Knee replacement surgery

[huzieiii11]

So i'm looking at the prospect of partial knee replacement surgery of the lateral compartment, and i'm thrilled. I'm 45 and my knee has given up the ghost so that's my best option. Wondering if anyone on here has had this surgery, is close to my age range and what their experience has been. Wondering if skiing on it is still an option. If you have any feedback on this, i'm all ears. Cheers. Huzie

[steelhead]

Hi Huzie,

I am older than you by about 18 years. I had a partial replacement on Sept 23rd last year and with an aggressive rehab was skiing again on January 20th of this year. The deal with the surgeon was to start easy and no bumps or jumping. It was a wonderful thing to be skiing on 2 legs again so for me, it was an improvement over the previous few seasons. By the end of the year I made it back to smooth blacks and this year should be able to go harder. Only advice I have is to not underestimate the impact of the surgery and work hard at rehab. Bottom line is skiing should be still an option for you but with a few limitations. Good luck!

[huzieiii11]

Thanks Steelhead, your input is much appreciated. I had the knee scoped about 2 weeks ago and they removed more meniscus and took pictures. Bad news is they told me i'm not a candidate for a partial anymore, but rather will need a FULL knee surgery! I'm even more screwed than I thought. I guess the condition of my cartilage on the medial side is not good enough so they want to do a full replacement. Not to sound callous steelhead, but replacements at your age are rather common, I can't seem to find anyone at my age who has had this surgery. I'm wigged out about the prospect of what will happen when it fails and i'm only in my mid 50's?! Were you a pretty aggressive skier before you surgery? thanks again for your feedback. Huzie

[steelhead]

No offense taken Huzie - my age and knee are what they are - I am just really happy to be skiing on 2 legs again. As for being an 'aggressive' skier, that is pretty subjective. I would say I was until my forties. I spent about 5 winters at Lake Tahoe in my late 20's and hammered my knees pretty well in the big bumps at Squaw in those days (much more grooming now). It caught up with me as I aged which resulted in being more cautious and staying more and more away from the bumps. Up until 2 years ago I was still skiing the steepest stuff on Mt Hood (where I live now) and hope to get back to it this year.

As for full replacement, there are several people in our locker room who have had them and they are still skiing. If you were/are a very aggressive skier you will probably have to make some compromises but that, at least to me, is way better than giving it up. Strongly suggest you obtain multiple opinions and don't do it until the pain in unmanageable. Best of luck to you.

[huzieiii11]

Again, thank you steelhead. In such a misery vortex over this situation that any feedback is super appreciated. I have never been a bump skier, in fact I suck in the bumps, but I do love the steeps and like to tackle that stuff aggressively and go hard and fast. I'm wondering if I can still ski near that level on steep stuff with a replacement? I'm glad to hear that guys in their 60's are still getting after it, i have something to look forward to. I had a stem cell injection this week that was taken from my hip, even tho I was told it wouldn't do anything for me, I did it anyway because I am desperate and hoping for a "Miracle" I guess. My fingers are crossed and my girlfriend is already trying to prep me for snowboarding this winter but i'm gonna keep hoping. Glad to hear you are getting back to healthy yourself and I hope we get a huge, deep winter! cheers. Huzie

[Vinman]

I've worked with bilateral TOTAL knee replacement folks that go back to skiing. The one guy was a heli guide back in the day. He still rips.

[huzieiii11]

Just out of curiosity VM, how old was this Heli guide? I guess my worry is that if I have this done at age 46 then i'm probably in for some serious trouble in my 60's and 70's. Appreciate the feedback tho.

[Tye 1on]

do it. Friend who was the first female patroller at Alta had both replaced, and is crushing it again. Don't worry about 15 years from now. Who knows what they will know/do by then.

[Powder Ho]

My wife had a total replacement 15 Nov 12. She is 55yrs old and had severe arthritis. A few areas of bone on bone per the surgeon.
She rehabbed like crazy. Started back to spin class in Jan and skied pain free for 2 hours 22 April. She mountain biked last Sat for an hour plus totally pain free. The last 3-5 years she's had to deal w/ pain and limitations. Now she wishes she had her knee done years ago.
Find a good surgeon and rehab hard. You won't be sorry.

[Orthoski]

As a general note, anyone having a joint replacement (knee or hip) with the goal of returning to skiing should have a long conversation with his/her surgeon. Joint replacements are a bit of a catch 22, in that they're done with the hope of making people more active but they also frequently come with prescribed limitations on what people can do. In that sense, a knee replacement will definitely make most people want to return to skiing, but on the flip side the cement-bone interface (the metal parts connect to the bone with cement in most cases) has a limited life span and can loosen over time. The more force/torque placed upon the implant, the shorter its life span. Then, the key thing that is sometimes harder to appreciate, is that a second joint replacement (i.e., a "revision") is not the same as the first time around. It's harder to do surgically, it doesn't last as long, etc. I've often heard surgeons say that you "only get one good bite out of the apple" (i.e., the second bite can be great, but is rarely as good as the first, and this applies to both apples and joint replacements). And while implants are getting better, they may not be getting better as quickly as people think - the first improvements made on original designs made joint replacements significantly better, but more recent improvements are arguably working at the margins. The other issue, of course, is falling. If you fall on a hip replacement, for example, that metal part can lever the bone and crack it, and fixing fractures around joint replacements is significantly more complicated than regular fractures, because the implants can loosen and one can't get stability into a broken bone (which often means revising the implant).

