knee osteotomy or joint replacement?

Hi,
One of my knees seems to have reached the point of no return. My last set of x-rays (2013) indicated that a osteotomy or joint replacement was on the cards at some point. As stairs are now becoming difficult, I'm off to the see the doc on Monday. I'm relatively young for a full replacement: 54 years old.

I'm after comments on how things have gone from anyone you has had either procedure, or alternatives (are there alternatives?). How long was the recovery, the ups, the downs, how easy was it to climb afterwards, how long it has lasted. Really anything.

Or from any surgeons, or researchers.

Thanks.

Not me but one of my climbing partners.

He was 60 and to the point of fairly constant pain before he got it done. He said the first ten days of recovery were pretty painful but abruptly after that it wasn't too bad. Diligent physical therapy for a while but after maybe two months he was up and getting around fairly regularly.

He got it done in November and enjoyed the climbing season that following spring. Walking was good but no running as the joint surfaces aren't designed for that kind of stress. Climbing was good other than some range of motion loss which he was hoping was temporary. Of course a good bit of muscle atrophy but he made most of that up in the first year. His overall impression was that he shouldn't have waited so long. Haven't climbed with him since this November but I know he's out there identifying 5.12 projects!

Man, I'm in the same boat but I'm 10 years younger. A recent MRI showed a grade 4 loss of cartilage in my left knee. I'm meeting a Dr. Soon to talk about autologous cartilage replacement. Sound awful, low chance of success and a long recovery too. I'm not sure a knee replacement is even an option at my age.

OP, Ive got arthritic knees, and on the threads about it, "beat up body parts", others, were several encouraging stories of folks being much, much better post than pre op.

Csproul, my info is that they made people wait because the replacements were only good for about fifteen years. Latest I've read though, is that the longevity of the spare parts is getting better. It also might not be as much of an issue to put in number two down the road.

Do tons of reading, and ask around for lots of opinions.

For myself, exercise, and keep my weight down. Truly, move it or lose it. When the "it" is your day to day mobility, it's pretty dang good motivation!

Stairs were becoming difficult for me, but the PT stuff and additional exercises have definitely helped. Getting my gait straitened out helped, also. Favoring the thing did not help!

You guys are both too young. My sympathies.

Best, Helen

Don't fear the knee replacement. It's painful initially but effective.

I held out bone-on-bone for a couple of years in the hope that autologous cartilage implants would be approved soon. And watched my climbing dwindle. But 5 years later there is still nothing new on the horizon. Waiting further didn't seem like a good idea. I'm now 63 and and 2.5 yrs post-op. Do not climb like a little-old-lady these days.

At 8 weeks post I was able to climb again, and by 12 weeks I was climbing my regular stuff indoors. Long hikes are no longer a huge problem. It has rejuvenated my climbing because I'm no longer in pain. I actually have no cartilage left in the other one, but have been able to do without a TKR on that because the other one is so strong and stable. (So I can no longer blame my failures on my knees.....)

Gave this advice to a local friend (who's in your age group) and she had the op and got the same experience.

Search on MP for longer thread on this topic in years past.

PS: my TKR implant (Stryker Triathlon) has a lifetime rating, & you can ski on it.

Old Lady H is right that PT can help. I did this for a couple of years before going under the knife and it helped 'some' but did not totally halt progression of arthritis. (I also got synthetic joint fluid and cortisone shots) Also did PT preoperatively in order to go in strong, particularly in the hips. I think this might be more relevant for women, who tend to have a bigger 'Q' angle at the knee which wears unevenly to start with, then we get chrondromalacia (misalignment) when our cartilage starts to go.

Good luck, whichever path you choose!

Osteotomy of the knee is typically done in younger (<35 year old) people and they generally end up getting a knee replacement eventually anyway.
If the damage is primarily limited to the medial (inside) compartment of the knee, a partial replacement is an option, with shorter recovery/rehab times. Minimally invasive surgical techniques help to minimize healing times as well.

I'm 60 and injured my medial meniscus 30+ years ago and was uninsured at the time, so never had surgery. Despite that, I continued to climb, run, backpack and ski. Over the past couple years, my knee has deteriorated to the point that any activity, even going up and down stairs or walking my dog, causes pain and my leg is severely bowed, so that I am unable to walk in anything close to a normal manner. More importantly, it limits my ability to do many things that I love doing (e.g. climbing) and I am having surgery for unicompartmental replacement in 2 weeks. If the remainder of my knee looks bad, there is a possibility of a total knee replacement.

I expect to be climbing again by this summer and am seeing one of the best joint replacement orthopedists in Denver.

I was told I was a candidate for a total knee replacement when I was 56 years old but encouraged to put it off as long as possible. At 60 I finally said enough and had the operation, I now look at those years between diagnosis and the operation as the lost years and wish I'd done it sooner. I'm completely happy with the knee never any pain the only issue is some loss in range as far as compaction of the knee which took some getting used to especially in crossing boulder fields. High steps when climbing can be a bit interesting as well.

For two weeks after the operation I was not loving life and swore I'd never do it again, but now that my other knee has become a problem I'm going to do it. Key is starting rehab asap and doing it religiously!!! It's all about regaining flexibility and strength with the flexibility being the toughest.

