The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Unicompartmental knee replacement => Topic started by: Lilalu on June 03, 2014, 08:24:16 AM

Title: Changing a PFJR possible?
Post by: Lilalu on June 03, 2014, 08:24:16 AM
Hi all,

maybe (I still hope to able to avoid this!) I will need a PFJR within the next 2-3 years. I have a kissing lesion on my kneecap as well as my patella groove - because of patella malalignment. All other parts of my knee are intact and I donīt have any arthritis there (not even Grad I).

Now I am worried! What, if the implant loosens or the patella plastic button just wears off with time?

I am reading a lot - and it seems a failed TKR always is changed into a complete TKR. I donīt want such a device - I guess I could live with a PFJR - but a TKR just would limit most of my outdoor activities and I just canīt live without them!

Does anyone know: Is it possible, to change a PFJR or PF inlay implant (like Hemicap Wave) into just a new PFJR or just change the plastic button - if the implant not the rest oft the knee fails? Has anyone had such a procedure or asked his/her surgeon about ist?

Thanks a lot!
Title: Re: Changing a PFJR possible?
Post by: MitzMom on June 09, 2014, 05:00:42 PM
I am 9 days post op of a PFR (custom pfjr) and I see my surgeon again on this Friday, I will let you know what he says about replacing just the button as it is a question I also have!  When he told me that I would probably need a TKR in the future, my response to him was "maybe I won't!!"  I am 44 and in the exact boat as you, only damage on the knee cap/femur area. 

I have posted several times on this forum and have never gotten a single response, seems like NO one has had the PFR that I have.  If you want to see more info on the custom implant that I have I will include the link....

I will be back in touch after Friday!
Title: Re: Changing a PFJR possible?
Post by: Lilalu on June 10, 2014, 07:43:34 PM
Hi Mitzmum,

thanks a lot for your reply! We are almost the same age (I am 46) and the same problem! Not nice for the two of us! But I hope you are doing well and wish you all the best for a quick and painless recovery!

I have read your post about the custom made implant. I am very interested in this, but I donīt think there is a clinic/surgeon here in Europe using them. I think up to this date, this implants are used only in the USA. Here the Hemicaps or maybe the Oxinium implants are used, I think. If there was a chance to get a custom made one, I would be very interested!

I guess our problem is not so common and thatīs why no one responded to you.

I forgot to ask the doctors about the changing issue the last time I went there and I wonīt have another appointment so soon - donīt want to hurry with this surgery and doing a lot of research into any other options first.

It would be very nice, if you let me know, what your surgeon says!

Thanks again!

Title: Re: Changing a PFJR possible?
Post by: FMRCathelete on June 11, 2014, 12:38:58 AM
Hi.  I have a PJFR (femoral groove and patellar button)-was 37 when it was done. I have an Oxinium implant by Smith and Nephew.  I have not had much luck with this, but I am not the norm.  I had nerve pain and rapid degeneration of my medial and lateral compartments.  We are all "too young" for this it appears.

To answer your question, I have spoken to multiple OS in NYC and Philadelphia area and the answer was always when the PJFR fails, they would have to do a TKR.  The reasoning is that it is very likely that by the time the PJFR fails, the other compartments are bad or headed there.  Hope this helps.

Good luck to you both! 
Title: Re: Changing a PFJR possible?
Post by: *Tiffany on June 11, 2014, 01:35:53 AM
Just going to jump in here with a bit of information.  I had a PFJR at 33, and at 37 had both knees changed to a TKR. 

My underlying condition is patella dislocation, which PFJR did not help.  If your underlying condition is something else your situation my turn out differently.

Good Luck,
Title: Re: Changing a PFJR possible?
Post by: Lilalu on June 11, 2014, 09:27:35 AM
Hi Cathelete, hi Tiffany,

thanks a lot for you replys!

Cathelete, thats the information I am always reading - the rest of the knee will degenerate also. But why? Did they tell you? If one is suffering from primary arthritis - o.k. the desease will go on, I guess. But if the damage was caused by injury or as in my case a patella malalignment - why shoul it go on? Or does the implant destroy the rest of the knee? Thatīs what I am afraid of!

Tiffany, wow what a sad story! My patella is in constant subluxation on the lateral side of the groove instead of in it. But I was told, this can be corrected by an osteotomie before or in the same surgery than the PFJR. I am not sure, if this works, but was told it can be done. You had a TTT done - didīnt it work to correct your instability? What did they tel you because of this?

Thanks a lot and all the best!
Title: Re: Changing a PFJR possible?
Post by: FMRCathelete on June 11, 2014, 10:48:13 PM
Based on all the studies I have read, it would seem that degeneration of other compartments happens more rapidly after one compartment has an implant.  This makes me believe the implant may be the cause.  Just my opinion based on lots of reading.  I know it is happening to me.  I almost went for TKR recently, but opted for knee denervation instead as I responded very well to a couple nerve blocks (also found out that I had a permanent suture through a nerve which caused a neuroma).  I opted for PJFR to "buy time".  Was hoping for 10-15 years before I would need a TKR.  Not sure I will get to 10 much less 15.  That said I am currently doing pretty well & in less pain than in years.  Still feel that the joint is just not right though, and have some unresponsive muscles in outer quad muscle -working on that but not going well.

