments for someone with arthritic lesions (again, assuming that it's articular cartilage that is your problem).  Doctors tend to pick one type of treatment and do only that--so if you talk to an OS that does Carticel/ACI, he or she probably doesn't perform microfracture or OATS procedures.  The best thing you can do in this case is get all of your x-rays, MRI's, surgical reports, and photos and seek multiple opinions to find a doctor whose expertise and plan fits with your particular knee problem.

Just off the top of my head, not knowing anything about your specific damage, there are a couple of options that spring to mind--TTT surgery, OATS, microfracture, ACI/Carticel, arthroscopic lavage, an unloader brace and/or taping, Synvisc injections.....As you can see, there are quite a few possibilities.  It would be a good idea to talk to your doctor about why these are or are not options for you--at least it would be a good start.

And if it comes down to it, a TKR might be the right choice.  I do know of someone who is 22 and had a TKR as the result of a devastating motorcycle accident.  He hikes, mountain bikes, and plays basketball, and he is also missing an ACL.  Who knows what his knee will be like in 10 years, but he's doing great now.
Try looking through the kneeguru home page, www.patellapain.com and www.arthritis.org for some ideas on medical and lifestyle ways to manage chronic knee pain.  

Hope this helps.

Heather
Posted by bayrab (bayrab), 28 February 2003

It's the meniscus that is bad.. I had a meniscus tear 3 years ago and arthroscopy for that, where they trimmed the torn part.. well, of course, now there is no meniscus in that area and the rest of the meniscus is very thin... the OS said I have less than 1/8" of cushion ... so I have pretty much bone rubbing on bone.. I may be missing the other kindtoo, I'm not sure, I'll ask! I do have some arthritis in that knee, but no bone spurs yet....
Posted by bayrab (bayrab), 28 February 2003

Heather? What is OATS? besides what I feed my horses, LOL??
Posted by hmaxwell (Heather M.), 28 February 2003

Hi again.

If you are missing the meniscus, do some web research on meniscal transplants (from cadaver).  

Also, there is a study in the US on collagen meniscus replacements.  One company that I know of is www.regenbio.com  You can read through their stuff, contact them, and see if there are doctors around you that are doing this procedure as part of their clinical trials.  It's brand new, cutting edge stuff.  Do a google search and see what other companies you come up with.

Have you looked into the Unispacer, as well?  It's another alternative to TKR, also fairly new and not a lot of long-term data.

As for OATS, it's also called mosaicplasty.  It's for people with large lesions in their articular cartilage, so it wouldn't help you.  Anyway, it stands for Osteochonral Autograft Transfer or something like that--don't quote me.  Again, it's not for people who have meniscal problems.

Good luck.

Heather
Posted by lbdeharak (Linda), 28 February 2003

Hi Chris,

I think you should go for more opinions too. I would not accept that you are too old for treatment. Seems like they have been having success with active healthy people yor age.

I used to manage an endurance racing ranch. It is a great sport! Too bad there are some nasty people in it though. i really miss the rides.

Good luck and keep us posted.
Linda
Posted by bayrab (bayrab), 28 February 2003

Thanks L inda. I'm going to seek opinions. We have some good sports medicine docs in Kansas  City, so I'll seek them out. I'm not ready to give up and accept that at 51 I'm too old!

I love this sport.. you're right there are some people in it for the wrong reasons, but I just ride my own ride and stay out of their way. I do CTR and endurance. My main horse and I are almost to the 1000 mile mark and I'm bound and determined to get there this year!!!

chris
Posted by lbdeharak (Linda), 28 February 2003

Hi Chris,

Competitive trail Riding is great for the younger horses. I had fun doing that too. I worked more than a few P&R teams when I wasn't riding.

Good luck in Kansas City, and don't be afraid to travel a little if you need to to see the right OS. You can always send your reports and stuff and then see what they say.

Keep us posted, and I will be with you in spirit when you get to 1,000!
Linda
Posted by davedoc911 (davedoc911), 2 March 2003

At our Center For Sports Orthopaedics, SC offices, we have had extensive experience with the UniSpacer Knee System, an alternative to total knee replacement. Our results to date are quite promising.

