KNEE ARTHRITIS - Total Knee Replacement :

Just Published this site - Feedback Wanted! - - Posted by dhudiburg (dhudiburg), 19 May 2003

Please take a look at this patient information site that I just published for my employer.  I would love to get some constructive feedback.  

We want this to be a true resource to patients who are considering knee replacement surgery.

Thanks,

Doug
www.knee-replacement-info.com
Posted by hmaxwell (Heather M.), 19 May 2003

Just a couple of thoughts after reading through this.   Keep in mind I know nothing about your employer or the focus of their products/audience:

1.  The indications for TKR/PKR aren't spelled out very clearly.  I think you'll find a lot of people on this web page who are being told they are 'too young' while other doctors feel that quality of life is the major factor.  You might want to address this with a discussion of when TKR is appropriate or not.  Also, there are other procedures to repair/replace cartilage in younger patients....I know your employer probably doesn't focus on these since they are in the business of joint replacement.  But reading this one can be led to believe that TKR or living with it are the only options.  There are a number of procedures leading up to TKR depending on the age of the patient:  microfracture, Mosaicplasty, ACI/Carticel, and osteotomy.  These are not appropriate treatments for those over 55 though--is this the sole target audience of the web page?

2.  Knee anatomy:  there is no explanation of the compartments of the knee (lateral, medial, patello-femoral or patella/trochlear component) in the knee anatomy section, only in the unicompartmental replacement section.  That makes it difficult to understand why someone is eligible for a PKR vs. TKR, and why bracing and other orthotics may be appropriate for a person with uni-compartmental arthritis, but not for someone with multiple compartments involved....

3.  There is no mention of patello-femoral joint replacement (PFR or PF variant of PKR).  Does this employer only do the unicompartmental replacement prostheses for lateral or medial compartments?  If so, it might be worthwhile to mention that there are new alternatives for people with a patellar/trochlear arthritis problem.  

4.  The complications section just mentions 'stiffness' not arthrofibrosis, which is a common and troublesome complication of joint replacement surgery.  It goes beyond loss of ROM and 'stiffness' to true pain and debiliation.  No mention is made of the manipulation under anesthesia or arthroscopic lysis of adhesions which are commonly required to address this problem.  Additional surgery is sometimes required in the case of DVT and infection as well.

Just a few ideas after browsing through.  While you say this is to be a resource for those considering knee replacement surgery, it is heavily focused on the 'old fashioned' treatments for older knee paitens--and doesn't address any of the newer stuff such as cartilage replacement and PFR for younger patients.  If that's what your employer wants to focus on, that's fair enough.  But there are other options out there.....

Overall, it was a very understandable site for the beginner to knee arthritis.

Heather
Posted by dhudiburg (dhudiburg), 19 May 2003

Wow Heather,

What fantastic feedback.

1.  The indications for TKR/PKR aren't spelled out very clearly.  I think you'll find a lot of people on this web page who are being told they are 'too young' while other doctors feel that quality of life is the major factor.  You might want to address this with a discussion of when TKR is appropriate or not...

I totally agree.  I will put some effort and research into some of the younger patients treatments.  Our treatments are not the only ones, and not meant to be specifically left out, we just know more about our stuff.

We have a new material (Oxinium) that allows TKR to be an alternative for younger patients if they are candidates.  It lasts much longer than cobalt chrome.

2.  Knee anatomy:  there is no explanation of the compartments of the knee (lateral, medial, patello-femoral or patella/trochlear component) in the knee anatomy section...

Good catch, we will enhance the anatomy section soon.  We do offer a pattelo-femoral joint that has a 10+ year clinical history.  Many of our consulting surgeons feel that there is limited benefit to a PF v. Oxinium TKR because total knees are much more likely to stay put v. a PF.  Still, we need to include information about the procedure.

Your other comments are helpful as well.

I really appreciate the time you put into your response.

Now...

Are you interested in writing an article for our site?

We have a sudden need for more content.  

Doug
www.knee-replacement-info.com

Posted by hmaxwell (Heather M.), 19 May 2003

Doug,

With respect to point 1:  There is a different medical need being served with the cartilage replacement options for younger patients that your web page didn't touch on.  These options are  targeted to people who have suffered from patello-femoral syndrome (PFS) or traumatic injury that has led to early osteo-arthritis, vs older folks who have age-related OA.  Your web-page is strictly focused on the aged, but I know I speak for lots of people when I say I'm getting darned tired of being told "if you were 30 years older I'd just replace the whole joint." PFS sufferers, you will find, are predominantly female (80%) in their 20's to 40's, with multiple arthroscopies and progression of symptoms over 10 years or more.  I think that sums up a lot of our most active kneegeeks here--I've had knee issues for 20 years now, since I was 13.

That's why PFR, PKR, and the so-called salvage surgeries tend to be the focus of discussions on this web page--we are too young and active for a TKR which may need multiple, multiple revisions during our lives(leading us to run the risk of arthrodesis when we run out of bone).  Additionally, the damage we have tends to be highly focused and deep, rather than widespread and less severe.  While your company may prefer its TKR to PFR, the loss of bone is substantial in TKR, and most surgeons can't justify hacking out perfectly good bone when there are 'only' a couple of deep lesions.  However, as you point out, the PFR has other problems with tracking, the need for customized parts, lack of surgeons performing the procedure, etc.  

So far, there really isn't a happy solution--not that I've found, anyway.  I hope some of our younger TKR and PFR patients will respond to your posting.  BTW, I'd be interested in how your consulting surgeons would respond to this fact:  many of us with patellar arthritis have been advised that even a TKR may not help, as the kneecap is kept with the TKR procedure, and for us the kneecap is the source of our pain.....

Anyway, for information on surgical and non-surgical alternatives to TKR, try visiting some of our favorite pages here:

www.kneeguru.co.uk  -- see steps 1-10 for more links than you can believe.

www.patellapain.com  -- excellent review of TKR vs PKR vs PFR  in the arthritis section.  This site has a true focus on patello-femoral syndrome vs. OA brought on by age

www.steadman-hawkins.com -- a shameless plug for my wonderful surgeon.  Very indepth page about chronic knee issues, and the progression from chondral defects to TKR. He also pioneered microfracture, so there is a lot of detail there

I'm hoping someone else will post sites with info on mosaicplasty/OATS and ACI/carticel, as these seem to be the real future for young patients who desperately need to put off TKR.  If you want to check out www.google.com you will get thousands of hits.

Anyway, as for posting (ahem) lengthy responses, I've never been known to be shy    I'm also a professional writer who loves to do research.  When I found myself in the midst of PFS hell from my "Title IX Knee" I went out and read everything I could.  In the case of younger patients with PFS, education seems to be the ONLY hope.  

I almost wish I were older and my problems could be fixed with a 'simple' TKR....anyway, I'd be happy to provide my less-than-professional but highly opinionated input to your web page.  PFS could be called 'the coming plague' in orthopedics....you can send me a private message through the IM feature on this page.  Just click my name and my profile will appear, allowing you to send me a message thru the site.

Heather
Posted by dhudiburg (dhudiburg), 20 May 2003

Heather,

Again, thanks for the additional information.  Your research abilities are apparent!  

For our site, I'm trying to keep it focused on knee replacement information and technology.  I will add some of the information you provided to the general knee surgery page, and beef up our coverage of the patella-femoral implant.

Thanks,

Doug
www.knee-replacement-info.com
Posted by Lorene (Lorene), 9 August 2003

I registered with this website and posted a message.  The following day I had one reply to my message.  Today I logged in and changed my password.  Now I can't find the message that I posted or the reply.

Where did they go??

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.