Knee replacement - help me understand them please!
Discussion
Not for me. For my 77 yo mother.
TLDR: she needs a knee replacement, but isn’t clear if she should have partial or full. What’s the benefit/risk to each? Also now thinking about spending my money on a private op - any advantages/disadvantages?
She’s been in the list for a full knee replacement (right knee) for some time. The delays caused by the pandemic have meant surgery has been forever been out back by NHS Wales.
Her surgeon has said all along that she should have a full knee replacement, rather than partial. His reason is that he does plenty of full replacements to fix partial replacements that haven’t lasted.
When presented with a firm date for surgery, my mother backed out. At 77 and generally on her own (my father still works and is away in the week), she’s fearful of the tales of lengthy recovery periods. She also has a fear of an allergic reaction to the implant.
So she’s got herself cross-referred to another surgeon who specialises in partial replacements. He seems to think she’s a candidate for a partial replacement, but would only be 100% sure on opening up her knee during the procedure.
Can anyone with any knowledge please help me with a few questions:
- What are the advantages/disadvantages of choosing a partial over a full replacement?
- Does her being 77 (and otherwise active) make a difference to long term (such as it is at that age!) benefit of either a partial or full replacement?
- What’s the recovery difference like after each surgery? I’ve heard weeks (partial) and months (full) - true?
- Having now lost her place in the NHS queue, she’s considering going private. Without any money it falls to her children to pay - me and my sister. Money isn’t the issue, but I’m more concerned whether this is the sort of surgery that’s best left to NHS or private?
- And if she goes private, any tips to get value for money (the one post-op consultation in the quote looks a bit light for something where there are potentially months of recovery)?
Thanks!
TLDR: she needs a knee replacement, but isn’t clear if she should have partial or full. What’s the benefit/risk to each? Also now thinking about spending my money on a private op - any advantages/disadvantages?
She’s been in the list for a full knee replacement (right knee) for some time. The delays caused by the pandemic have meant surgery has been forever been out back by NHS Wales.
Her surgeon has said all along that she should have a full knee replacement, rather than partial. His reason is that he does plenty of full replacements to fix partial replacements that haven’t lasted.
When presented with a firm date for surgery, my mother backed out. At 77 and generally on her own (my father still works and is away in the week), she’s fearful of the tales of lengthy recovery periods. She also has a fear of an allergic reaction to the implant.
So she’s got herself cross-referred to another surgeon who specialises in partial replacements. He seems to think she’s a candidate for a partial replacement, but would only be 100% sure on opening up her knee during the procedure.
Can anyone with any knowledge please help me with a few questions:
- What are the advantages/disadvantages of choosing a partial over a full replacement?
- Does her being 77 (and otherwise active) make a difference to long term (such as it is at that age!) benefit of either a partial or full replacement?
- What’s the recovery difference like after each surgery? I’ve heard weeks (partial) and months (full) - true?
- Having now lost her place in the NHS queue, she’s considering going private. Without any money it falls to her children to pay - me and my sister. Money isn’t the issue, but I’m more concerned whether this is the sort of surgery that’s best left to NHS or private?
- And if she goes private, any tips to get value for money (the one post-op consultation in the quote looks a bit light for something where there are potentially months of recovery)?
Thanks!
I'm a knee surgeon.
This is very good and almost independent :
https://hipknee.aahks.org/full-vs-partial-knee-rep...
[quote] What are the advantages/disadvantages of choosing a partial over a full replacement?
- Does her being 77 (and otherwise active) make a difference to long term (such as it is at that age!) benefit of either a partial or full replacement?
- What’s the recovery difference like after each surgery? I’ve heard weeks (partial) and months (full) - true?
[/quote]
Partial will recover quicker, feel more normal, and possibly allow her to do more sports.
But at the cost of a higher revision rate(might need redoing earlier) and it might be overcomplicated for her needs. There is no doubt that a Total is a more reliable procedure.
The most important thing is to find a surgeon who does a lot of both. Because there is no substitute for experience, and experience of surgeon means he or she will pick the right option for your relative
Surgeon operation volumes and numbers are found here.
https://surgeonprofile.njrcentre.org.uk
Put in the surgeon's name and look for "36 month practice profile"
A top surgeon could be doing >100 knee replacements a year.
Less than 20 of any variety makes you wonder
Private vs NHS, it's usually the same guys doing the same surgery, just on a different timescale and with better biscuits.
I don't have an A game and a B game
It's a conundrum for us surgeons, total vs partial with no answers
This is very good and almost independent :
https://hipknee.aahks.org/full-vs-partial-knee-rep...
