Partial Knee Replacement

[hadfield4wd]

Long story short. I grew up 10 miles from a ski slope. I've had meniscal tears in both knees. The right has always been worse. I did a compound tear to the right medial meniscus in February while skiing. I do ride dirt bikes but no MX. Just woods and single track. I do small jumps associated with that riding. I've been riding on the knee since then. It's been pretty painful, kickstart only 4 stroke.

Had surgery last friday. The MRI was inconclusive so the Dr. started with a scope to see how bad it was. Then i gave him the authority to trust his judgment on what to do next. I woke up with a partial knee replacement. I knew this was an option and I also got a second and third opinion. Quite frankly i trust my Dr. And his judgement. I've been in considerable pain for the last 10 years or so. They had to take out a bunch the first surgery.

Oh I'm 42, 6' and 193lbs. I'm going to work at losing 15 lbs so i can be back where I was in college. I was given the option of a cartilage transplant but opted not doing it. Recovery was too long and I'd miss too much work. I work on my feet. I've taken 2 weeks off plus I have 3 more if I need them.

I'm on some hefty pain pills for a couple days and PT starts tomorrow. I've already been doing straightening and bending exercises.

My main question is I don't use braces now when I ride. I think its a good idea now, but I'd like to get the Dr. to prescribe them. Is this possible? I've reached my out of pocket maximum on my insurance so if he prescribes them then they are covered. Does this make sense? Am i asking for too much?

[hadfield4wd]

Also Doc says i'm off the bike for 8-12 weeks.

[DrMark]

It is doubtful that the well meaning lay persons who inhabit this website have much experience with return to sports after partial knee replacements, and I am certain that you would not be happy with my recommendations. You indicated that you trust your doctor. He/she should help you make these decisions.

[hadfield4wd]

It is doubtful that the well meaning lay persons who inhabit this website have much experience with return to sports after partial knee replacements, and I am certain that you would not be happy with my recommendations. You indicated that you trust your doctor. He/she should help you make these decisions.

I respect that. I do try to get recommendations from everybody. I'm not a typical forum rat that will try to argue that my way is the only way. I'd love to hear your point of view. You're obviously a dr. familiar with our sport. Edited August 4, 2014 by hadfield4wd

[DrMark]

I don't do partial knee replacements on off road riders. They won't last in the young, non golf and tennis types. A valgus tibial osteotomy would have preserved the entire knee joint, and allowed the knee to heal without relying on metal, cement, and plastic that has to deform every time you land from a jump, until it fatigue fractures and needs replacement. I would keep my wheels on the ground from now on.

[Arctic Pride]

good excuse to get a bike with electric start!

[hadfield4wd]

valgus tibial osteotomy

Ok so I know its too late for me but what is this? I wish i knew this part of the forum was here. Maybe somebody can learn from my mistakes.

good excuse to get a bike with electric start!

I hear although I just got done building this bike this winter.

Edited August 4, 2014 by hadfield4wd

[DrMark]

It is likely that you were bowlegged. Those folks take nearly 100% of their weight on the medial compartment of the knee, and the lateral compartment is unused and perfect, as in your case.

An osteotomy cut the bone and realigns it so that weight is equally distributed, or actually unloads the medial side to only 40% of the body weight. Modern surgical techniques can accomplish this without the need for a bone graft, and allow accelerated rehabilitation after surgery. This knee is still the one that our Creator gave you and it can respond to stresses better than one made by the medical equipment company. This is the preferred plan in the young extreme athlete. The mature adults, do better with cement, metal, and plastic.

[hadfield4wd]

Yep a lttle bowlegged. So as my cartiage was already torn once. I had that scoped and trimmed about 10 years ago. This time it was torn more significantly. So in your repair what what would happen to the damaged cartilage?

I ask this because my left knee was scoped 8 years ago and I wonder if this is something I should look into for it.

I appreciate the advise. Just trying to learn.

What do you think about a brace then? Could i get a prescription do you think? Thats probably a call to my insurance company.

Also i mentioned I ski. That is really my best sport. I stopped doing moguls after my first surgery. But i am still an aggresive skier. I can live without racing anymore. I raced in HS and college and still compete at local events. According to my "ski tracks" app on my phone I still regularly hit speeds of 50+ free skiing.

People tell me snowboarding is easier on the knees. I could switch it would be a truggle mentally though i've skied for 34 years. I think if snow boarding is inherently easier in the knees that good, but it will also serve to slow me down.

Keeping in mind no jumps. No halfpioes etc.

Oh and by the way thanks for calling me young at 42! I've got 10 years on all my riding friends i'm the old guy.

[DrMark]

The cartilage regenerates when the alignment is set straight. This has been suspected for decades, but only definitively proven in the last few years.

