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Author Topic: PKR and athletic activity level  (Read 5452 times)

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Offline nicholas

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PKR and athletic activity level
« on: June 08, 2004, 03:06:18 AM »
   I'm 49, 6'5", 225 and am in otherwise good shape. I'm about to have PKR on my left knee medial compartment. If that provides pain relief then I'll probably have my right knee done PKR. I have strong hope that I will come out of both these ops pain free. My real question is what, if any athletic activity level, can I push for without ruining the replacements.
  I haven't been able to jog for years now but I have biked, surfed, and powder skiied before and since the onset of these problems 15 years ago. Yes, I may have exacerbated my problems but I believe I would have ended up in this place, in any event, because of a mild varus deformity.
  How have any of you out there fared post surgery in pursuit of athletic endeavors?  I suppose I'm looking for hope that I can still return to at least my pre-surgery levels and not completely wear out my polyethylene platform 10 years down the road.

Offline davedoc911

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Re:  PKR and athletic activity level
« Reply #1 on: June 20, 2004, 09:43:27 AM »
I guess you are referring to a 2-piece metal on poly, similiar to half a knee replacement. You must not be referring to a UniSpacer Uni-knee, in which case there wouldn't be a poly component to worry about.
We tell patient's that doubles tennis would be better than singles post-op UniSpacer, as would walking or biking as oppossed to jogging.
Good luck to you.

David  H Trotter, MD
President/Founder
Center for Sports Orthopaedics, SC
Hoffman Estates, IL
www.orthodoc.aaos.org/centerforsportsortho
[email protected]

Offline Cindy2

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Re:  PKR and athletic activity level
« Reply #2 on: July 12, 2004, 02:40:39 AM »
Dr. David:
I really need your advice.  I am 46 yr old single mom, who does secretarial work for a living at a University but also has a 2nd job as a wedding/high school photographer.  I NEED MY KNEES.   I have had osteoarthritis in BOTH knees for the last 12 years.  I injured my knees 12 yrs. ago in a domestic incident (politically correct term but needless to say I have divorced the problem).  I now have no meniscus left on the insides of BOTH knees with my left leg being the worse.  I have been walking bowlegged (which I really didn't notice).  I went to see a Dr. DeMeo (Pittsburgh, PA) who has done quite a bit of these surgeries.   I have been to unispacer.com but I have also been trying to reach various people regarding THEIR surgeries.  So far, I find more negative and some PR type positives.  On the negative side, I am hearing that the unispacer will move on you while sleeping, that I will never get full range of motion back for my knees, will be lucky to bend them, all kinds of stories.  I NEED MY KNEES.  I realize I will never be able to run or jog again, but I do not do that now.  I am too young for TKR.  I have not been through any injections for my  knees, but I am told that I can only have that procedure done once, I can't keep getting it done on a regular basis until I reach my 60's.  I really need someone to be totally honest with me.... I am serously thinking about NOT having the surgery now... but I am dealing with more pain now than ever... I love my photography and do not want to be forced to give it up... it is a much needed 2nd source of income.  ANY guidance you can give me would be GREATLY appreciated.   Cindy

Offline Heather M.

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Re:  PKR and athletic activity level
« Reply #3 on: July 12, 2004, 02:53:54 AM »
Cindy,

I have no idea why your doctor said you can't get repeated SYNVISC injections.  Unless he was perhaps talking about cortisone injections, which shouldn't be done more than two times a year for no more than a couple of years to provide short-term relief--from what I've been told, anyway.  But I think SYNVISC injections can be repeated as long as they help the patient, and seem to have about a 50% success rate.   Worth a try.

Anyway, I also wanted to say that you are not too young for TKR.  Obviously it's not ideal, but when you get to the point that you can't live your life and support your family, you are looking at a serious knee problem.  If a TKR would resolve that for you--if you are a good candidate--than being age 46 shouldn't stop you or your doctor.  It's not a decision to be made lightly, or because tylenol isn't cutting it anymore.  It should be made, though, when the patient's life is being dictated by knee pain.  

