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Author Topic: pkr or tkr ?  (Read 18119 times)

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Offline turbostar

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pkr or tkr ?
« on: July 01, 2014, 10:27:57 AM »
Seem's like i have 4 options.
1, stay as i am bone on bone lateral side.
2, injections, are they any good?
3, part knee lateral side.
4 full knee replaced.
All suggestion's welcomed.

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Re: pkr or tkr ?i
« Reply #1 on: July 01, 2014, 10:50:35 AM »
Hyaluronic acid injections help me, but seems like only about 50% of people benefit.  They are also quite expensive if you have to pay.  I've had 3 so far, and aim to get topped up about every 18 months.  I am not bone on bone though (I have a lateral defect with fibrocartilage).  Steroid can help with inflammation too, might be worth trying

Other options that could help are an unloader brace, or depending on your age an osteotomy.

If you decide on surgery, make sure you see a surgeon who is expert in the type of surgery, be it osteotomy, pkr (lateral ones especially require lots of expertise), tkr.  So do lots of research on the experts in your country

All of the surgeries are major and not without issues, also none will last forever, so best to delay as long as possible if you can live as you are

Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #2 on: July 01, 2014, 11:00:15 AM »
I'm middle 50's not over weight, had no mensicus lateral side for 12 yrs now.
Bone is starting to crunch together also putting knee in different postion, that pulls and stretches everything in painfull places.
Oh what to do a pkr could take me into my 60's
or tkr could take me midd 70's
not sure about acid injection seeing as i'll have to pay for them

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Re: pkr or tkr ?
« Reply #3 on: July 01, 2014, 11:43:19 AM »
If you are in the UK and considering a lateral PKR, consult with the Oxford group who are the real experts according to an OS I spoke to (indeed they invented some of the PKRs)

http://www.oxfordkneegroup.com/

 The advantage of a PKR over a TKR is you preserve the good compartments and can revise to a TKR later.  A TKR straight off is a one way street, lucky to get 20 years.  However, in 10 years you could get a TKR to take you to the end of your days

My OS does 200 TKR's a year, and pioneered robotic replacements so I'd feel perfectly happy with him doing a total, but I'd want to discuss PKR carefully with him and seek a second opinion

Contact Adrian Wilson in Hampshire about osteotomy too before making a decision.  Pretty sure he does replacements too

http://www.hampshireknee.co.uk

You can get HA injections on the NHS, ask your GP/surgeon (similarly all of the surgeries, assuming the surgeons have an NHS practice)

I certainly wouldn't make a decision on the basis of cost as your other post, especially as these ops are available on the NHS
« Last Edit: July 01, 2014, 12:00:40 PM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #4 on: July 01, 2014, 12:00:34 PM »
Interesting, thanks.
I'm in Berkshire OS i see is in Bristol, Mr David Johnson
He's preety good i'll ask him about Oxford knee Centre

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Re: pkr or tkr ?
« Reply #5 on: July 01, 2014, 12:01:57 PM »
Just edited a bit

Also ask him about Adrian Wilson, although in mid 50s, osteotomy may not be a viable option, normally for younger patients to delay time to replacement. Basingstoke is not far from Berkshire though

Berkshire to Bristol is a bit of a yomp for treatment.
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #6 on: July 01, 2014, 12:09:23 PM »
Sure is a trek but seing as the first 2 OS i saw 12 yrs ago local messed the knee up. Sometimes the travel out ways getting the right treatment.

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Re: pkr or tkr ?
« Reply #7 on: July 01, 2014, 12:24:58 PM »
True. I've been lucky that my GP referred me to an excellent guy locally 5 years ago. I did have to be referred to another surgeon 2 hours away for a cartilage repair that never happened thanks to my then insurance company playing silly beggars.  However, it was an utter pain and I am glad to be back with the local guy (well not glad as it followed an accident but you know what I mean!)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #8 on: July 01, 2014, 12:39:03 PM »
One thing that does concern me is seeing as i have had a lateral release and a ttt how good would the pkr be? along with 3 mensicus removals

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Re: pkr or tkr ?
« Reply #9 on: July 01, 2014, 12:51:44 PM »
You'd need to discuss with the surgeon.  However, for a uni I think the other compartments need to be in good shape, presumably your patello femoral joint isn't if you had an LR and TTT as those are petalla alignment ops? Also everything should be aligned I think for a unilateral replacement?

What does Mr Johnson suggest? Sounds like yours is a pretty complex history
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #10 on: July 01, 2014, 01:00:20 PM »
Well he says the medial sides good and the pf joint is good also. Knee caps tracking in the middle. Just the lateral side shot away from being knocked knee'd all my life.

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Re: pkr or tkr ?
« Reply #11 on: July 01, 2014, 01:27:33 PM »
That's good then.  I am knock kneed too, although no issues until the injury.  That's why the other surgeon wouldn't repair the cartilage without an osteotoy, although my regular surgeon believes the valgus is very mild.  I've started using orthotics to help
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #12 on: July 01, 2014, 01:34:21 PM »
I looked into them, think thats a ? for physio when i see them. Do you find them any good?

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Re: pkr or tkr ?
« Reply #13 on: July 01, 2014, 01:38:01 PM »
I can't use them in all my shoes but where I can they put my feet and knees in a more neutral position for walking so certainly should be of benefit - my knees roll in when I walk, when I squat etc.  I have muscle wastage on one side too right now, which doesn't help and weak hips

Didn't cost me anything as Bupa paid so can't lose really (although they weren't that much)

If you only have one knee affected, it's probably worth asking your physio about an unloader brace too as a conservative measure for now
« Last Edit: July 01, 2014, 01:40:06 PM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #14 on: July 01, 2014, 02:00:28 PM »
Snap, my hip hurts all the time from being pulled on more. Feel's like the leg needs proping up on the outside. Hip hykes seem to be the best excercise to control it.