Boarding or skiing is as difficult on the knees as the athlete makes it. With good skills, its pretty easy on the knees. With bad skill, well that speaks for itself. LOL, a halfpipe just reminds me of my Lexus payment. A skier with a knee replacement, partial or total, is best staying on the groomed blues and black, and leave the moguls and the trees for others. With a healed osteotomy, a guy can do absolutely anything he wants to do.

I suspect your doc will write you an Rx for a brace. Don't ask me which one. I don't share that information because I am not in the business of selling braces, and people will rely on what I say.

[hadfield4wd]

Nope I won't ask which one. Thank you for the advice. I hope this helps someone down the line. This has been very informative.

[hadfield4wd]

Well in an effort to keep me from getting bored and keeping people informed, I'll keep updating this.

Today was day 2 of PT. And i'm supposed to do these exercises 2 times a day with or without the Physical Therapist. Who, by the way, if she had been born in the middle ages probably would have enjoyed performing disembowlements.

The are fairly simple so I won't go into specific detail as to the exercises themselves but the goalis to get full extension as soon as possible. While keep working on the flexion.

Now i was on morphine and percocet, however the morphine was violently rejected by my stomach. So its just the percocet. And quite honestly the pt hurts.

[hadfield4wd]

I have no idea how people get addicted to pain meds. All they do is make me sick.

Tuesday am projectile vomited 6 hours. Figured it was due to morphine. So I came off it. Still on percocet

Wednesday was doing great. Best day yet. Second day of pt doing ok but a lot of pain.

Thursday am dry heaved for 4 hours then slept all day. Headache excruciating. No food no pt. Feeling rather lousy.

Friday am major headache. No desire to eat. Pt chic coming no pain meds just tylenol. I pushed through and did well. Still have barely eaten.

They presribed me another pain pill viciden. Not taking it. The pain sucks but don't want to go through what i did again.

[lilGirl]

I have no idea how people get addicted to pain meds. All they do is make me sick.

After hip surgery the Hospital gave me oral Hydromorphone/Dilaudid (?) and it did nothing for me but make me sad. They didn't dispense Tramacet, which is what I used at home (because it doesn't pack enough punch). I finally got oral version of hydromorphone and it worked. They let my husband bring me in some of my tramacet the next day and within 2 hrs I felt much better and was up and walking. It works good for me, doesn't make me down and gives me just enough pain release to giddyup. I also have not had any problem getting off of them (both before and after surgery), which I had heard people say was a problem.

Edited August 9, 2014 by lilGirl

[hadfield4wd]

Well still only doing Tylenol. No more then 4000mg's/24 hours.

The pain is tolerable unless I'm vertical for a long period of time like the shower. Then I get an ice bag.

Therapy is going well.

[slowgs2001]

Yo, buddy keep on going buddy. You sound like a trooper. Stay positive.

[hadfield4wd]

Yo, buddy keep on going buddy. You sound like a trooper. Stay positive.

 

Well unfortunately this is not my first injury.  I know the therapy is key.  And I'm kinda used to pain.  Been injured a lot.  Pretty much started with a broken neck at 11.  Goes on and on.

 

Update.

Still can't get my leg bent enough to keep it out of the way to drive so I'm doing the world a favor and staying off the roads at this point.  Having people shuttle me around is getting old though. 

 

Getting around the house for the most part with no crutches. When I go out I take them both and concentrate on putting as much weight on the leg as possible.  I just have the crutches for protection from people hitting it.  Also since I'm off my blood thinners now Dr wants me taking more Ibuprophen and backing off the tylenol.  Its helping with the pain.

 

Outpatient PT starts Tuesday.  Trying to get as straight as possible before they really begin to torture me.  I can get to 5deg myself and when the home PT person was pushing she could get it to 2deg.  Flexion I can get to around 87deg.  She forced it to 91 deg.  So I'm getting there.

[hadfield4wd]

Pretty happy with where I am today. Week of outpatient. Plus all the home stuff.

Pushed it to 0 degrees today but when I'm walking normal it still doesn't get straight. Making progress slowly. She didn't measure flexion today. Last time she did and I got to 95 percent.

[spaceboy]

This is some good info. I've had both knees scoped, the left has been good since the surgery back in '06 but the right that was scoped in '11 has never been right. It's slightly better than it was and will probably eventually need replacing but apparently I'm considered too young (38) for that. The doctor had also cut my t band to help unload the joint from having the knee cap pop out to the side and I feel that that has lost a lot of the stability in the knee now. The knee is still twice its normal size all these years later and I get the fluid removed every so often (they remove about 100cc's each time). Current doctor just wants to keep giving injections of cortisone or synvisc which only seems to help for 2 weeks.

[DrMark]

I have reviewed you post op X-ray.  The prosthesis has not been put in straight.  The femoral component is angulated with respect to the tibial segment.  I an not smart enough to upload the close up view, but it can be formatted from the frontal view you presented. 

 

I am afraid the prognosis is guarded.