What is the Best Type of Total Knee Replacement?

Total Knee Replacement (TKR) is an operation where the worn ends of the bones that make up the knee joint are resurfaced with metal and plastic implants.  Surgeons have many options to choose from.  Not only do several manufactures make different brands of knee replacements, but within each brand are different types.

For example, in a “PCL sacrificing” knee replacement, the PCL (posterior cruciate ligament) in the knee is removed and its function is replaced by the special geometry of the implant.  There are also a group of implants known as “mobile bearing” or rotating platform” where one of the components (the tibial insert) actually moves or rotates relative to the metal tibial implant affixed to the tibia (shin bone).

Given the myriad of implants available, it is natural to ask, “Which total knee replacement is best?”  Unfortunately, the answer to that question is not straightforward.  While each manufacture will tout the benefits of their particular design, long-term follow-up of most contemporary implants yields similar results.  In reality, it is probably more important for perspective patients to seek out a good, experienced surgeon, rather than a particular product.

This is because factors such as proper alignment of the implant components and restoration of appropriate soft tissue tension (things which the surgeon directly controls) are more likely to influence the outcome of a total knee replacement than the particular brand of implant.

At the end of the day, perspective knee replacement recipients should seek out a doctor they are comfortable with and one that has a lot of experience with a particular implant system.  Experience is important because the technique of total knee replacement is rather involved.   The surgeon must utilize a series of complex instruments to perform the operation.  Often, these instruments are “implant specific” so surgeons will usually become loyal to a single brand allowing them to develop familiarity and expertise with a particular system.

So the answer to the question “What is the Best Type of Total Knee Replacement?” may simply be the one which your experienced surgeon has chosen to utilize.

Comments

19 Responses to “What is the Best Type of Total Knee Replacement?”

  1. Is One Really Better? Fixed vs. Mobile Bearing Knee Replacement : totalkneeweb.com on February 19th, 2009 3:15 pm

    [...] you’re new here, you may want to subscribe to my RSS feed. Thanks for visiting!In our recent post “What’s the ‘Best’ Total Knee Replacement?” it was suggested that more often than not, it “may simply be the one which your experienced [...]

  2. Javi on February 9th, 2011 5:18 pm

    The word “perspective” in your discussion should be replaced by “prospective.”

  3. Steve on September 16th, 2011 12:01 am

    My wife is scheduled for total knee replacement, how do you determine the best implantant?

  4. Michael E Moyer on February 13th, 2012 5:12 pm

    I received a TKA using a Smith-Nephew Journey, which is an oxinium implant, in 2008 after being ACL defficient for approximately 32 years. I had four previous surgeries on the knee, including a Slocum procedure in 1979 following a traumatic injury playing football, 2 arhroscopic surgeries to remove torn catilage and a botched ACL transplant using cadaver ligament.
    My knee was a mess and I am a very active person. My knee locked up while on a deer hunting trip to southern Ohio. I decided it was time for replacement. Being 46 years old at the time, I was concerned about the durabilty of the implant. Dr Robert Schaefer in Portage, Michigan performed the surgery. He Found a screw fom the previous ACL reconstruction wearing a groove in the condyle of my femur-probably to cause of my knee locking. The procedure went as planned, but was traumatic to my leg because of all the prior surgeries. Four weeks out I had to undergo manipulation under an epidural for three straight days. I was back to day one as far as rehabilitaion, but I did regain full range of motion. I returned to Ohio to hunt that fall with no problems. I do have a clunk when I walk. It doesn’t seem to be patellar but rather more like the centering post in the tray knocking. I can run when necessary , although still uncomfortable the squat or kneel. I joined the volunteer fire department 1 1/2 years ago at age 49. The knee is not like the original but allows me to keep active. At this time my knee is swollen for no apparent reason, hopefully just over-use. The battle continues….

  5. Mildred Love on February 21st, 2012 12:41 am

    I had a total knee replacement in June 2009 and I am still having problem with my knee. My kne feels like a log when I try to step up on a step ladder and when I lay down to sleep my leg feels like a heavy log if I put it on top of my other knee. I have just lately found out that I am allergy to mercury and alumina when I kept having dental problem and I was told by the doctor that I was illergy to metal and the knee replacement is made out of titanium. My knee is still swallon and hurt to bend. I don’t know what to do.

  6. Tom Walsh on February 27th, 2012 8:40 pm

    I’m 57 and had a TKR after 30 years of running. Surgery took place in November, 2011. The replacement was a Vanguard. I did all the therapy and the results have been wonderful. The pain immediately after surgery was intense. I pushed thru the PT and as a result I have full range and motion. I do 40 minutes of cycling per day mixed with 5 miles on the elipical follwed by leg extension exercises. Pain is completley gone with some mild swelling stillpresent. Tomorrow I am playing golf. I think the key is to push thru physical therapy no matter how painful. Good luck everyone

  7. Howard R. Decker on May 29th, 2012 2:00 am

    II have had 4 total replacements. the first one in 2006, 2nd in 2008, 3rd in 2009. Each about 18 months apart. In 2010 my dr. thought I was having reffered pain and replaced my left hip in 2010. I still experienced extreme pain. I changed doctors and he found the prothesis had again come loose. He replaced it with a different brand of knee.