Also, if you have isolated damage only to the medial compartment of each knee (i.e. no real damage to the lateral or patello-femoral compartments) you may be eligible for partial knee replacement.  This takes up much less bone than a TKR, but it is a newer procedure and not a lot of doctors perform them.  If your OS hasn't mentioned this procedure to you, it may be because he doesn't do them (or you have more wide-spread damage).  

If they were my knees, I honestly wouldn't go with the unispacer.  I know that bad outcomes are concentrated on web pages like this, but I have seriously yet to hear a good outcome from anyone but the manufacturers.  Before I tried a unispacer, I would go with a custom unloader brace and then a TTT/osteotomy to unload the medial compartment surgically.  Or I would go straight to the TKR.  I know people younger than you who have had them.  I know a 23 year old who has had one, and a member of this board had two PKR's at age 28.  When everything about the procedure is right for the patient, age should not be the determining factor, quality of life should.  That's just my humble opinion, and that of a few doctors out there as well.  My point at age 34 is that I need my knees NOW, and so I don't see the point of preserving them in horrific shape until I'm 65, then having a TKR.

Heather
« Last Edit: July 12, 2004, 03:10:18 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Cindy2

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Re:  PKR and athletic activity level
« Reply #4 on: July 12, 2004, 03:03:24 AM »
Heather:
Thank you so much for your quick response.  I have read up on partial knee replacement which is MUCH preferable to a TKR.  BUT from what a few doctors have told me, if you get KR done early on, that due to the increased activity level say a person in their 30's or 40's would have compared to someone after 65 yrs of age, that a normally 15 yr. run on any kind of knee replacement would last someone like us 8 years and we would have worn it out... which means revision surgery, which is really painful and more sawing, cementing, and a MESS.  That is why I have held off.  I have had osteo for 12 years, noticed a BIG difference these last 2 years as to the quality of life left in the ol' knees.  As I do secretarial work and photography (2 jobs) I really need my knees... which we all do.  I feel like crying right now.... this is such a big decision.... I could try that supartz injection stuff but I have no clue just to how long something like that would last....and the injection thing I heard about you can only have once.  SO... big decision... scared to death right now.... but if I were to have this unispacer surgery done, and I can't walk right, I would just die.  So you can see my dilemma.

Cindy2

Offline Heather M.

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Re:  PKR and athletic activity level
« Reply #5 on: July 12, 2004, 03:25:26 AM »
Cindy,

Yes, you may have a shorter life to a knee prosthesis than someone in their sixties.  But the question is would you rather have the good years now and hope that medical science continues to provide knee replacement advances, or in twenty odd years from now and be miserable in the meantime?  I've been talking a lot to a woman I met here where I live who is 45 and had her knee replaced last year.  She was in so much pain before the TKR that she lost her job, her house, her marriage.  She had an extreme case of severe arthritis caused by a staph infection, but the fact remains that she had no cartilage left.  And her job involved sitting (long-haul trucker) which she just couldn't do after the arthritis set in.  So she begged her doctor for a year, and he finally replaced the knee.  30 days later she was back living alone, taking care of her animals.  A year later she has a new business--landscape maintenance.  In fact, I'm going to hire this 45 year old woman with a knee replacement to take care of my property, because my crappy knee won't allow me to be on my feet long enough to do it myself.  The irony of this has not escaped me.

Anyway, my point is that age should not be the deciding factor in whether to do a TKR or not.  Knee function and quality of life should be.  I'd frankly to a TKR and hope for 10 good years rather than wait 20 years while I was miserable and look forward to a working knee in my retirement!!

I know of no injectible treatment that can only be done once in a person's life until they are in their sixties.  All I can think of is cortisone injections, which really should not be done on a repeated basis, but can certainly be done more than once!  SUPARTZ and SYNVISC are allowing many people in their 40's and 50's to put off knee replacement, so it should seriously be considered.

I'm going to put in a link to my surgeon's web page.  He's definitely a knee guru, and people come in from all over the world to be treated in his clinic.  There is a lot of really good information on TKR's and what can be done with degenerative joint disease on this link.  In the last page of FAQ's on this link, it very clearly shows that age is not an indicator of the need for TKR, but rather "incapacitating pain, limited function, and poor quality of life."  So it is often a choice made between the patient and the doctor when every other conservative method has been tried and has failed.  Maybe you are not at that point yet, and that is what your OS is trying to say?  Another opinion from a knee specialist might be very helpful.  You may also want to consider an integrated pain management program to buy a few years--consisting of PT, acupuncture, deep tissue work to keep the rest of the body in alignment, medications, lifestyle modification assistance, TENS units, and so forth.  I found lidoderm patches and my home TENS unit through this program, and I really couldn't live without them on some days.

