Knee replacement surgery is a common procedure designed to alleviate pain and improve function in individuals with severely degenerate knees.
This type of surgery involves replacing the problematic knee joint with an artificial one to enable smoother movement and alleviate discomfort.
Knee replacement is generally recommended for those suffering from severe arthritis or significant injuries that impair the quality of life. There are two main types of knee replacement surgery: partial knee replacement and total knee replacement.
Each type offers its own set of benefits and risks, which we will explore further in the following sections.
Understanding Knee Replacement Types
Knee replacement surgery is a common procedure designed to alleviate pain and restore function in arthritic knee joints. It is generally recommended when other treatments such as medication, physiotherapy, injections and lifestyle modifications fail to provide lasting pain relief. There are two main types of knee replacement surgery: total knee replacement and partial knee replacement. Understanding these procedures can help patients make informed decisions about their health care.
What is Partial Knee Replacement?
Partial knee replacement, or unicompartmental knee arthroplasty, is a less extensive procedure compared to total knee replacement. This option is typically available for patients whose arthritis is confined to a specific area of the knee. Instead of replacing the entire joint, the surgeon only removes and replaces damaged tissue in the affected compartment of the knee (medial, lateral or patello-femoral). This approach preserves more of the natural bone and tissue of the knee. As a result, partial knee replacement offers a more conservative surgical option for suitable candidates.
What is Total Knee Replacement?
Total knee replacement, also known as total knee arthroplasty, involves replacing the entire knee joint with artificial components. This surgery is often recommended for patients with severe arthritis affecting most or all of the knee. During the procedure, the surgeon removes the damaged bone and cartilage from the thigh bone, shin bone and knee cap and replaces them with artificial surfaces made of metal and plastic. The primary aim of total knee replacement is to relieve pain and improve function, allowing for better mobility and quality of life.
Comparing Partial and Total Knee Replacement
Both total and partial knee replacements aim to relieve pain and improve the function of the knee joint. However, they differ in terms of the extent of surgery, recovery time, and the outcomes.
Total knee replacement is suitable for widespread arthritis affecting the whole knee, whereas partial knee replacement is an option when arthritis is limited to one part of the knee.
While partial knee replacements tend to be less invasive, patients must meet specific criteria (disease isolated to one compartment, intact ACL function, absence of fixed flexion or other fixed deformity and normal BMI); otherwise, total knee replacement will be recommended as a more comprehensive solution.
Benefits of Partial Knee Replacement
For patients eligible for partial knee replacement there are several potential benefits when compared with total knee replacement.
Less Invasive Procedure
A significant advantage of partial knee replacement is that it is a less invasive procedure. Since the entire knee is not replaced, there is usually less disruption to the surrounding tissues. This conserves more of the patient’s natural bone and cartilage and can result in less post-surgical discomfort. For patients, this often means a smaller incision and reduced trauma during surgery.
Faster Recovery Time
Due to its less invasive nature, partial knee replacement often facilitates a faster recovery time compared to total knee replacement. Patients are typically able to resume their daily activities more quickly. For active individuals who wish to return to low-impact exercises or activities that do not put excessive strain on the knees, partial knee replacement can be a favourable choice.
Preservation of Natural Knee Function
Another advantage of partial knee replacement is the preservation of natural knee function. Since only the damaged section is replaced, this procedure allows for the retention of natural ligaments and more of the knee’s original structure. This preservation can result in a more natural feeling knee post-surgery, providing patients with greater comfort, stability, and function in their daily lives.
Risks of Partial Knee Replacement
Partial knee replacement, while a less invasive option compared to total knee replacement, carries its own set of risks that patients must consider before opting for this surgical procedure.
Limited Success for Severe Arthritis
Partial knee replacement is generally suited for patients whose arthritis is confined to a single compartment of the knee. This means that if arthritis affects multiple compartments, the success rate of a partial knee replacement significantly decreases. Patients with widespread arthritis may not experience adequate relief from a partial procedure, as the surgery does not address other affected areas. This limitation can result in ongoing discomfort and dissatisfaction with the procedure.
Potential for Needing Further Surgery
Another risk associated with partial knee replacement is the potential need for revision surgery. Because the procedure only addresses part of the knee joint, other areas may continue to degenerate. This progression can lead to the necessity of additional surgical intervention, potentially escalating to a total knee replacement. Patients must weigh the initial benefits of partial surgery against the future possibility of more extensive operations.
Risk of Implant Failure
As with any surgical implant, there exists a risk of failure. Implants used in partial knee replacement may loosen, wear or fail over time, potentially requiring revision surgery. Factors such as patient activity level, weight, and adherence to post-operative care can influence the longevity and effectiveness of the implant. While implant failure is not a common occurrence, it remains a possibility that can impact long-term outcomes. A common problem leading to revision of a partial knee replacement is progression of degenerative change in the remaining knee.