Thus, like most things in life, skiing after a joint replacement involves trade offs. For someone like an Alta ski patroller, this is her livelihood. It's hard to imagine a doctor that would be draconian enough to say that you shouldn't ever do the activity that puts food on the table. On the other hand, for those of us for whom skiing is a hobby, one really has to ask 1) whether to ski, and 2) what type of terrain/how aggressively. Cruising on groomers is very different than sending pillow lines.

In any case, as someone who absolutely loves skiing and frequently ponders what I would do after a joint replacement, I just hoped to share that it's a very personal decision that involves some serious risk/benefit analysis. There isn't going to be one right answer, and everyone is going to have to draw on their individual priorities to answer this.

[Bird Blaster]

Well said. I tell my patients that they really shouldn't get back to skiing. I personally worry more about the knees.

[pinto]

What about partial (patellofemoral) replacements? I am/will be a candidate for this on both knees some time in the next 3, 5, 10 years, not sure, but I don't know anyone who has had it done. Right now I am taping, with great success (I didn't tape today, and ouch!), but eventually my doctor says I will need to get the patellas done.

Oh -- source is poor tracking, and I have plenty of joint space in the rest of my knees. Not at all a candidate for TKR.

[spook]

My wife had a total replacement 15 Nov 12. She is 55yrs old and had severe arthritis. A few areas of bone on bone per the surgeon.
She rehabbed like crazy. Started back to spin class in Jan and skied pain free for 2 hours 22 April. She mountain biked last Sat for an hour plus totally pain free. The last 3-5 years she's had to deal w/ pain and limitations. Now she wishes she had her knee done years ago.
Find a good surgeon and rehab hard. You won't be sorry.

i had no idea you could rehab that fast from a knee replacement. i'm probably looking at the same thing before too long.

[Orthoski]

What about partial (patellofemoral) replacements? I am/will be a candidate for this on both knees some time in the next 3, 5, 10 years, not sure, but I don't know anyone who has had it done. Right now I am taping, with great success (I didn't tape today, and ouch!), but eventually my doctor says I will need to get the patellas done.

Oh -- source is poor tracking, and I have plenty of joint space in the rest of my knees. Not at all a candidate for TKR.

Patellofemoral replacements are on the newer end of the technology spectrum, and there's going to be less data out on them. A recent review article in the Journal of Bone and Joint Surgery (2012) quoted, "Many studies have shown good to excellent results at three to seventeen years of follow-up for 66% to 100% of patients." Problem is, 100% sounds great, but 66% excellent outcome is down-right horrible compared to traditional total knee replacement, whose success rate is generally 98-99%. Newer technologies will definitely improve this over time, but my worry would still be the cement-bone interface, especially if you have pre-existing malalignment which, if severe, may require corrective surgery. The short of things is that the best part of your post was that you said taping is helping. I would stick to non-operative management for as long as you can and then broach the issue with your surgeon if the time does indeed come. Best of luck.

[pinto]

Patellofemoral replacements are on the newer end of the technology spectrum, and there's going to be less data out on them. A recent review article in the Journal of Bone and Joint Surgery (2012) quoted, "Many studies have shown good to excellent results at three to seventeen years of follow-up for 66% to 100% of patients." Problem is, 100% sounds great, but 66% excellent outcome is down-right horrible compared to traditional total knee replacement, whose success rate is generally 98-99%. Newer technologies will definitely improve this over time, but my worry would still be the cement-bone interface, especially if you have pre-existing malalignment which, if severe, may require corrective surgery. The short of things is that the best part of your post was that you said taping is helping. I would stick to non-operative management for as long as you can and then broach the issue with your surgeon if the time does indeed come. Best of luck.

Thank you! And it's as I suspected ...

[Powder Ho]

i had no idea you could rehab that fast from a knee replacement. i'm probably looking at the same thing before too long.

She started her PT 4 days after surgery. She was doing her hour long routine everyday at least once and most days twice. I was an athletic trainerlong ago so I was able to help her. The key was getting ROM back and then work on regaining strength. Skiing this season wasn't her goal, but the surgeon cleared her after her last post op visit.

[splat]

Orthoski - as one who would seek to avoid joint replacement as much and long as possible, you very much echo most all my sentiments on this issue. I guess average life cycle on knee hardware is, like, 20 years, yes? And people can kinda guess the ballpark of their genetic/lifestyle life span estimate. So, if you divide that number by only ever wanting to do a joint replacement once in your lifetime, a reasonable minimum age can be determined that would support the one time approach.

