Knee Surgery: Knee Replacement
Patients come in with knee pain from knee arthritis – and we’ve failed all conservative management and start talking about surgery – there are some patients within the population that a partial knee replacement is an option instead of a total knee replacement. A partial knee replacement is where we only replace part of the knee. Typically, that’s replacing only the inside half, or “medial compartment” of the knee. That area is most likely to wear out. We can do partial knee replacements on the lateral, or outside, aspect. We can also do it under the kneecap aspect of the knee. Those are the three main parts of the knee, and we can replace any or all of them.
The advantage of a partial knee replacement is that we don’t have to do as much to the knee to get it done. The best way to explain that is it feels more like a normal knee after surgery.
We don’t always have the answer as to why a knee is worn out. The key for discussing partial knee replacement is whether only part of the knee is worn out from knee arthritis, or whether it’s worn out from an old injury. Arthritis is interesting, and it often is because the alignment of our leg is off in some way over time. As it comes off, it puts more pressure on one part of the knee, so that’s the only part of the knee that wears out. If we can re-align that to a normal point with a partial knee replacement, then we don’t anticipate necessarily that it will wear out.
The conversion from a partial knee to a total knee replacement, although it is knee surgery, is not significantly worse than a total knee replacement in the first place. So if we can get good results, even if they’re for ten years, that feel more normal with a partial knee replacement and then do a total knee replacement, I often feel that that’s of benefit to the patient.
The range of motion return is much easier for the majority of patients after a partial knee replacement. The therapy involves using [the knee], strengthening the leg, and then focusing on range of motion – getting that full extension and deep flexion all the way back, that full range of motion of the knee.
A straightforward total knee replacement is an option for everyone, but a partial knee replacement may be an option for some. That’s a discussion many surgeons won’t have, whether by personal preference. I will say with any joint replacement that I would recommend having surgery with someone who does a higher volume of them. The more knee replacements you do, the better you get at it, the more consistent your results are.