Good Luck

if the knee is shot then you don't have much choice. The TKR gets better all the time.....strength in the quad before surgery really helps because you will have significant muscle loss.

Knees are tougher to rehab than hips ( I have both hips and one knee) But after a couple of weeks you see significant improvement.

if you don't get it done, other joints will develop problems for sure..the old knees only lasted a dozen years or so, newer models are much better

Best wishes for tomorrow, Mr. Coley, whatever you decide.

You do have one huge advantage, remember. You're a climber*! Which means, you expect results, and will have the tenacity to accomplish whatever you deem is possible, and worth the effort.

You've got this, sir!

Best, Helen

• stubborn, opinionated, hard-headed, focused, did I mention stubborn??...

I had a partial knee replacement 1 week ago today and am doing great. I was sent home from the hospital the day after the surgery and am walking without any problems. Never needed a walker or a cane. I haven't taken any pain meds since I left the hospital and can walk normally without much pain for the first time in years. Still a bit sore and pretty swollen but improving every day and have 107 degrees of flexion already.
Won't be climbing or hiking for a few weeks but I expect that I will be able to do much more than I could before surgery.
Hope this helps you to decide what you need to do. Obviously, my good experience doesn't guarantee you or anyone else a good outcome and a total knee requires more rehab than unicompartmental. I'd also highly recommend looking for a surgeon who does minimally invasive technique.
Good luck whatever you decide.

I'm doing really well at 6 weeks post PKA. I haven't started climbing yet but think I'll go to gym sometime in next couple weeks to see how feels.

Anyone else have this surgery done? How long before you were climbing again?

OP- did you get your surgery done?

David,

I talked to a Stryker rep today, specifically about the Triathlon knee. I have great knees, I just happen to be a circulating nurse in the OR and today was an ortho day for me, so I asked.

First off, that model, the Triathlon is about 20 years old and nothing weird has come up. It's going strong and lots of people are still rocking the originals.

Running is kind of off the table. He said they wear out a lot sooner if you run and the knee doesn't have nearly the give of actual cartilage so it's more jarring to run. It sounds like a lot of people are very successful skiing, hiking, and cycling on one though. Climbing is a bit of an outlier, so I don't know how that goes. If it's a matter of packing to the cliff and being able to do some highsteps, I'd imagine it'd be extremely beneficial. If you frequently climb offwidths with feet over your head and/or bust out wild drop knees, it might be a little different. Although if you're in the market for a total, this may not be a huge concern.

You asked about the age. I pretty much see people 45 and over total knees. You aren't the youngest. They last a while. They might not last your life, you might need to get a new one down the road.

Talk to your Ortho. It'll probably give you a lot of your old life back but you'll never be quite where you'd be if you didn't have knee problems.

highaltitudeflatulentexpulsion wrote:

David,

I talked to a Stryker rep today, specifically about the Triathlon knee. I have great knees, I just happen to be a circulating nurse in the OR and today was an ortho day for me, so I asked.

First off, that model, the Triathlon is about 20 years old and nothing weird has come up. It's going strong and lots of people are still rocking the originals.

Running is kind of off the table. He said they wear out a lot sooner if you run and the knee doesn't have nearly the give of actual cartilage so it's more jarring to run. It sounds like a lot of people are very successful skiing, hiking, and cycling on one though. Climbing is a bit of an outlier, so I don't know how that goes. If it's a matter of packing to the cliff and being able to do some highsteps, I'd imagine it'd be extremely beneficial. If you frequently climb offwidths with feet over your head and/or bust out wild drop knees, it might be a little different. Although if you're in the market for a total, this may not be a huge concern.

You asked about the age. I pretty much see people 45 and over total knees. You aren't the youngest. They last a while. They might not last your life, you might need to get a new one down the road.

Talk to your Ortho. It'll probably give you a lot of your old life back but you'll never be quite where you'd be if you didn't have knee problems.

Hey, thanks for the post! If something is lasting that long now, maybe they won't make me wait until I can't do anything. Knees are actually better than they were, I've even managed to up the mobility, but we'll see how it goes once the cold weather hits.

Best, Helen

Just an update. I've not had the op (yet). I have retuned to large amount of knee strengthening in the gym. This will at least get the muscles as strong as possible before an autumn op.

David Coley wrote:

Just an update. I've not had the op (yet). I have retuned to large amount of knee strengthening in the gym. This will at least get the muscles as strong as possible before an autumn op.

I did a lot of weight lifting and leg strengthening prior to my surgery and it really helped speed recovery. Surgery was 6 weeks ago yesterday and I am doing well. I am going to try climbing in gym next weekend. Have been lifting weights for several weeks and did a deadlift of 295 pounds recently. 

David Coley wrote:

Just an update. I've not had the op (yet). I have retuned to large amount of knee strengthening in the gym. This will at least get the muscles as strong as possible before an autumn op.

Good to hear from you! You aren't the only one working the gym for bashed up parts these days. I'm sure more than just myself are cheering you on from afar.

While I'm at it, thanks for your writing, and all you've contributed to climbing, too!

Best to you! Helen