Partial Knee Replacement – A Total Solution to A Partial Problem
There tends be a lot of questions and often misconceptions around partial knee replacement. Is it as good as a total knee replacement? Why get a partial knee replacement when I can get a full replacement? Some patients are skeptical because they think a partial replacement may only be a temporary solution. If I get a partial replacement now, will I need to get a full replacement later? Friends and family say just do the whole thing – based on misunderstanding of what we are doing. For the right patient, a partial knee replacement can be the total solution to a partial problem and often people who get partial knee replacements are some of the happiest patients.
The History of Partial Knee Replacement
Partial knee replacements have been around since the 1980’s, however, initially they had a bad track record. This was the case for a couple of reasons. First, because early designs were not great and second, surgeons did not know to put them in, and most importantly we didn’t know how to choose the ideal candidate for a partial knee replacement. Partial knee replacements, therefore, got a bad reputation with surgeons who tried the procedure without success. Over the last couple decades, things have changed and now the outcome data is good – showing that a partial knee replacement is just as good as a total knee replacement. Even though the data is good today, not all joint replacement surgeons have experience doing partial replacements and many respected surgeons who were not trained with partial knees are biased by older techniques as they don’t have experience with it.
The Right Patient and the Right Surgeon
In order to have a successful partial knee replacement, we need to have the right patient for this type of surgery. Additionally, you must have a surgeon who specializes in this type of procedure. The right patient for a partial knee replacement is one who has truly isolated arthritis in one of the three compartments of the knee. Arthritis that occurs in one compartment is not usually related to a general diagnosis of osteoarthritis but rather a congenital defect or a previous injury to the knee, for example:
- A congenital defect such as bow leggedness – may overuse the inside portion of the joint only and the rest of the knee doesn’t get that same wear, Therefore, leaving one compartment of the knee with arthritis
- Someone who had a traumatic injury and often a meniscus surgery where over time the cartilidge in one area of the joint was worn
- Oseteonecrosis, where one part of the bone dies or damaged, is another condition that may be an indication for a partial knee replacement.
In order to determine how much arthritis is in the joint and what areas of the joint are involved, we utilize an x-ray, physical exam and a history. The doctor will usually make the final decision in the operating room, so if they get into the joint and notice that other areas of the joint are worn or if the knee is not healthy we do a total joint replacement.
The benefits of a partial knee replacement
Patients who have partial knee replacements are some of the happiest! They love the partial knee replacement because their joint feels more natural. Often these patients may forget which knee was operated on over time. Some of the common reasons that partial knee replacement is a popular option:
- It is generally a faster, easier recovery with less pain and less downtime
- It tends to feel more like a natural knee – it is often known as a forgotten knee – patients don’t remember they had it done.
- There is less risk for infection, blood clots and stiffness.
Because this procedure is less painful, individuals are often off pain medications within a couple days of their surgery. They are usually not requiring a walker within a week. People are pleasantly surprised by how reasonable the recovery was.
As a surgeon it is our philosophy is do the minimum we can do to make the patient whole – whether that is operative or not. If it is operative – we want to do the minimum needed to have a result that brings the patient back to 100%.
Dr Jared Foran is a joint replacement surgeon at Panorama Orthopedics & Spine Center. He performs more than 500 hip and knee replacements each year. His specializes in minimally invasive and partial knee replacement procedures.