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Foot, Ankle & Knee
Partial Knee Replacements
New Techniques Mean Quicker Recovery for Some Patients
The human knee joint can behave as though it
is one joint or three separate joints. Each part of the joint
is called a compartment. There is one compartment on the inside
of the knee (medial), another on the outside (lateral) and the
third compartment is the kneecap (patella). There is normally
a preponderance of medial compartment arthritis of the knee,
with an accompanying bowing deformity, with variable involvement
of the other compartments. If the other compartments are not
as arthritic, a partial replacement can be considered.
There are several different patterns of osteoarthritis
of the knee joint. Some are widespread processes involving all
parts of the joint with large bone spurs, marked deformities
and scarring. Usually such patients have much limitation of
joint motion. These types of arthritis are best treated with
a total knee replacement because it allows for correction of
these associated problems (with release of the scarring, removal
of the spurs and restoration of alignment and soft tissue balancing).
Other types of osteoarthritis are more limited
in the joint and are not associated with the problems described
above. The uninvolved parts of the knee are often entirely
normal.
One treatment option in this circumstance is a partial knee
replacement. Partial replacement of the knee joint is an old
procedure — TCJR has been doing them since 1986 — that
has benefited from improvements in surgical technique and more
modern
prosthetic implant designs. It is only suitable for osteoarthritis,
and can resurface the inside, outside, or the kneecap part
of
the knee, leaving the other parts untouched. A partial knee
replacement can restore the alignment of the leg, and retension
the ligaments if the deformity is small and flexible.
Partial (left) and Total Knee Replacements
Now the rehabilitation has been dramatically
reduced with the introduction of new surgical techniques. These
techniques permit the partial knee implant to be inserted without
opening the entire knee joint that is required of a total knee
replacement. In most individuals the surgeons at the TCJR can
insert the partial prosthesis through a small incision of about
2 to 3 inches, thanks to some new techniques that are proving
very effective. The quadriceps muscle does not have to be split,
which is routinely done in total knee surgery and is one of
the reasons for slow healing with the total knee. In addition,
the partial knee prosthesis does not disturb the normal uninvolved
parts of the knee joint and produces less swelling and bleeding,
so that knee range of motion comes much quicker in the rehabilitation
phase after surgery. Some patients can go home the day after
surgery. Rarely is a blood transfusion necessary. Routine activities
can be done in 1-2 weeks. Survival of the partial implant is
over 90% at 10 years. Conversion to a total knee is sometimes
necessary if the rest of the joint becomes arthritic.
Hospital Course and Follow-up Period for
Partial Knee:
Day of surgery: General or spinal anesthesia is necessary.
The patient is usually able to lift the operated leg off the
bed and walk in the room with a walker and bend the knee to
90 degrees by 6 hours after the surgery. A pain injection is
usually necessary, but pills may be sufficient. A light supper
is tolerated.
First day after surgery: The patient
can walk into the hall with a walker or crutches, and can get
on/off the commode. Pain is well controlled by pills. The range
of motion of the knee is more and the patient can eat a regular
diet. Some patients can go home this day if cleared by physical
therapist. Second day after surgery: Knee motion and walking
comfort are improved. Most patients can be discharged.
One to two weeks: Return to office,
ready to resume light housekeeping, office duties. Should be
able to drive a car.
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