Tri-compartmental arthritis managed with TKR


Clive is a 60 year old gentleman who came to see me a few years back with a complex problem with his left knee.

He had seen several orthopaedic surgeons in the past and he had a progressive valgus (or bow-legged angulation) on the left side and lateral meniscal deficiency, having previously had a lateral meniscectomy and also a tibial tubercle transfer and lateral release for chronic patellofemoral issues.

He had problems with the knee as far back as his childhood, and had locking and catching in his 40's and episodes of giving way. Initially he had the lateral meniscectomy, but then went on to have the lateral release and tibial tubercle osteotomy in 2002 - which helped to a degree - but he had further instability and pain.

Arthroscopic examination followed by TKR

I saw him in really quite significant valgus on the left, and initially I thought of a distal femoral osteotomy to deal with the alignment issues and lateral compartment disease. But when I got into the knee as part of an arthroscopic assessment in 2014 he sadly had a very worn medial compartment, so we abandoned the idea of an osteotomy as he had in effect tri-compartmental disease. He didn't get a huge amount of benefit from the arthroscopy which is no great surprise, so in 2016 we went for a total knee replacement.

total knee replacement

18-month follow-up

On reviewing Clive today he is really quite ecstatic about the result and describes it as the best thing he has ever done, which was really great to hear in terms of follow-up. He walks now without pain, having had decades of really severe discomfort and he is enjoying being pain free on the left side.I would have liked to have done something 'joint-preserving' here, but given that he had disease in all three compartments I decided that total knee replacement was the best way to go although he is fairly young we do hopefully get as much as 20 years out of a knee replacement now before we need to think about a revision and this has proven to be an excellent decision for Clive.

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Adrian Wilson

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Patient's Testimonial

"I have always had valgus legs. The left one wore the meniscus out on the outside of the knee and tore the last bit away. I was 40 years old then.

"After having that removed by a local surgeon it left my leg even more bent and made my kneecap dislocate.

"On to a different surgeon and had a tibial tubercle transfer. worked a bit but still left my leg bent.

"15 years on Arthritis set in and looked into having a osteotomy by Mr Wilson. Unfortunately damage was found on both sides of the knee which led to a total knee replacement.

"My late mother had the same problem as me she had both her knees replaced 18 months apart and went dancing after recovery 3 times a week.

"As she lived with me and my son I got to see how it can change your life so I knew this was the right decision I was making - pain free sitting, standing and sleeping - so I expected to be more comfortable at the very least.

"After my surgery the first thing I noticed when I stood up for the first time was how level I felt on the new knee and my hip muscles did not hurt anymore.

"If you are in the same situation that I was, don’t be terrified of having it done it’s really not that bad - straight away you notice the difference. Do your exercises and go with it, I was walking three miles a day after two months.

"Hire a GameReady ice machine for the first month you won’t need it after that and use cling film to wrap over the scar while taking a shower. Over time you’ll notice that your soft tissues have adjusted as the swelling goes down. Hence why full recovery takes a few months.

"I have been back to see Mr Wilson last week to sort out my other knee. Pretty sure I have a torn meniscus on the inside which is very sore and catches. Looks like my right knee is wearing out the same as the left one did. I'll see him next week after the MRI scan to discuss the options".

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