Benefits of Total Knee Replacement
Total knee replacement is a comprehensive surgical solution for those suffering from severe knee conditions. This procedure offers various advantages that can enhance the quality of life for patients experiencing significant knee problems.
Long-term Pain Relief
One of the primary benefits of total knee replacement is long-term pain relief. By replacing the entire knee joint, the procedure effectively addresses the root cause of chronic pain associated with severe arthritis or injury. Many patients report a substantial reduction in discomfort, leading to improved function and quality of life. This pain relief allows individuals to return to daily activities with greater ease and enjoyment.
Extended Longevity of the Implant
Total knee replacements are designed for durability. Modern advances have led to the development of high-quality materials and surgical techniques that contribute to the extended longevity of the implants. Many patients experience successful implant performance for 20 years or more, provided they maintain a healthy lifestyle and adhere to recommendations regarding activity levels.
Broad Application for Severe Conditions
Total knee replacement is highly versatile, catering to a broad range of severe knee conditions. Unlike partial knee replacement, it is suitable for patients with arthritis affecting multiple compartments or those with complex knee deformities. This comprehensive approach ensures that individuals with severe or widespread issues can obtain relief and stability that might not be achievable through other methods. This adaptability makes total knee replacement an attractive option for many who need a long-lasting, effective solution for their knee pain.
Risks of Total Knee Replacement
Undergoing a total knee replacement can be life-changing for those suffering from severe knee pain. However, like any major surgery, it carries certain risks that potential patients should consider.
Longer Recovery Period
One of the primary issues associated with total knee replacement is the extended recovery time. The procedure requires significant healing, which can take several months. During this period, patients may experience discomfort and swelling and are typically required to engage in physiotherapy and home exercises to regain normal function. The length of recovery can impact daily activities, requiring an extended time away from work and limiting the ability to perform regular tasks.
Potential for Complications
There are several potential complications that can arise from total knee replacement surgery. These may include:
– Infection: Although precautions are taken, there is always a risk of infection at the surgical site (less than 1%).
– Blood Clots: Surgery increases the risk of developing blood clots (DVT or PE), necessitating preventive measures including use of blood thinners in the post-operative period.
– Bleeding: Post-surgical bleeding is a risk and may require additional medical attention.
– Nerve or Vessel Damage: There is a small risk that nerves or blood vessels around the knee may be damaged during surgery.
Risk of Implant Wearing Out
The artificial joint used in a total knee replacement may wear out over time, especially for younger, more active patients. While most implants last 15-20 years or more, there is a possibility that the joint may require revision knee replacement surgery if it becomes loose, worn or unstable. This may lead to additional surgery in the future, making it an important factor to consider when deciding whether or indeed when to undergo knee replacement.
Quick Re-cap
When contemplating knee replacement surgery, it is crucial to weigh the risks and benefits associated with both partial and total knee replacements.
– Partial Knee Replacement: This surgery usually offers quicker recovery, less pain and a more natural knee motion. However, it is generally suitable for patients with arthritis limited to one part of the knee, however, there is a chance of needing additional surgery in the future.
– Total Knee Replacement: This procedure is appropriate for those with severe arthritis or damage affecting multiple parts of the knee. It typically provides comprehensive pain relief and improved function. However, recovery may take longer.
Post-operative risks including infection, DVT and PE are broadly similar for UKR and TKR.
Understanding these factors will help you when consulting with a healthcare provider to determine the best approach for treating your painful knee.
About Knee Surgery
Knee replacement surgery replaces the worn out, painful and stiff knee joint with a new prosthetic joint. This procedure which may be a partial or a total replacement is normally performed under spinal anaesthesia and is usually followed by a night or two in the hospital. Day-case knee replacement surgery may be an appropriate option for you.
About Mr Stitson
David Stitson is a Plymouth-based Consultant Trauma and Orthopaedic Surgeon. Trained both in the UK and internationally, he has worked in medicine for more than 20 years for the NHS, for the Royal Air Force and in private practice. Mr Stitson operates privately at the Nuffield Health Hospital, Plymouth.
The Nuffield Plymouth CQC Rating
The Nuffield Hospital has a history that spans over half a century and has built a reputation for high standards of care, professionalism and expertise in delivering health services. They aim for continuous quality improvement in everything they do.
Active Quality and Governance programmes are in place at the Nuffield Hospital Plymouth. As part of this, the hospital is inspected by independent healthcare regulators to ensure it meets the fundamental standards of quality and safety as determined by the regulating body (CQC).
In the most recent inspection, Plymouth Nuffield Hospital was rated as ‘Good’ overall, however, the surgical element of the inspection was rated as ‘Outstanding’. The hospital was referred to as:
“Outstanding in effective and caring, and
Good in safe, responsive and well-led.”