Here's the link--be sure to look through all five or six pages of this.

http://www.steadman-hawkins.com/knee/overview.asp

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Cindy2

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Re:  PKR and athletic activity level
« Reply #6 on: July 12, 2004, 03:49:46 AM »
Heather:
Again, thank you.  I did check that link out you sent me, but it doesn't touch on revision surgery at all... guess they don't want to scare you.  I have a 2nd opinion appointment in the next couple weeks.... I need to make a decision by August what to do.... I have a few photography jobs booked up through Oct 2nd and if I go with any kind of surgery, will need to schedule it that 2nd week of OCT.  If there is no limit to the supartz injections, that sounds like a safe plan for now... I just do not want to wait too long as I am already bone on bone on the inside of my knees... i have seen SUCH  big decline in the quality of the knees... pain... I can't take Aleve as it is hard on my liver and whenever I get bloodwork done, my liver enzymes are up... so I am trying to be careful with that sort of thing.    I use to teach country line dancing too..... I blew my knee out 3 years ago just dancing... not falling, slipping etc.. and THAT is when I found out how bad my knees were.  As to unispacer... the grips that I have read.... if you look at the dates of their surgery if it was before 2003, I think they have made many positive changes after 2002... the unispacer now comes in various sizes to fit the person.  I also tend to wonder if the ones who had major problems with unispacer, if it was because it was fairly new surgery and the doc not having much experience, etc. etc.  Don't know, guessing at this point.  I have researched unispacer.com and various other sites and have found positive stories as well.    I just do not want to wait to the point where the damage to the bones forces me into TKR before I am ready to do so.... does that make sense?  Meanwhile the pain comes and goes, but mostly is there all the time any more.  I go to bed after a day of walking or working in the yard, etc. and the pain just shoots up my legs while I am trying to sleep.  Like I said, I am really scared.  Thank you Heather... I am so glad someone got back to me.  You have given me a lot to think about.  Cindy2


Offline davedoc911

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Re:  PKR and athletic activity level
« Reply #7 on: July 12, 2004, 09:27:51 PM »
Cindy2:

You seem to have a rationale approach and understanding of the various options available to those that suffer from early medial compartment arthrosis. Indeed, the UniSpacer surgical procedure has been  refined and results reflect that. Having just been with the co-developers and major national users, I can tell you that the procedure continues to, in the appropriate patients, bring significant results. Should you desire a brief general educational discussion (can't ever diagnose by phone or internet of course), feel free to call and ask for Joanne, who will assist in facilitating a call back to you. We usually ask for standing knee films in advance of an actual in-person evaluation.

DTrotter, MD
Center for Sports Orthopaedics, SC
Joanne, Office Mgr.
847.884-7771 x23

Offline SueLB

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Re:  PKR and athletic activity level
« Reply #8 on: July 14, 2004, 05:52:51 PM »
Cindy,

I've been doing research for my husband who is 57 years old and is bow-legged, bone-to-bone on one knee. He is moderately active and somewhat overweight. I've heard the same negative stories about unispacer. I think the best options for him is either an osteotomy to correct the bow-leg and shift the alignment or a PKR.  But, I haven't been able to find a doctor close to us that does alot of osteotomy.

Anyway, one thing you can consider instead of the TKR is PKR (partial or unicompartmental knee replacement). This is not a unispacer. If a revision to a TKR is necessary, it is supposed to be less complicated since more of the orginal knee is preserved after the first surgery.  The newer material, "oxinium", is supposed to last longer.

Here's a couple of links I found on PKR:
http://www.cartilagedoc.org/downloads/knee/KneePainCase.pdf
http://www.emedicine.com/orthoped/topic631.htm

Good luck!

