Although some time has passed, I didn't forget about this thread and do want to share what's been going on since I wrote the
article on the previous page to basically right now... It also seems to be a topic that comes up on the forum somewhat regularly and I've learned so much that hopefully can benefit others who are in the market for a TKR.
But first, a brief summary and answers to some questions I've had:
• No, this injury is FAR WORSE than the ligament tears and reconstructions Lindsey Vonn had. I only wish mine was a ligament tear!
• Short of osteotomies and a lateral release, I'm blessed to pretty much cover the spectrum of types of knee surgeries with 9 surgeries total on my Left knee including: two ACL/MCL/meniscus reconstructions, a triple microfracture, biologic articular cartilage restoration, full medial meniscus transplant from a donor cadaver, Staph infection irrigation + removal of new meniscus, manipulation under anesthesia, tibial bone biopsy for possible osteomyelitis and debridement, and finally a total knee replacement... try not to be jealous.
• At 34 years young, this 5-year + knee situation has turned into a statistical anomaly and I'm currently the youngest patient my doctor has done a TKR on (and I repeat verbatim: "Caroline, you have the sh***iest knee we have ever seen in any 30 yr. old patient." I love having such a bold title!).
•
Injections: prior to all off this mess, I've had just about every type of substance injected into my knee including multiple rounds of cortisone, all hyaluronic acid varieties, and prolozone shots.
None of these helped and I personally think if your knee already is bad, it's a waste of time and money trying to delay the inevitable. I had far too much damage for PRP so I elected not to even try it, and I was turned down by the Centeno-Schultz Clinic for Stem Cell Therapy also due to far more damage than it would treat.
What I've learned through this entire process:
• Do. Your. Homework researching doctors and absolutely get multiple opinions - two are great but I think three are better and many leading doctors will do free phone opinions if you can upload or send them previous images/reports. I had 6 total opinions
before my TKR. At this point, my new current doctor (Dr. Thomas Rosenberg - Rosenberg, Cooley Metcalf Clinic in Park City, UT) agreed to a TKR after having exhausted all possible biologic reconstruction options.
• Colorado has very good doctors, but my research and experience has found the best doctors to be out of state and in big cities - especially for complicated cases. Dr. LaPrade at Steadman Hawkins in Vail was one who turned me down. I also saw a doctor at Hospital for Special Surgery in New York City - HSS specializes in complicated cases.
• A
huge thing for me when choosing which doctors to get opinions from was their level of involvement with everything that's going on in the knee orthopedic research and technology. I've had two of my more 'standard' surgeries from Dr. Eric McCarty but he doesn't stay on top of all of the latest technology. I went with someone who is world-renowned, runs his own research lab and clinic and is constantly on top of the latest tech - Dr. Kevin Stone of
The Stone Clinic in San Francisco and he deemed me an eligible candidate for his self-developed
BioKnee biologic replacement technique. His level of expertise blows me away and unfortunately I got the Staph infection from the meniscus transplant surgery (Phase II of the BioKnee). He does do free phone consults and it's 100% worth it with him.
My experience so far being one month post TKR:
• A total knee replacement surgery is
NO JOKE. My surgeon also did some extra bone work removing a previous tibial screw causing more pain. I know tons of people who told me they know someone who's had a TKR and they sailed through recovery, went home the day of surgery, and relatively little pain. I was expecting that. WRONG. I ended up having to stay 3 nights in the hospital instead of 1 and barely remember the first week post-op. The pain was so immense, falling closely behind the Staph infection pain.
• The CPM machine becomes your best friend. I've never heard of any doctor prescribing a CPM for knee replacements until my current doc in Utah. I sat in that machine 22 hours per day for 2 weeks. I can't imagine not ever having a CPM for any knee surgery.
Other advice:
• Consider what type of knee replacement to get - I had a
cementless replacement (also known as a
press-fit; my doctor calls it the
Athletic Knee Implant. Typically most joint replacements use some sort of cement or glue to adhere the parts to bones. The benefits of a press-fit are that they are geared towards younger patients hoping to return to more rigorous activities, and also for those who have had Staph (Staph loves the cement). By not using cement, those replacements are seeing a solid 20 years of life because there is no cement that can loosen the implant up from activities. If you are a uni or bi-compartmental OA patient, the Makoplasty robot is a phenomenal choice for a Partial replacement.
• Like Dr. Stone, Dr. Rosenberg was also a U.S. Ski Team doctor and they understand the need for an athlete to get back into competitive or rigorous skiing having dealt with thousands of knee injuries. I like a doctor with that mindset, rather than several non-inventive doctors who would tell me what I
can't do post replacement. Neither of them put any physical activity restrictions on me. Especially with my TKR, I was pretty stoked for that. My plan has always been to come out of this mega-inury fitter, faster, better and stronger than I ever was prior to, which will help immensely on the longevity of my implant. I also plan to continue using the awesome knee brace I've been using while somehow skiing the past few seasons from here on out. I'm sure I'll run some again (heck, the model of implant in my knee is called the Stryker Triathlon!), but full-spectrum intelligent cross-training will remain my priority.
**My bottom line: if this implant lasts the said 20 years for me, yes I'm going to do what I want to do while I still have my youth and in prime years. By then they'll have something even better replacements so I'm not going to just take is easy for the next 20 years.
• Another super legit biological joint replacement (similar to what Stone does) that I came across too late in my process is the
Mizzou BioJoint Center in Columbia, MO. Might be worth checking out of they do phone consults to see of biologic restoration is still a possibility before the end-of-the-road artificial prosthetics have to be used. Again, another orthopedic institute pursuing the latest and greatest joint restoration science.
• I will mention that the Stryker Triathlon TKR system is one of the best out there, geared towards those wanting to return to their lifestyle, highest degree of range of motion, also designed with longevity in mind and comes in gender-specific models for better fit. Knowing what implant you are getting is key, too - you don't want to have one that is known for a lot of recalls or without enough cases to back up science on a prosthetic. Most people I know post replacement have no idea what was put inside of them, cemented or not, or what the benefits or patient complaints have been spoken about it.
•
NEVER GIVE UP! Without hope, we have nothing. There are more options out there for you that you maybe haven't come across yet.
Injured Athletes Toolbox is an awesome support-like website that helped me cope.
I couldn't resist posting this photo (click thumbnail to enlarge)...
The top photo shows how destroyed my knee was. You see the bottom of my femur with nothing but an uneven,
chunky, and missing cartilage surface with major unevenness along all edges too. The exposed bone is pink and yellow-ish
in some areas. And the bottom photo shows my new knee - the white plate with the titanium plate below it is the tibial
implant, and the main piece is obviously bottom of the femur. Off to the right side is a little gray button - my patella is
flapped over to the side and that button is on the underside of my kneecap as that compartment was arthritic too.
I hope this helps you (or anyone in a similar situation) a little bit. I'm sure I missed a lot more on what I wanted to say but never hesitate to ask any questions! Ahh, now I'm really regretting not going to Med school!
