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At 265K - I don't think the shocks have ever been replaced, and going over speed bumps at any speed is a killer.

Looking on Amazon, I can get the full assemblies, or I can get the gas piston where I re-use the existing spring for about 1/3 the cost. How do I know if I need to replace the whole thing or just the gas piston?

Also, how difficult is the job with springs involved? I've done read shocks on my Odyssey, but it has no springs.
 

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Do yourself a favor and get the complete units. Swapping out just the cartridge will require a spring compressor, time and some expertise. Also top bearings and springs wear so you would need to consider replacing those too (top bearing for sure, spring maybe).
I personally would get the KYB strutaplus. #SR4229 and #SR4228. They are around $170 each and should be a sure thing for a reliable replacement.
 

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I replaced mine with KYB's, but without the springs. Borrowed a spring compressor from a friend's shop and swapped the factory springs to the new struts. Not a horrible job however, had I bought the complete assembly with the springs, I would have saved about 2hrs in labor. Keep in mind, regardless of which brand you install, the ride is going to be stiff. With over 260k miles, might want to invest in new control arms too as I'm sure the ball joints/bushings are shot.
 
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