    It has been about 18 months and I seem to be ok. If I walk too fast or too far I have extreme pain in both my knee and hip.

    I am 74 years old and am not sedentary, i visit a gym 3 days a week and exercise vigorioulsy for an hour each day.

  8. Steve Buchholz on June 18th, 2012 12:36 pm

    Well, I have reached this website after many years of pain. I had my first knee surgery in 1977 (because of football @ age 17) and it was called a 5-in-1….because they did 5 things and hoped 1 of them worked. It was the same surgery Joe Namith first had supposedly. Now at age 52 I have had 2 ACL replacements, one at age 28 and the last one at age 38. My knee is now just a mess. I still play tennis, softball, golf, and ski but all with considerable pain. To complicate things I now weigh 300 lbs and still participate in the 4 activities mentioned above but the pain is getting unbearable and I have to admit my knee replacement is coming soon. I have been putting it off for years but I can’t ignore it any more. I need to know the best brand/kind of knee joint for a large person who still NEEDS to play sports…..there has to be a more sports oriented/heavy duty joint that is sturdier than others….any suggestions would be appreciated….I’ve seen a lot of ads for STRYKKER but don’t know if it has a track record……thanks

  9. Glenda on June 22nd, 2012 6:05 am

    To all my fellow TKR’s. I feel your pain. But know this one thing if you don’t move you lose vital function to the knee. My pain kept me from wanting to move. But every time I pushed through the pain I felt better. With each day you are healing. As you heal you will have pain. Don’t believe what some write about no pain after 2-6 months. Not true especially for those of us who packed on a few pounds when we couldn’t move b/c of arthur. Weight is a stumbling block. The more you lose the better your knee will feel. Try to fight thru the pain & exercise as though your life depended on it. No two people experience pain the same. I do know that your healing & recovery is through patience (giving your body time to heal) and dedication to keep moving. I want to be mobile again, so I’m giving it my all. Keep moving!

  10. Glenda on June 22nd, 2012 6:20 am

    I have a Stryker knee. Can’t say it’s the best but I researched it before my surgery and I liked what I read about it. I had one done May 2010 & recently in January 2012. I wished I had done both at the same time. B/c while the first was healing I totally destroyed my already other bad knee which caused me to be immobile when I needed to move. If you are quite active it want matter what knee you put its gonna wear out. But you will have fun doing it. I figure if I get 15 years I’ll be happy. But Stryker toots 20 years. I’ll be ready for my scooter by them anyway. Lol…… And hopefully would have done all the things I love to do to the fullest. If I hadn’t had the surgery I would be unable to walk by now. My bones were grinding themselves down. Doctor couldn’t understand how I was even walking around. Of course having a high pain thresh hole take you a long way. So take what you can get it is worth it to add extra mobile years to your life.

  11. Leon. Telvi on September 17th, 2012 6:40 pm

    I had a total knee replacement of my right knee last year November 3rd 2011 I did everything I was supposed to do as far a rehabilitation it’s now sept 17th and I need the left one done also. I knew that I could only do one at a time so I choose the right one first. After month went by my knee felt netter and better but I had doubts about it’s clicking and not being able to do some of the things things that my original knee allowed me to do. I had athroscopy surgery in my right arm and it feels like 99 percent had been restored. So when I went for the knee I thought I would get the same results. I spoke to the doctor again and he sent me for an x-ray and told me it looks great. But I explained to him that I feel limited I feel that the r person that made the implant should have been a person that needed to use it or an engineer. Joking around I told my doctor before the operation can I add a inch or two can it be stronger or jump higher I told him I would pay more if necessary. He told me he could charge me more but it would be the same implant he would use on himself. Since than I see all ads on tv about Stryker and triathlon knees that are supposed to be exceptional but I don’t know so I call my doctor I make an appointment for next Friday he is out of town and I have to ask him which brand he used. But she explained to me that when I get the left knee done the doctor will not switch brands I get the same as the right knee or go to a different doctor. I plan on seeing him next week but I believe 80 to 90 percent is good and I don’t think I would change it but if I can get better than that’s what I want I know I am over weight I cannot do the exercise I would like to do because of my left knee. My doctor doesn’t know how I walk at all. When I walk up my stairs it feels like I’m carrying 20 pounds more on my legs. I’m 61 years old 270 pounds 5 feet 9 inches. And usually very active but since the operation I move around less. And getting very depressed. Thank god semi retired. I could never do what I used to. Private medical plan not old enough to get social security I don’t know what to do for my left leg so many different brands and I don’t know what’s best for me. I need help.