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Re: pkr or tkr ?
« Reply #15 on: July 01, 2014, 02:02:59 PM »
I think my hips are suffering while I cycle due to the weakness in my leg, ditto my lower back

I don't know what a hip hyke is?
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #16 on: July 01, 2014, 02:17:27 PM »
it's a excercise for hip flexors. I find flexing the hips helps, look it up on the web. Being doing clambs on the floor as well.

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Re: pkr or tkr ?
« Reply #17 on: July 01, 2014, 02:39:57 PM »
Ah ok, think you meant hikes.  Yes, clams I do, with a theraband, as well as glute bridging

At the request of my surgeon, I am having a break from physio, on the bike much less too at his request and as am poorly :(
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

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Re: pkr or tkr ?
« Reply #18 on: July 01, 2014, 02:57:29 PM »
Oh dear, i try to jump on the bike as much as poss to keep the the legs going.

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Re: pkr or tkr ?
« Reply #19 on: July 01, 2014, 03:05:01 PM »
Me too until my accident ( knocked off bike :( ) and surgery in February.  My injured leg is placing strain on hip and back on the bike....I've done over 1000 miles this year, but I am having to limit distances for a bit.  Just joined a gym to try to do some other stuff and some strengthening.  Injury was fortunately not to my knee but has placed a strain on my whole left side
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

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Re: pkr or tkr ?
« Reply #20 on: July 01, 2014, 03:23:28 PM »
I,m only on light physio at the mo.

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Re: pkr or tkr ?
« Reply #21 on: July 01, 2014, 06:06:20 PM »
There is an interesting discussion about the merits of pkrs by Jonathan Bell in a skiing forum I belong to. I found it an extremely interesting read to be honest:
http://snowheads.com/ski-forum/viewtopic.php?p=2471606&highlight=knee+replacement#2471606

If you can get to see Jonathan Bell he is extremely knowledgeable and is really pro sports, especially after these types of treatments. He is based in west London but only does private practice these days.

BTW I believe the unicompartmental replacements he refers to are also called partial knee replacements aka PKA). My apologies if I've got the wrong end of the stick though.
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline turbostar

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Re: pkr or tkr ?
« Reply #22 on: July 01, 2014, 06:25:32 PM »
Thanks for that, i'll look him up.

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Re: pkr or tkr ?
« Reply #23 on: July 01, 2014, 06:32:11 PM »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #24 on: July 01, 2014, 07:12:28 PM »
I'll have a word with my GP and see if i can get seen in Oxford on the NHS also.

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Re: pkr or tkr ?
« Reply #25 on: July 01, 2014, 07:21:09 PM »
Looks like some of the surgeons practice on NHS :)

http://www.ouh.nhs.uk/hipandknee/about-us/knee-group.aspx

You could also ask your current surgeon for a referral perhaps?

http://www.ouh.nhs.uk/hipandknee/referrals.aspx
« Last Edit: July 01, 2014, 07:25:48 PM by Vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #26 on: July 01, 2014, 07:39:09 PM »
Wonder what the wait time will be?

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Re: pkr or tkr ?
« Reply #27 on: July 01, 2014, 09:28:49 PM »
Are you in the NHS system?  I think you have to be seen within 18 weeks?  Assuming you can get a referral there.  Alternatively, perhaps you could see them privately and then transfer to NHS list for any surgery?


I don't know, all my specialist care for 5 years has been private, with insurance (other than trips to A&E)!
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline turbostar

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Re: pkr or tkr ?
« Reply #28 on: July 01, 2014, 09:33:07 PM »
Could do both i suppose, God knows how long you wait on the NHS.

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Re: pkr or tkr ?
« Reply #29 on: July 01, 2014, 09:35:19 PM »
You can only ask.  I don't know if the summer holiday is a good or bad thing in this scenario

£250 normally to see a specialist privately, they probably quote prices on the website.  You'll need a GP referral either way and to get your notes across
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

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Re: pkr or tkr ?
« Reply #30 on: July 01, 2014, 09:59:26 PM »
Having to deal with the fantastic or not so GP, deep joy!!!!

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Re: pkr or tkr ?
« Reply #31 on: July 01, 2014, 10:04:02 PM »
Perhaps if private, they'd accept a specialist referral, call them to discuss the options. 

In my not inconsiderable recent experiences, GPs are generally more than happy to refer patients for private treatment as there's no budgetary impact for them ;)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

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Re: pkr or tkr ?
« Reply #32 on: July 01, 2014, 10:09:56 PM »
I've always found them hard work to deal with. But i'll give em a go.

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Re: pkr or tkr ?
« Reply #33 on: July 01, 2014, 10:22:14 PM »
Interesting,GP practices evidently vary a lot.  For anything to do with my leg, I try to see the same GP who treated my knee initially in 2009.  She is very sweet (and popular, have to book ages in advance)!

I'd call the clinic first and find out exactly what they require for a private referral, should smooth the process with the GP.  Print this link off, take it with  http://www.oxfordkneegroup.com/healthcare-professionals/

Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

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Re: pkr or tkr ?
« Reply #34 on: July 01, 2014, 10:32:34 PM »
Thank's  :)