Partial Knee Replacement
(Unicondylar) knee replacement simply means that only a part of the knee joint is replaced (i.e. Partial Knee) through a smaller incision than would normally be used for a total knee replacement. Unicondylar knee replacements have been performed since the early 1970's with mixed success. Over the last 25 years implant design, instrumentation and surgical techniques have improved markedly making it a very successful procedure for unicompartmental arthritis. Recent advances allow us to perform this through smaller incisions and therefore the procedure is not as traumatic to the knee making recovery quicker.
Advantages & Disadvantages of Partial Knee Surgery
The decision to proceed with knee replacement surgery is a cooperative one between you, your surgeon, family and your local doctor.
The benefits following surgery are relief of symptoms of arthritis. These include:
Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
Pain waking you at night.
Deformity - either bowleg or knock knees
Stiffness
Conservative Treatment Prior To Surgery
Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes or physical therapy.
Advantages
Smaller operation
Smaller incision
Not as much bone removed
Shorter hospital stay
Shorter recovery period
Blood transfusion rarely required
Better movement in the knee
Feels more like a normal knee
Less need for physiotherapy
Able to be more active than after a total knee replacement
The big advantage is that if for some reason it is not successful or fails many years down the road it can be revised to a total knee replacement without difficulty.
Disadvantages
Not quite as reliable as a total knee replacement in taking away all pain long term results not quite as good as total knee.
Candidates For Partial Knee Replacement
Who Is Suitable?
Ideally should be over 50 years of age
When pain and restricted mobility interferes with your lifestyle
One compartment involved clinically and confirmed on X-ray
Who Is Not?
Patients with arthritis affecting more than one compartment.
Patients with severe angular deformity.
Patients with inflammatory arthritis e.g.. rheumatoid arthritis.
Patients with an unstable knee.
Patients who have had a previous osteotomy.
Patients who are involved in heavy work or contact sports.
Pre-Operative Checklist
Below is a list of items that will be completed before surgery.
Your surgeon will send you for routine blood tests and any other investigations required prior to your surgery.
You will be asked to undertake a general medical check-up with a physician.
You should have any other medical, surgical or dental problems attended to prior to your surgery.
Make arrangements for help around the house prior to surgery.
Cease aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding.
Cease any naturopathic or herbal medications 10 days before surgery.
Stop smoking as long as possible prior to surgery.
Day of Surgery
The list below is an outline of your day of surgery and things that will occur on that day.
You will be admitted to the hospital usually on the day of your surgery.
Further tests may be required on admission.
You will meet the nurses and answer some questions for the hospital records.
You will meet your anesthetist, who will ask you a few questions.
You will be given hospital clothes to change into and have a shower prior to surgery.
The operation site will be shaved and cleaned.
Approximately 30 minutes prior to surgery, you will be transferred to the operating room.
Surgical Procedure
Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.
Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery will take approximately two hours.
The Patient is positioned on the operating table and the leg prepped and draped.
A tourniquet is applied to the upper thigh and the leg is prepared for the surgery with a sterilizing solution.
An incision around 7 cm is made to expose the knee joint. Smaller incisions are made if the surgery is done using arthroscopy.
The bone ends of the femur and tibia are prepared using a saw or a burr.
Trial components are then inserted to make sure they fit properly.
The real components (Femoral; Tibial) are then put into place with or without cement.
The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.
Post-Operation Care
Once stable, you will be taken to the ward. The post-operative protocol is surgeon dependant, but in general your drain will come out at 24 hours and you will sit out of bed and start moving you knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the 2nd post-op day to make movement easier. Your rehabilitation and mobilization will be supervised by a physical therapist.
To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.
Your orthopaedic surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT's, which will be discussed in detail in the complications section.
A lot of the long term results of knee replacements depend on how much work you put into it following your operation.
Usually you will remain in the hospital for 3-5 days. Depending on your needs, you will then return home or proceed to a rehabilitation facility. You will need physical therapy on your knee following surgery.
You will be discharged on a walker or crutches and usually progress to a cane at six weeks.
Your sutures are sometimes dissolvable but if not, are removed at approx 10 days.
Bending your knee is variable, but by 6 weeks it should bend to 90 degrees. The goal is to obtain 110-115 degrees of movement.
Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 6 weeks.
More physical activities, such as sports previously discussed may take 3 months to be able to do comfortably.
When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your sleeping arrangements especially if they are up a lot of stairs.
You will usually have a 6 week check up with your surgeon, who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent, but there can be a problem only recognized on X-ray.
You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the blood stream and find their way to your knee.
If you have any unexplained pain, swelling, or redness or if you feel generally poor, you should see your doctor as soon as possible.
Risks And Complications
As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages.
It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or local complications specific to the Knee.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.
Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.
Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.