Written By: Debjani Arora | Published : April 27, 2018 11:14 AM IST
As you age, knee pain can become a gnawing problem. Most people find it difficult to deal with the same, some become immobile as the joints start to erode and make one disable and for other, the pain degrades their quality of life. It could be really debilitating to put up with a degenerative joint disease of the knees. Here are six common causes of knee pain that you need to know.
Knee pain can manifest in different ways stiffness, swelling, pain, numbness and heaviness all of which can make walking, standing and sometimes even lying down and sleeping a challenging chore. Once a person has tried all the viable means to try and soothe the pain like using hot and cold compressors, pain relief medications, herbs, analgesics etc., and nothing helped then a replacement stands to be the only option for pain relief. However, your doctor might come to the conclusion of a knee replacement only after taking into account the entire condition of the knee and the extent of its damage. Here are four reasons to avoid a total knee replacement.
Here Dr Miten Sheth, Orthopedic Knee Surgeon, The Knee Clinic, Mumbai speaks about the advantages of partial knee replacement over total knee replacement.
When should one go for total knee replacement or partial knee replacement?
Whether you need to go for total knee replacement or a partial knee replacement depends on a lot of parameters. The knee has three distinct compartments. A total knee replacement (TKR) involves removing all of the destroyed cartilage in every compartment and resurfacing it with smooth and durable metal and polyethene parts. For many patients, TKR is the best option as they have arthritis of multiple or all compartments of the knee.
However, not all patients need to go for total knee replacements. An alternative to it is a partial knee replacement, also known as unicompartmental knee arthroplasty (UKA). This procedure replaces the cartilage only in the diseased or damaged portion of the knee. The remaining healthy cartilage and ligaments in the middle of the knee are preserved.
Total knee replacement resurfaces all three compartments in the knee and thus largely eliminates pain related to knee arthritis. This has been a highly effective operation and has helped millions of people regain mobility. However, there is room for improvement! While the majority of people do very well after total knee replacement, multiple studies have shown that some percentage of patients, between 10-20% in fact, may be dissatisfied with the results. Common reasons cited for dissatisfaction include failure to meet expectations in terms of the feel and function of the knee or the occurrence of a complication requiring re-admission to the hospital.
Have a detailed discussion with your doctor to know if you should go for total knee replacement or a partial knee replacement.
What are the advantages of partial knee replacement?
Here is why a partial knee replacement is better than a total knee replacement:
What are the short-comings of partial knee replacements?
A medical procedure is never free of side-effects and UKS has its own share. The concept behind UKA is to only replace one knee compartment out of three, so there is a theoretical risk of developing arthritis in the other areas. Partial knee replacement may not be a reasonable option if there is significant damage in one knee along with arthritis in more than one compartment. Even in cases where arthritis is clearly confined to a single compartment and UKA is done, it is possible for arthritis to later develop in the other compartments, which may force subsequent conversion to a TKR.
Since the implants used for UKA are smaller than TKR implants and require meticulous technique in their insertion, early studies reported higher rates of implant loosening after UKA. However modern implant designs and evolution in surgical technique have led to significant improvements in long-term outcomes after UKA, with studies demonstrating over 90% of implants remain in place at 10 years and over 80% remain in place at 20 years. Statistics from a large Australian database revealed that at 10 years, the probability of survivorship for a UKA was 0.9 times the probability of a TKR.
Who can go for a partial knee replacement?
Partial Knee Replacement is a safe and effective treatment option for the patient with:
The decision to consider partial knee replacement should be based on a thorough history and physical examination carried out by your surgeon and a careful review of the knee radiographs.
Though every effort is made to determine if a patient is a good candidate before the day of surgery, the final decision to proceed with a partial replacement needs to be made in the operating room once the surgery is underway. A quick look at the cartilage in the other compartments of the knee joint, along with an assessment of the cruciate ligaments, should take place prior to proceeding with UKA. If significant damage is noted, a TKR can be done instead.
How do one's functional activities improve after a partial knee replacement?
While early studies suggested that UKA must be reserved for elderly and more sedentary patients, recently a number of studies have noted excellent outcomes in younger, more active patients. Patient goals and expectations are changing. One studied noted that 83.4% of patients had resumed sports after partial knee and 90% of patients reported that they felt little or no limitations in their athletic activities.
It is an exciting time for medical technologies, and the field of orthopaedics is no exception. With new techniques, new implants and minimally invasive techniques using small incisions, more operations are becoming ambulatory and rehab stints are becoming shorter and less painful. Patients should think carefully before having any elective surgery. But if a knee deteriorates to the point of pain and dysfunction, a partial knee replacement, performed by an experienced surgeon using minimally invasive techniques, should be part of the discussion.
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