Susan

Offline SueLB

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Re:  PKR and athletic activity level
« Reply #9 on: July 14, 2004, 08:32:11 PM »
Cindy,

I forgot to mention. My husband has been getting a series of synvisc injections about once a year for the last 3 years. He said he hasn't really noticed much of an improvement. He just finished his last round of 5 injections on 7/1/04. The doctor thought it was harmless to try another round of injections. But they affect people differently. So you may see some improvement.  

Susan

Offline Cindy2

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Re:  PKR and athletic activity level
« Reply #10 on: July 15, 2004, 06:01:08 AM »
Sue:

Thanks a LOT ! !  Yes I was researching PKR along with the Unispacer, the unispacer seemed to be the lesser of all evils at the time.  I have a 2nd appmt with a different specialist (this one specializing in PKR & TKR).  I am already working on my list of Qs.

One thing I found out about injections... please be VERY careful of anything that is a steroid... no matter NOW good it makes you feel.  Some of these newer injections recently discovered in the last couple years do not have any statts on long term effects on the body.  I met a 67 year old woman who had TKR 2 years ago.  Prior to that she was told to wait till she was 65 before getting her TKR.  In the meantime, to get through the pain (she was working full time),  she was going through some kind of injections in her knee every 3 months for a couple years.  Turns out the injection was a steroid, and it affected her eyesight.  She ended up with lens replacement in both eyes.  THAT is scary.  I do take Glucosamine & Chrodroiton (sp?) supplements (homeopathic) for the last 4 years.. it really helps.  
As to the osteotomy.... wait and look into the PKR.   I am learning from others that after the unispacer OR PKR (doesn't matter which) that the bowlegs will correct themselves.  (this is what I am hearing).  

TODAY on a local Pittsburgh TV station, I heard of a NEW TKR which uses titanium (25 yr. lifespan of product) and they use a 3 in. incision compared to being sliced down the leg.  Less damage to tissue/muscle and much faster healing time.  I missed the 5 PM news but I will try to catch it tonight.  IF I can find it on their website as well, I will come back here and post it for everyone.  IF this really works out, give it time to get it in my area and I may go that route.  Will ask the 2nd opinion doc about this as well... so there is hope.

My mom wants me to wait quite a few years before getting anything done... but the bottom line is, do I want my quality of life NOW or after I am 65 years old?  Who knows?  I may not live to see 65 .... and to mask the pain or hide it with injections or extra pain killers, anti-inflamatory (hard on liver)..... that is just not me.  So keep me in all of your prayers and I will do the same for you.

Take care, I will be back periodically with updates.... if any news I can find out will help someone else... then I will do it!

Thanks again Sue
Cindy

Offline Cindy2

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PKR and athletic activity level
« Reply #11 on: July 15, 2004, 07:06:08 AM »
OK all.... here is that link about a better way to TKR.
Go to:

http://kdka.com/doctors_paul_and_maria/local_story_196160519.html

This is at Rush University Medical Center.  Check the following links as well:

http://www.rush.edu/rumc/page-R12368.html

and

http://www.rush.edu/rumc/page-R12369.html

and this one gives the most detail:

http://www.rush.edu/webapps/MEDREL/servlet/NewsRelease?id=535

So everyone read it and tell me what you think?????
Hopefully this will come to Pittsburgh soon.

I will keep all posted.

Cindy2

Offline SueLB

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Re:  PKR and athletic activity level
« Reply #12 on: July 15, 2004, 05:03:12 PM »
Cindy,
I have read that 95% of the newer TKR design are expected to last 15-20 yr both for titanium and cobalt-chromium alloy. So a 25 yr lifetime is not unrealistic. The problem occurs with the friction between the metal and the polyethylene liner. Supposely, the ceramic material such as Oxinium has lower coefficient of friction with polyethylene and might last longer. However, how long the TKR lasts depends on the activity level of the person. I do know a woman who had a TKR done a few years ago. She was in her early-50's and said it was the best thing she did.  

If you live in Pennsylvania, you might want to go to one of the inventor of the Unispacer, Dr. Hallock (Penn State). He has done many unispacers and in his paper claims higher success rate.

I'm not quite sure what to do with my husband. He's in alot of pain. However, his last surgery, 4 years ago, to repair his knee using a microfracture procedure seemed to made it much, much worse.

Susan
















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