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Published on March 04, 2015

Should I Have Partial or Total Knee Replacement?

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Should I Have Partial or Total Knee Replacement?

Dr. Andrew Star explains the key differences between the surgeries.

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Strong, healthy knees are a crucial part of a healthy and active life. You need them to run, jump, walk and keep moving. But, your ability to bend and flex your knees can be compromised when injury or arthritis cause damage, inflammation and pain.

With time, this damage can progress, making it more difficult to stay active. Injury or arthritis can cause deterioration of your joint and its surrounding tissue, making basic daily tasks difficult to perform. As the cartilage in your knee wears and bone rubs against bone, you may experience pain and reduced mobility.

After physical therapy and other non-surgical options, the most common solution to dramatically relieve this pain and regain mobility is knee replacement surgery. If you are considering knee replacement surgery, you have options.

Your doctor may be able to perform partial or total knee replacement depending on the severity of the damage to your knee.

“Partial knee replacement means that we resurface one portion of the knee as compared to a total knee replacement [in which] we resurface the entire knee,” said Dr. Andrew Star, an Abington Hospital orthopedic surgeon.

Their names essentially describe their differences: during partial knee replacement surgery, the surgeon only repairs the portion of the knee joint that is damaged. With total knee replacement, a surgeon repairs all three compartments of the knee joint.

“We describe the knee as having three segments: the knee cap, medial inside the knee, and the lateral compartment in the outer section,” Dr. Star said. The most common area for degeneration is the medial compartment. However, the arthritic process typically starts in one compartment, so partial replacement can work well for someone whose arthritis hasn’t progressed to the other compartments.

“The partial knee replacement covers the bony surfaces with a thin metal layer. Then a piece of plastic goes in between to smooth out the bone that has become rough and to replace the worn away cartilage,” he explained. With partial knee replacement, since only the one problem area is resurfaced, the implant is much smaller and the surgeon only reconstructs the bone and soft tissue that’s unhealthy.

“A partial knee [replacement] has advantages over a total knee [procedure] since it feels much more normal. None of the ligaments are removed so the knee motion is like that of a natural knee in contrast to a total knee where some ligaments are always removed,” he said.

According to Dr. Star, other benefits of partial replacement include a faster recovery, shorter supervised physical therapy and less pain.

“Many patients can go home the same day or the day after surgery. And supervised physical therapy is usually about half of the time required by total knee,” he said. Other benefits include a smaller incision, less soft tissue dissection, less blood loss, a lower probability of early complications and a quicker return to normal activities.

However, partial knee replacement is only an option if the damage is isolated.

“Unfortunately only five to 10 percent of knee arthritis patients qualify for partial knee replacement usually because there is too much damage to several areas,” Dr. Star explained.

But that’s not the only requirement for performing this surgery.

“Generally, partial knee replacement patients are younger, more active and not quite ready for a total knee. It is best if the patients are not too overweight and have relatively full range of motion,” he said, noting that a full range of motion means having the ability to flex and extend your knee. It’s also important that the other knee compartments be well aligned and positioned.

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