  12. Linda Jacobs on November 2nd, 2012 10:30 pm

    I had a partial knee replacement a year and a half ago. The recovery went well. 5 mos of PT and I was able to do all excercises without difficulty. I am very limited on walking, and still experience a lot of pain. I recently saw a new ortho surgeon and he has concurred that I need total knee replacement. I’m skeptical,however, due to 2 previous surgeries and not much better than I was to start with. The only real change that I see is the constant swelling. I still have swelling after activities,and must still elevate and ice it. I’m confussed and really not sure what to do. Please give me some feed back so that I can make a decision. This is all been from an on the job injury in 2000,so I am limited on time due to Labor and Industries.

  13. Thomas on March 19th, 2013 8:52 am

    To all the above with knee pain now or after your knee replacement.You must lose weight right now !!!!!!!!!! I am sure your doctor told you this already and if he didn’t get a new doctor .Losing the weight and keeping it OFF is 99% of the problem having pain.I am going in June 2013 to get my right knee replaced .I had my left one done in 2010.Keep the weight off and do light stretching exercises.No tennis,golf or RUNNING !!!!!!!!!! If I told my doctor I was doing that stuff he would lock me up.,.,. in the nut house.My wife is an ER nurse and she has told me the same thing constantly.Keep the weight off.I am 5’9″ 190 65 years old and she says lose more weight or lose future years of being mobile.Good Luck.

  14. Maureen Samad on April 30th, 2013 12:07 pm

    Thanks for the support from all off you that has gone through knee replacment , mine is due in July , it seem pain can’t be avoided , what I want to know will it eventually get better , is it worth it , I hope to be more mobile , as I am feeling quite limited right now , and grandkids expect me to bend , or walk as fast as them .
    I am being positive and want to get it done .

  15. Glen on June 7th, 2013 4:17 am

    I’ve read all the comments and rest assure I empathize with each of you. I am not a recipient of a TKR; but my wife of over 30 years soon will be and I’ve never been so scared. We both know its got to be done or she’ll not be walking. She has an extremely high pain tolerance and the determination and drive I hear in each of you. So I’m trying to get as much information on TKR as I can. Much of it is redundant. Her Dr., uses the Stryyker replacement. And has performed this surgery a lot. So I put it to those in the know… What can I do to prepare, to best aide her through all of it.

  16. Sandy on June 15th, 2013 2:45 am

    I have been researching diligently since 1997,when I was told at age 42 that I needed total knee replacement on nothingness.Hence to date I have deferred the procedures.both my parents both had double procedures performed at the same time and I watched how they struggled for a year recovering. As I research medical journals,articles everywhere and have had 6 opinions I still am afraid to have even one knee done.haVing athroscopy done on now each knee once(that was a pain ful nightmare in itself),recovery was horrible.I had the best surgeon in our area,referred by many friends and colleagues.For now,I will use my canes, and probably opt for the inevitable scooter sooner than later.I can not opt for surgery any time soon with too many cons,recalls on both Stryker and Dupuy hardware,and need for 2nd surgeries. GOOD LUCK AND BLESSINGS TO YOU BRAVE SOULS.

  17. Nancy S. on June 29th, 2013 4:15 am

    Both knees are bone on bone yet I am still walking and stay pretty active. I still enjoy swimming but have given up bicycling which I do miss. i am scheduled for surjury in July. Very hesitant to do both although my doctor would allow it if I decide to. he uses Stryker get around knee. what can you tell me far as any recalls or problems. i know p/t will be very rough. I’m 57 normal weight 5’4. oh yes I’ve become bow legged. Pain is not to bad but I feel the bones rubbing. any advice is appreciated. is it better just do it or can I wait awhile?

  18. Cam Watson on February 5th, 2014 12:54 pm

    I posted comments in another section but here are some more. I have a Zimmer NGK LPS mobile bearing knee. 3 months after surgery, back at work, BUT, you MUST fight through the pain at physiotherapy and do all the exercises religiously. One year after surgery i skied again, at a very very high level, skiing chutes, and back bowls at Whistler Mtn in 20 inches of new snow, no swelling , no pain, and no fatigue. I worked very hard to get the balance and strength back, it payed off, Weight is definiotely an issue, I am 5″10″ and 170 lbs, still could lose another 5 ilbs, but overall reasonably fit for 55 yrs old. I love my new knee, surgery Dec 2011.

  19. Leroy on May 31st, 2014 10:27 pm

    My husband had zimmer knee put in 14 month ago has had nothing but pain had went back to the Dr whom did his replacement and he maded several reason why he still had a lot of pain no real answear . My husband went for a second apinon an had a Nucular test done and was told it had came loose is now having to get A revisin done so if your not liking what you Dr is telling you get another apinion.

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