[quote] What are the advantages/disadvantages of choosing a partial over a full replacement?
- Does her being 77 (and otherwise active) make a difference to long term (such as it is at that age!) benefit of either a partial or full replacement?
- What’s the recovery difference like after each surgery? I’ve heard weeks (partial) and months (full) - true?
[/quote]
Partial will recover quicker, feel more normal, and possibly allow her to do more sports.
But at the cost of a higher revision rate(might need redoing earlier) and it might be overcomplicated for her needs. There is no doubt that a Total is a more reliable procedure.
The most important thing is to find a surgeon who does a lot of both. Because there is no substitute for experience, and experience of surgeon means he or she will pick the right option for your relative
Surgeon operation volumes and numbers are found here.
https://surgeonprofile.njrcentre.org.uk
Put in the surgeon's name and look for "36 month practice profile"
A top surgeon could be doing >100 knee replacements a year.
Less than 20 of any variety makes you wonder
Private vs NHS, it's usually the same guys doing the same surgery, just on a different timescale and with better biscuits.
I don't have an A game and a B game
It's a conundrum for us surgeons, total vs partial with no answers
Good reply there by The Doc.
My father in law had both knees done (12 months apart) when he was 76, he was in a bad way and they have transformed his life for the last ten years.
He put it down to being an old skool plumber spending years kneeling on cold stone flags
Now aged 86 and still in good health he has started having trouble with one of them, and is contemplating having the bad one done again, but his doctor wasn't too sure and just advised he does some physio.
All on the NHS (God bless 'em)
My father in law had both knees done (12 months apart) when he was 76, he was in a bad way and they have transformed his life for the last ten years.
He put it down to being an old skool plumber spending years kneeling on cold stone flags
Now aged 86 and still in good health he has started having trouble with one of them, and is contemplating having the bad one done again, but his doctor wasn't too sure and just advised he does some physio.
All on the NHS (God bless 'em)
@The_Doc
Interested if you could offer some advice as to what’s wrong with my knee as Google is sending me round the bend! I don’t think I need a new knee though.
Been a road jogger for many years and had the old hamstring and lower shin pulls into that time but I’m at a loss with the new problem. Came on after a short sprint several months ago and despite ceasing running since when I try to get back into a jog it comes back within a few yards.
Trouble is I can’t locate the pain in the exact spot. It’s at the back of the right knee and if I had to guess slightly on the outside and slightly lower than the crease so very top of lower leg. I can walk and cycle without issue but after it’s aggravated I feel the ache/pain coming down stairs and if doing a deep squat. Go into a short run to say cross the road and it’s there again. Tried usual stretching exercises but won’t go away and after two months without running it’s starting to annoy me.
Any ideas? I’m thinking a doctors appointment then referral for a ultrasound is where I’ll end up and however long that will take.
Interested if you could offer some advice as to what’s wrong with my knee as Google is sending me round the bend! I don’t think I need a new knee though.
Been a road jogger for many years and had the old hamstring and lower shin pulls into that time but I’m at a loss with the new problem. Came on after a short sprint several months ago and despite ceasing running since when I try to get back into a jog it comes back within a few yards.
Trouble is I can’t locate the pain in the exact spot. It’s at the back of the right knee and if I had to guess slightly on the outside and slightly lower than the crease so very top of lower leg. I can walk and cycle without issue but after it’s aggravated I feel the ache/pain coming down stairs and if doing a deep squat. Go into a short run to say cross the road and it’s there again. Tried usual stretching exercises but won’t go away and after two months without running it’s starting to annoy me.
Any ideas? I’m thinking a doctors appointment then referral for a ultrasound is where I’ll end up and however long that will take.
Sorry bud.
I don't do personal advice over the internet.
Too difficult to be accurate, and so it's just guessing.
And I'm a surgeon, we don't guess. We are just right all the time
Ask to see a good GP or physio, or a knee surgeon. Don't bother with an ultrasound. I have NEVER ordered one in 15 years of chopping into knees.
the discussion above with OMITN was solely about finding a person, not diagnosis.
sorry to be strict.
I don't do personal advice over the internet.
Too difficult to be accurate, and so it's just guessing.
And I'm a surgeon, we don't guess. We are just right all the time
Ask to see a good GP or physio, or a knee surgeon. Don't bother with an ultrasound. I have NEVER ordered one in 15 years of chopping into knees.
the discussion above with OMITN was solely about finding a person, not diagnosis.
sorry to be strict.
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