Sorry I cannot be more helpful.  Nothing is definite in medicine, much as we'd like it to be.  I am hoping in my lifetime we will be able to "print" joint replacements for an exact replica of the original.  Cheers-A
Title: Re: Changing a PFJR possible?
Post by: Lilalu on June 12, 2014, 08:06:53 AM
Hi Cathelete,

thanks for your reply again!
Yes, thatīs what I think too - the implant may cause more or faster degeneration. I donīt want to have an implant at all - but if you are in pain and there is no other possibility (still loooking for one) ...
But I have also read studies, with people having an implant for 10 or even 15 or 20 years. Itīs mostly about the medial or lateral PKR and not a PFJR - but the materials are the same.
Of course I am still hoping I will be one of those for whom it will work! But we all do hope and we all donīt know!

All the best!
Title: Re: Changing a PFJR possible?
Post by: MitzMom on June 16, 2014, 01:52:02 AM
I see I missed a lot of this discussion... my OS said YES, the button on my PFR can be replaced if it loosens.... and yes, a lot of times by then, the rest of the joint has deteriorated to the point that it needs a TKR anyway....I hope this does NOT happen to me....  I have pics of my xrays before and after my PFR if you are interested...

Glad to see you got some responses, I see that my post still has been left untouched!!!  ;-(
Title: Re: Changing a PFJR possible?
Post by: Lilalu on June 17, 2014, 09:41:49 AM
Hey, thanks a lot for asking and posting here!

itīs good news, the button can be changed! Is it only the plastic patella button, that can be changed or also the metal component in the patella groove?

Of course I also hope, the rest of my knee will stay o.k. over time - even with an implant in it. I had contact with a woman, who has had a PFJR for 8 years now and still is doing very well with it. Seems the outcome differs a lot. I am not sure, what causes the difference. Material, individual things like e.g. allergy against the material, quality of surgery, implant specifications?

I donīt know, why they donīt use the custom implant here. It should be the best option, I guess. They have good outcomes over quite a long period of time as far as I know.

How are you doing with your rehab? Everthing o.k. so far?

All the best!
Title: Re: Changing a PFJR possible?
Post by: MitzMom on June 20, 2014, 01:10:05 AM
I didn't ask about the metal part being replaced!!  hahaha  I will ask him when I see him next!!  He already thinks I am crazy anyway...!!! 

I started PT on weds, so I am a bit more sore, doing well though...still on one crutch, but getting close to being able to walk ....the quad is stubborn and it's mad...once it kicks back into gear, life will be good! 

The custom partials really do seem to last a lot longer with more satisfaction... I hope this holds for me!!  I also wonder why more aren't doing many OS don't seem interested in joint preservation...

Title: Re: Changing a PFJR possible?
Post by: Lilalu on June 20, 2014, 08:40:06 AM
Hi MitzMum,

 ;D I know, I always have a lot of questions! But why should your surgeon think you are crazy? Itīs a big surgery and itīs your knee and ability to move! It should be o.k. to have many questions!

Yes, many surgeons are not interested in joint preservation. I think, money is the reason and complicated operation technique and ability to do this. Most people suffer from a primary arthritis and have damage in all compartments anyway. A TKR has become a standard surgery and almost every surgeon can do this. And he has many patients, who need it and earns a lot of money this way. Isolated PF damage is rare (not many patients and not a lot of money) and I was told operation technique is rather different and needs a lot of experience. Most just donīt bother with this!

And of course almost no sugeon tells you, he doesīnt know how to do it and refers you to someone else!

I think itīs the same with the custom implants. The hemicap implants have a standardized and more easy operation technique, I was told and more and more surgeons are starting to do them. I guess, itīs not so easy with the custom implants - you really need a specialist for PF damage to do those.

I am glad you are doing well with your rehab! All the best!
Title: Re: Changing a PFJR possible?
Post by: jillyb on April 04, 2016, 09:58:34 PM
Hi Tiffany,

I saw several of your posts regarding the issue of chronic dislocations and your partial knee replacement. I wonder if you are willing to give me a few pointers with my condition because I am having issues with my pfr and it has been over a year since my bi-lateral PFR. 

My doctor knew that I had dislocations and I was also diagnosed with end stage arthritis in both knees. So after x-rays and an MRI, he decided we would need to do TKR surgery, but in the operating room he discovered enough cartilage so that he did the TFR instead.

My surgery was last March. Since then my recovery has been pretty slow.  My knees get worse every time I try to exercise and do the basics. My left knee feels ok, but my right knee has given me problems almost since the beginning and it is now feeling like it will dislocate again, I am very scared of this happening and am walking super careful.

I wanted to find out how you handled these dislocations?  Also, since you got the TKR surgery is that part with the dislocations getting better?  My doctor just says my x-rays look normal and he cannot help me, so I am trying to find out what my options could be and if it will do any good. Thanks. Crystal