Knee Replacement: Total and Partial
Knee Replacement: Total and Partial
Outcomes from knee replacement surgery has advanced considerably in the last 30 years with newer surgical techniques, new technology, and new materials used in the design of knee prostheses. The rate at which orthopaedic surgeons perform knee replacement surgery has increased over the years and is expected to boom with our aging population.
Age related degeneration (osteoarthritis) of the joint surfaces leading to pain, swelling, stiffness and loss of mobility is the most common reason to consider a knee replacement.
Rheumatoid arthritis or a history of injury to the knee(s) leading to a loss of articular cartilage and bony changes can also cause dysfunction of the knee joint. Knee replacement surgery is widely performed for patients 50 and over, yet some younger patients also benefit from this type of procedure.
When non-surgical treatments fail, knee replacement surgery may be an option. There are several different surgical options when considering a knee replacement. For a select group of patients who have osteoarthritic changes limited to one side of the knee, a partial knee replacement may be a good option. The potential advantages of this include a shorter operation, less bony and cartilage resection, and a quicker post-operative recovery. With a partial knee replacement, the surgeon removes only the diseased cartilage and bone on one side of the knee and implants a metal and plastic prosthesis. For the right patient, this solution can be just as good as a total knee replacement.
A total knee replacement involves making an incision over the front of the knee and removing the ends of the bones and cartilage that form the knee joint. Specialized instruments allow the surgeon to do this in a safe and effective manner. After the joint is resurfaced, metal components are affixed to the ends of the bones and a thick plastic spacer is placed between. While this description is very simplistic, the operation can be very complex in some cases. Newer techniques including the use of computer navigation and smaller incisions leading to less disruption of the surrounding tissues may enhance outcomes.
The operation may take up to several hours to perform and patients normally stay 2-4 days in the hospital following surgery.
The medical literature shows that approximately 90% of patients who have undergone knee replacement surgery are satisfied with the outcome. The overall goal is a reduction in pain and improvement in regards to the ability to perform daily activities. Persistent discomfort, stiffness, and loss of overall range of motion may be a long-term problem for some.
Complications from this type of surgery are relatively low. Unfortunately, some of the potential complications can delay or prevent a full recovery from this type of surgery. A superficial or deep wound infection, fracture of the surrounding bone, dislocation of the prosthesis, blood clots and other major medical complications such as heart attack and stroke can occur. These complications may appear early after surgery or years later.