Stuart Kozinn MD Scottsdale Joint Center / Ask the doctor Questions and Answers
These are real questions submitted by real patients to our www.ScottsdaleJointCenter.com “ask the doctor feature.”
Dear Dr. Kozinn,
My knee is getting progressively more bow-legged and it hurts on the inner side when I walk. Am I a candidate for a partial knee replacement or do I have to have a full Total Knee Replacement? I prefer the partial knee because i have to get back to work as soon as possible!
K.B., Scottsdale Arizona.
Partial vs. Total Knee Replacement
Dear K.B.,
Maybe you can have a partial. Only 30% or so of varus knees will qualify for a partial. The rest are already too advanced in the amount of arthritis. We really need to see you in the office for an X-ray (we have the Xray machine here for your convenience!). If there is bone on bone contact in your knee , then you will be a candidate for either a partial or total knee replacement depending on how severe the problem is. The total knee is preferred if the arthritis has spread to both sides of the joint. If we catch the arthritis early enough, the partial knee has a much faster recovery and much less pain.
Stuart Kozinn MD
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Dear Dr. Kozinn,
My Total Knee was done outside of Arizona over 10 years ago. I am starting to have pain again with activities. Does that mean I need to have my knee re-done?
G.H. , Phoenix, Arizona
Dear G.H.,
It is hard to say for sure. A physical exam and an X-ray in the office will tell me what you need. Some of the older plastics we used ten years ago can wear out over that period of time. Usually that results in swelling and a feeling that the knee is less stable. Often, we just have to exchange the plastic liner with a new one made up of better quality “highly crosslinked” polyethylene. (Just like changing the tires on your car). Sometimes, the metal portion can get loose from the bone over time – cement can crack over years of use just like it does on the sidewalk outside! If the implants or cement is loose, then we can exchange the entire knee replacement with excellent results in most cases. Sometimes the knee ligaments will stretch out over time, and the knee will swell as it becomes less stable. When the problem is severe enough, another surgery can fix the problem.
Stuart Kozinn MD
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Dear Dr. Kozinn,
I had arthroscopic surgery on my knee 6 months ago and it still hurts! The doctor said I had more arthritis than he expected. Now he thinks I need a Total Knee. How long will it take me to recover?
B.D. Mesa, Az
Dear B.D., An Orthopedist may try to extend the life of your knee before replacement by offering an arthroscopic “clean-out”. Unfortunately, you cannot cure arthritis (the permanent loss of cartilage cushion), with a scope.
Sometimes we try this with the understanding it may not work!
The water lavage does sometimes make it feel better for a while by flushing out particles that cause inflammation. I tell most patients over 60 that “scoping” the knee has only a 50/50 chance of helping.
If there is already bone-on-bone wear, even in a small area, then a total knee may be indicated. Patients often have old knee x-rays done lying flat. You must have a standing “weight bearing” view of the knee to see the arthritis. Most of my motivated total knee patients are back to light duty jobs in two weeks. Full recovery often takes about 3 months. More and more of my patients are choosing an internet directed or home therapy program to save money and time over standard physical therapy. We will discuss your individual needs and options after your surgery.
Re-do Total Knees have stems and thicker plastic implants for better stability in softer bone.
Stuart Kozinn MD
