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Partial Knee Replacement
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Unicompartmental arthroplasty (UKA), also called partial knee replacement, is an option for some patients. The knee is generally divided into three "compartments": medial (the inside part of the knee), lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). Most patients with arthritis severe enough to consider knee replacement have significant wear in two or more of the above compartments and are best treated with total knee replacement. |
A minority of patients (the exact percentage is hotly debated but is probably between 10 and 30 percent) have wear confined primarily to one compartment, usually the medial, and may be candidates for unicompartmental knee replacement.
Advantages of UKA compared to total knee replacement (TKA) include smaller incision, easier post-op rehabilitation, shorter hospital stay, less blood loss, lower risk of infection, stiffness, and blood clots, and easier revision if necessary.
While most recent data suggests that UKA in properly selected patients has survival rates comparable to TKA, most surgeons believe that TKA is the more reliable long term procedure. Persons with infectious or inflammatory arthritis (Rheumatoid, Lupus, Psoriatic ), or marked deformity are not candidates for this procedure.
The minimally invasive approach to surgery is controversial. Opponents say that surgery is made more difficult without altering the long-term prognosis. They suggest that more technical errors will be made particularly during the "learning curve" when the surgical team is less familiar with the procedure. They also say that the procedure is not backed by clinical results.
Proponents, however, say there are significant benefits for patients. The smaller incision in the knee causes less trauma to the underlying muscles and soft tissue in the joint. Post-surgery pain is thus reduced, with patients able to return sooner to physical activity.
We still do not know whether cemented or uncemented components last longer in the knee. Many surgeons cement the tibial component, but opinion is divided about the femoral component. Sacrifice of the posterior cruciate is also controversial, with some surgeons performing this routinely and others trying to preserve as much normalcy as possible.
Resurfacing the patella is also subject to scrutiny. Some studies have suggested that there is no advantage to resurfacing the patella. However, many surgeons continue to do this because resurfacing the patella during a later procedure is often necessary.
There are many different components designed for total knee replacement. Studying the results of one design versus another is expensive, time-consuming and relatively unrewarding -- because designs change frequently and may be withdrawn by the time a reliable long-term study has been completed. Many nations, led by Sweden, have set up registries of joint replacements with voluntary or mandatory reporting of the components and techniques used. These registries may yield information about the outcomes of different designs.
New research by Dr. Robert Litchfield, September 2008, of the University of Western Ontario concluded that routinely practised knee surgery is ineffective at reducing joint pain or improving joint function in people with osteoarthritis. The researchers did however find that arthroscopic surgery did help a minority of patients with milder symptoms, large tears or other damage to the meniscus — cartilage pads that act like shock absorbers between upper and lower leg bones.
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