Had an appointment with another orthopedic surgeon today. He was an old fart, the kind of doctor who has seen the evolution of medicine and says things like, "well, back in my day they would've fused your leg..." What he lacked in archaic experience, he make up for in genuine honesty. Basically he told me I'm definitely a candidate for a PKR. In his opinion, the x-rays showed degenerative disease in the lateral compartment that was worthy of surgical intervention.
He questioned the patellofemoral resurfacing though and didn't recommend it in my case. Maybe I didn't fully convey to him my anterior knee pain because I was surprised to hear him say that. He felt the additional hardware wouldn't be suitable and gave me the impression that PF pain tends to resolve itself following PKR procedures. I assume this is due to re-alignment of the kneecap post-op.
Granted my X-rays did not reveal any major PF arthritis, though the MRI showed a focal cartilage defect (read: isolated cartilage damage). My PF pain is significant. Is it as bad as the lateral compartment? No way, but needless to say it would be extremely upsetting to go though this whole procedure and still have considerable anterior knee pain.
He questioned the patellofemoral resurfacing though and didn't recommend it in my case. Maybe I didn't fully convey to him my anterior knee pain because I was surprised to hear him say that. He felt the additional hardware wouldn't be suitable and gave me the impression that PF pain tends to resolve itself following PKR procedures. I assume this is due to re-alignment of the kneecap post-op.
Granted my X-rays did not reveal any major PF arthritis, though the MRI showed a focal cartilage defect (read: isolated cartilage damage). My PF pain is significant. Is it as bad as the lateral compartment? No way, but needless to say it would be extremely upsetting to go though this whole procedure and still have considerable anterior knee pain.
Which brings me to some concerns about my options:
Option A) Lateral replacement only: maintain my PF joint and hope the anterior pain resolves after the PKR. More bone conserved and one less piece of hardware that might fail. Fun fact: the #1 cause of unicompartmental knee failure is advancement of disease into the other 2 compartments (mainly the PF joint).
Option B) Combined lateral and patellofemoral compartment resurfacing: resolves any indications of knee damage by resurfacing both compartments. This resolves any future PF degeneration issues I may have down the road. Food for thought: the possibility of hardware failure doubles and a positive outcome isn't certain.
Overall it was an informative visit; well worth the hassle of insurance paperwork to get the second opinion authorization. On the bright side, the outlook is very promising for lateral PKR's. Every OS I've spoken with has affirmed excellent clinical outcomes with this procedure. Current data even suggests better lateral UKA prognosis compared to medial (and even medial data is impressive). It's a viable long-term solution; hearing these various testimonials definitely helps ease my worries. Regardless, I'm still feeling a little overwhelmed now thinking about my options. What I should be thinking about is my upcoming wedding and my beautiful bride. This sucks.
Option A) Lateral replacement only: maintain my PF joint and hope the anterior pain resolves after the PKR. More bone conserved and one less piece of hardware that might fail. Fun fact: the #1 cause of unicompartmental knee failure is advancement of disease into the other 2 compartments (mainly the PF joint).
Option B) Combined lateral and patellofemoral compartment resurfacing: resolves any indications of knee damage by resurfacing both compartments. This resolves any future PF degeneration issues I may have down the road. Food for thought: the possibility of hardware failure doubles and a positive outcome isn't certain.
Overall it was an informative visit; well worth the hassle of insurance paperwork to get the second opinion authorization. On the bright side, the outlook is very promising for lateral PKR's. Every OS I've spoken with has affirmed excellent clinical outcomes with this procedure. Current data even suggests better lateral UKA prognosis compared to medial (and even medial data is impressive). It's a viable long-term solution; hearing these various testimonials definitely helps ease my worries. Regardless, I'm still feeling a little overwhelmed now thinking about my options. What I should be thinking about is my upcoming wedding and my beautiful bride. This sucks.