What's best? Advice needed please

[Caggie]

Heya,

This knee of mine is getting worse n worse. I'm in the UK and have lateral degradation of the knee joint and some degradation to the medial side.  I'm 41 they aren't keen on doing anything but my quality of life is pretty crap - I have another consultant appointment in a week and have sent away prior to this one 3 months ago by the consultant with homework to research osteotomy, partial and full knee replacement.  I would kinda have liked some guidance from surgeon but he has been clear I'm in a difficult bracket of 'young adults' and that he would not recommend anything!  I don't like the fact I feel I have to put a case forward to the consultant just because of my age! Could anyone offer any advice or signpost me to any resources in respect of the 3 procedures?

Thanks

Caggie

[Vickster]

Hi there
Sorry to hear of your problems.

There's good info in the learning portfolio, in the arthritis primer and there are other articles too.

https://www.kneeguru.co.uk/KNEEnotes/learning-portfolio#Primers

On the web more generally, these are good sources for osteotomy and Replacements

https://profadrianwilson.co.uk/knee-treatments/knee-realignment-surgery-osteotomy/
https://profadrianwilson.co.uk/knee-treatments/knee-replacement/
http://www.professordavidbarrett.co.uk/procedures/

The Oxford group are experts in PKR having pioneered these
https://www.oxfordkneegroup.com/our-team

Are you knock kneed as a result of the lateral compartment damage or reasonably well aligned as that will determine your suitability for osteotomy vs a replacement. If you are, it could be worth trying a custom unloader brace to see if that gives relief. It could indicate if osteotomy is the answer

Are you reliant on the NHS or do you have private insurance /ability to self fund as the latter might give you access to more specialists and new techniques / prostheses for the different options. Where in the Uk are you?

You are certainly young for a TKR if you have other options as both osteotomy and PKR can be revised to a TKR in the future while a TKR is a one way street and can only usually be revised once. They're all big painful ops unfortunately with long rehabs, so you should certainly discuss each in depth with your Consultant (is he expert in all options or would he refer you to someone who is?) it seems odd that he's offering all as options as if you are suitable for osteotomy or PKR, then you likely aren't far enough down the road for a TKR.

Your job and level of activity will also need to be considered. My surgeon has seen that lateral PKRs don't last well in active patients but can loosen and can need revising to total quite quickly. Get your surgeon to advise based on his knowledge and experience

Presume you've tried all the non surgical options of targeted physio, orthotics, bracing, injections etc? Have you had cartilage repair in the past, microfracture or similar? How big is the area of wear in each compartment and where? How much 'good' cartilage is there?

 I'm 46 and in a similar boat (albeit a recent scope has shown areas of grade 3-4 arthritis in all 3 bits of my left knee), I'm hoping to get another 10 years before a TKR, nothing else is really an option anymore

Good luck

[Caggie]

Thanks in advance