Navigating Knee Replacement Options at 36: Insights on MISHA, UKA, and HTO
At the age of 36, with my upcoming partial knee replacement surgery on the horizon, I find myself exploring various options to address my knee issues. Diagnosed with inflammatory arthritis and Ehlers-Danlos syndrome by my rheumatologist, I am now in remission from rheumatoid arthritis and have been off any rheumatic medications for approximately five months. My current medication regimen includes Gabapentin, Topamax, Amlodipine Benazepril, Duloxetine, and Omeprazole. My knee journey began early; I underwent my first arthroscopy at 13 to remove a plica. A second procedure at 22 took a dramatic turn when an arthroscopic shaver malfunctioned, necessitating the removal of metal fragments from my leg. After being referred for an OATS procedure at 22, I experienced an extended period of pain-free mobility until the age of 34. Unfortunately, a scooter accident led to a partial meniscectomy that resulted in a challenging recovery. Subsequently, I was directed to another orthopedic surgeon for MACI. I underwent arthroplasty and a MACI harvest at 36, with various treatments like physical therapy and cortisone injections in between, but progress has been minimal. My insurance also denied coverage for the second phase of MACI. X-rays revealed at least a four-degree varus deformity, prompting my orthopedic specialist to recommend a high tibial osteotomy (HTO). There was a documented note expressing some annoyance that the X-rays were not taken according to protocol (non-weight bearing). Just as I was preparing for surgery next week, my surgeon encountered a medical emergency and will be unavailable for the foreseeable future. Currently, I'm relying on a cane for mobility. My activity level has severely decreased, preventing me from engaging in the activities that once brought me joy, such as competitive running, which I deeply miss. Thanks to some generous referrals, I've been introduced to a leading surgeon in my area who has indicated that my choices are limited to a unicompartmental knee arthroplasty (UKA) or a total knee replacement (TKR). He does not perform HTO or MISHA, and although he acknowledges that these alternatives may be viable, he cannot confidently endorse them. So, I’m reaching out: has anyone had experience with MISHA? Has the HTO technique fallen out of favor? The thought of the recovery from HTO seems daunting when compared to UKA, yet if it could potentially safeguard the integrity of my knee, could that make it worthwhile? I have grade 2+ degeneration in one area and grade 3+ in another medial region.
Answers (1)
2/9/2026, 6:30:37 AM
OpenHealth AI
You're navigating a complex situation with your knee replacement options, especially given your specific medical history and current challenges. It’s important to carefully weigh the pros and cons of each procedure to support your mobility and quality of life moving forward.
Overview of Options:
You are considering three primary options for your knee issues: Unicompartmental Knee Arthroplasty (UKA), High Tibial Osteotomy (HTO), and MISHA (Partial Knee Replacement).** Each has its benefits and potential drawbacks, particularly in relation to your underlying conditions and the degree of knee damage.
Explanation:
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Unicompartmental Knee Arthroplasty (UKA): This is a minimally invasive option that replaces only the damaged compartment of the knee. It typically offers faster recovery times and may preserve more of your natural knee function. However, it is only suitable if only one compartment is severely affected.
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High Tibial Osteotomy (HTO): This procedure corrects the alignment of the knee and can help prevent further degeneration by redistributing weight across the knee joint. While recovery can be longer and more challenging, it might be beneficial to your overall knee health, especially considering your significant varus deformity.
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MISHA (Minimally Invasive Subvastus Hemiarthroplasty): This is a less common approach aiming to minimize damage to surrounding tissue. Information is limited in terms of outcomes, especially compared to UKA and TKR, but it may also have low recovery times.
Next Steps:
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Discuss with Your New Surgeon: You're already connected with a reputed surgeon; raise your concerns about HTO, especially in light of your medical history and current functionality. Ask for their perspective on how each procedure aligns with your goals for mobility and pain relief. Ensure that you express your desire to regain activity after surgery, as this can inform their recommendations.
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Assess Your Degeneration: Since you have a mix of degenerative grades in your knee, it's crucial to understand how each procedure could address both regions of degeneration for optimal longevity and functionality in your joint.
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Explore Rehabilitation Plans: Inquire about personalized rehabilitation strategies post-surgery. Understanding the recovery process and physical therapy options will help you set realistic expectations and goals.
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Seek Support and Information: Consider connecting with others who share your experiences. Peer support groups or forums for individuals with similar conditions (like Ehlers-Danlos syndrome or inflammatory arthritis) can provide insights into their recovery and outcomes from each surgical approach.
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Reflect on Quality of Life: Prioritize your own values and needs. Post-op quality of life should guide your choice, so think about which option brings you closer to the activities you love, like competitive running.
Your next steps should focus on dialogue with your healthcare team, evaluating the risks and benefits of each procedure, and ensuring that any decision aligns with your long-term mobility and lifestyle goals. Let me know if you need further information or if there are specific aspects you want to explore!
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