The number of total knee replacements performed per year, is expected to more than triple, reaching over 3 million procedures per year by 2030, according to recent published studies. The primary reasons for this increase are the growing rates of baby boomers moving into the over 65y/o demographic while desiring to maintain youthful active lifestyles.
Historically, knee arthritis has been treated with total knee replacements to relieve arthritis pain, stay active, and maintain their quality of life. A full knee replacement always replaces all three compartments of the knee: the inside and outside portions of the knee, as well as the portion underneath the knee-cap. This is great if all three parts of the knee are diseased or arthritic. However, many recently published studies now show that between 15 and 30% of total knee recipients are not fully satisfied with the function or feel that they have achieved with their total knees. This is felt to be, at least in part, due to the altered knee kinematics or knee motion, that is caused by the removal of the anterior and posterior cruciate ligaments at the center of the knee, during a total knee replacement.
Osteoarthritis is today, the most common form of arthritis treated with a total knee replacement. The vast majority of osteoarthritis is triggered by an injury to the cartilage that leads to progressive deterioration of the joint surface and is accelerated by a progressive deformity that is accentuated by the cartilage wear that occurs. Patients develop pain and a progressive deformity that is either bow-legged or knock-kneed depending on whether the inner or outer compartment of the knee is involved. Many of these patients have intact anterior and posterior cruciate ligaments.
I now pose to you a question: If the most common form of arthritis is osteoarthritis and it is triggered by trauma to a single compartment of the knee, and the ligaments of the knee are intact, why would we opt for a procedure that removes not only the bad bone and cartilage from the damaged 1/3rd of the knee but also all the good bone and cartilage from the normal 2/3rds of the knee, while also removing two functionally intact ligaments?
The answer to this question is that we no longer have to. We have another option for the treatment of single compartment arthritis of the knee. It is the partial knee replacement. Advances in their instrumentation, implants, technique and patient selection have led to a renaissance in partial knee replacement awareness.
Why are partial knee replacements not offered as a surgical option by the majority of orthopedic surgeons?
Partial knee replacements have historically had poor clinical results, often needing revision or conversion to total knee replacements in 5-7 years. Over the last 15 years though, partial knee replacement results have improved to match the survivorship of total knees and far surpass them clinically in terms of lower complication rates and increased return of function, as measured by range of motion and rates of return to pre-surgical sports activities.
Less than 10 % of orthopedic surgeons have been trained on contemporary Partial knee replacement techniques. Partial knee replacements are technically more demanding than total knee replacements. Most orthopedic surgeons do fewer than 5 partial knee replacements per year and, like all other surgical procedures high volume surgeons tend to have better results.
The attraction for patients to the partial knee replacement stems predominantly from these 7 points:
As with any surgical procedure your choice of surgeon is paramount. You should seek out a surgeon who is well trained and has extensive experience in partial hip replacement. No matter the surgery you want a surgeon who you are comfortable with and has performed a high volume, usually greater than 100, of the type of surgery you are seeking. The more procedures the surgeon has performed, the better they will be at providing you with a great outcome.
So, what can you make of all of this? Let’s sum it up: partial knee replacement shows some serious pros when it comes to a faster “return to normal” in early recovery. In saying this, having a replacement done by an experienced surgeon you’re comfortable with is the top priority. A great, high-volume surgeon is the “trump card”. In the end, patients who’ve had both partial and total knee replacements have had very successful, lasting recoveries.
If you’ve been experiencing knee pain and you, your spouse or partner has noticed a bow-legged or knock-kneed deformity, don’t ignore it! You could be suffering from arthritis. Treating your condition early might mean you can spare more of your natural knee tissue, which can result in less pain and better function for years to come.
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