The procedure isn't for everyone, however, it represents what appears to be a breakthrough in treatment of arthritis of the knee in still active but slowing down athletes.
Posted by bayrab (bayrab), 3 March 2003

I live near Kansas city. Is the any sports medicine clinic in that area that does this procedure?
Posted by davedoc911 (davedoc911), 3 March 2003

Unispacer.com is a good source re. doc's who perform the procedure. My knowledge of individual doc's experience with the UniSpacer and/or ACL procedures is limited however. Hope this helps and good luck to you!
Posted by enuff81020 (enuff81020), 8 March 2003

Hi!

I'm 47 and had my first tkr in December.  My new knee is so great that I'm sorry my ortho made me wait so long doing so many other things.  He was thinking that I was too young for the procedure...I can bend it to 125 degrees now--and had about 80 before the surgery--no cartillage of any kind in my knee...bones were "pearlized" with holes rubbing in femur.

That said, I did want you to know that although a ntkr is such a big procedure, it can give you back your life.  The restrictions that I have are no repeated movements--like jogging or squatting.  

I plan to have the other one done in July and am so looking forward to going for walks and playing with my kids after I recuperate.  I am riding a stationary bike quite well now, after 10 weeks...Sylvia
Posted by bayrab (bayrab), 8 March 2003

Thanks sylvia, for the encouraging words! I saw the orthopedist yesterday and we're going to try synvisk injections starting next week. I'm not in terrible pain. He understands my need to keep riding, LOL.. And I'm afraid the kind of riding I do IS  lot of repetitive motion.. I ride at a trot a lot and do posting, which is like doing deep knee bends on a moving target...

I learned a lot at my recent visit. It' not the meniscus that is causing me trouble. He said he took out only a small part when he did the arthroscopy two years ago. He said it is the artciulate cartilage that is my problem.. or rather the lack of that cartilage. He thinks I'm a good candidate for relief with synvisk.. I'm willing to try it.. like he said, three injections versus major surgery is a no brainer....

I'll let you all know how it goes. And we're timing the injections to meet my ride schedule. My first ride is a 30 mile ride on April 6....

chris
Posted by davedoc911 (davedoc911), 8 March 2003

Chris,

Good luck in your search re. alternatives to TKR.

At the Center for Sports Orthopaedics, SC, we have extensive experience with the UniSpacer Knee System, among other alternatives. You might want to check out more information re. bracing, injectables and surgical alternatives such as the UniSpacer prior to opting for a knee replacement. Although some of the posters call TKR "life-changing", what will it be called if a person in their 40's, or, even a much older person, has to have their already totally-replaced-knee revised in a very major and even less predictable overhaul??

In any event, good luck to you in your search and educational pathways!!
Posted by davedoc911 (davedoc911), 9 March 2003

Thats the remarkable thing about the UniSpacer,,,as opposed to other forms of partial or 'Uni-Knee's',...... there are no bone cuts (and even no cement or screws etc., whatsoever).

Good luck in your quest and may you acheive sucess in your pathways!
Posted by lbdeharak (Linda), 10 March 2003

Hi Chris,

It was my articular cartilage that was damaged as well. Do you know how big the lesion is? Does your OS think that you might be able to try OATS, ACI or something of that sort?

I hope the injections work for you!
Linda
Posted by bayrab (bayrab), 10 March 2003

Thanks Linda. I haven't mentioned OATS to my orthopod yet, but will. I know after reading the web site on the unispacer that I'm not a candidate for that. I have no ACL .......sigh....

Posted by davedoc911 (davedoc911), 10 March 2003

The nice thing about the UniSpacer is that you dont necessarily need an ACL.......... as long as an ACL reconstruction is performed, likely during the same procedure setting.

Good luck in your educational pathways!
Posted by enuff81020 (enuff81020), 11 March 2003

Hi Again,

Do you have a coming appointment?  The one helpful thing is that this is considered "elective" (ha ha) surgery--and you can do all of the research and take all of the time you need and want in making your decisions.  I hope that you get all of the pieces figured out and can make the best decision for your situation...Take care, Sylvia

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