I've talked knees on the chair with guys (late forties/early fifties) sporting metal knees. One guy had kind of a cavalier attitude of "Yeah, my knee was beat from skiing, so I got a new one and now I can rip again." I asked him if he'd ever heard about Arnold Schwartzenegger's incident in Sun Valley (a friend with two joint replacements told me this). Supposedly, Arnie fell and popped the pin out through the femur where it was cemented in. Anyways, I don't have a firm verification on that story's truth or accuracy, but I told the story to that guy, cause I felt like his next knee was not going to go as well as the first. And I also noticed I never hear about Arnie skiing anymore after he was known to shuttle back and forth to the slopes.

[spook]

She started her PT 4 days after surgery. She was doing her hour long routine everyday at least once and most days twice. I was an athletic trainerlong ago so I was able to help her. The key was getting ROM back and then work on regaining strength. Skiing this season wasn't her goal, but the surgeon cleared her after her last post op visit.

congrats to her for sure! i'm going to do everything possible to avoid one as long as possible, but i'm overweight and most of my medial meniscus is gone in one knee and bone spurs have started to form. the surgeon said there was nothing that she could do that would make it better enough to justify another invasive procedure (acl reconstruction and 2 mm surgeries).

[Orthoski]

Orthoski - as one who would seek to avoid joint replacement as much and long as possible, you very much echo most all my sentiments on this issue. I guess average life cycle on knee hardware is, like, 20 years, yes? And people can kinda guess the ballpark of their genetic/lifestyle life span estimate. So, if you divide that number by only ever wanting to do a joint replacement once in your lifetime, a reasonable minimum age can be determined that would support the one time approach.

You're right Splat, in the sense that ideally everyone would be able to wait until they're elderly to get their joints replaced. But arthritis can be such a debilitating condition that unfortunately not everyone is that lucky. For a number of reasons, be they genetic or traumatic, some people need joint replacements at a younger age. Thankfully, revision joints (once the first pair wears out) can be successfully performed so young people shouldn't necessarily live in fear, but the harder part with younger people is that they understandably want to be active, especially when suddenly feeling good about their knee/hip for the first time in years. But unlike bone, which can heal, a metal/plastic replacement has a limited lifespan and that lifespan is to a large extent dependent on how you use it. It's analogous to a car - do you drive it like Mario Andretti or like Morgan Freeman in "Driving Miss Daisy"? Furthermore, revision joints aren't the same as the first time around; they're harder to perform surgically and don't necessarily last as long, so young people should bear this in mind. For this reason, as I mentioned above, it's all a personal decision with a cost-benefit analysis. The discussion I hoped to stimulate among the community is that we're good at seeing the benefits (i.e., skiing), but sometimes less equipped to fully appreciate the costs (i.e., your Arnold example). There isn't going to be one universal right answer.

On a reassuring note, there is no orthopedic contraindication to après-ski (enjoyed responsibly, of course)....

[Moeghoul]

Good stuff in this thread, my wife (57 YO) has bad arthritis, bone on bone , and is scheduled for full knee replacement on May 8.

[splat]

I have no idea who orthoski is, but I sure appreciate what he brings to this forum...

[Shredhead]

My wife had a total replacement 15 Nov 12. She is 55yrs old and had severe arthritis. A few areas of bone on bone per the surgeon.
She rehabbed like crazy. Started back to spin class in Jan and skied pain free for 2 hours 22 April. She mountain biked last Sat for an hour plus totally pain free. The last 3-5 years she's had to deal w/ pain and limitations. Now she wishes she had her knee done years ago.
Find a good surgeon and rehab hard. You won't be sorry.

Do you know which device her surgeon used?

And while implants are getting better, they may not be getting better as quickly as people think - the first improvements made on original designs made joint replacements significantly better, but more recent improvements are arguably working at the margins.

Which devices for TKR do you recommend?


I had THR 2/11/13 and TKR is a matter of when, not if, at this point.

[Orthoski]

Device companies spend a lot of advertising money trying to convince patients that their components are uniquely better (i.e., gender-specific designs, ones that use pre-op CT to measure the bones, etc). Humility makes me point out that these companies also spend a lot of money on R&D trying to make better devices, but that's a separate point. With the exception of recent metal on metal failures that you hear about in the media, there is a real convergence of outcomes irrespective of manufacturer when it comes to total joints. Best go with the one that your surgeon uses on a regular basis.

[Powder Ho]

Do you know which device her surgeon used?
Stryker Triathlon. My wife did some research and didn't really see a big difference between brands. In the end it didn't matter as that's the brand her surgeon used.
BTW you tube has some excellnt videos of TKR surgery. My wife has yet to look at any of them.





Which devices for TKR do you recommend?


I had THR 2/11/13 and TKR is a matter of when, not if, at this point.

IMHO it's the skill of your surgeon and your determination early on in rehab that ultimatley determines the success of your TKR. Good luck.

[valli]

Just out of curiosity, what do people (especially orthoski) think of the bioknee replacement they do at the Stone Clinic? I know one person who did it and was very happy, but I know it's more out there.