What is a Partial Knee Resurfacing? Is it Better than a Total Knee Replacement for Knee Arthritis?

Full vs. Partial Knee Replacement: What’s the difference?

While it may seem appealing to have half of a surgery compared to a full surgery, it is important to understand the differences between a unicompartmental or partial resurfacing or replacement and a total knee replacement surgery. Each type of knee replacement surgery is unique and has its own outcomes after surgery for knee pain and osteoarthritis.

The knee is composed of three compartments: the inside (medial), outside (lateral) and underneath the knee cap (patellofemoral or anterior). Each of these compartments can be replaced individually in partial knee replacement surgery, or all three can be replaced in total knee replacement surgery. A partial knee replacement is technically one-third of the surgery of a total knee replacement. If you have a partial knee replacement, you will find improvement in the function of your knee and reduction of knee pain, but there are some long-term factors to consider.

Partial Knee Replacement

In the past, partial knee replacement was for patients over 60 years old whose ligaments were in good condition, had little knee deformity and could move their knee pretty well. Today, the procedure is being done on younger patients who have pain and other symptoms in one part of the knee.

Because a partial knee replacement is less surgery with a smaller scar, it has often been reported to have an easier, quicker, more complete recovery and greater satisfaction than a full knee replacement. Complications during surgery like blood loss, transfusion and blood clots (DVT) tend to be less with a partial replacement or resurfacing. The risk to your life (mortality) from the surgery although very small normally is significatly lower with a partial replacement versus a total knee replacement.

Because partial knee replacement retains most of your knee tissue, you are still susceptible to meniscal tears and progression of arthritis in the rest of the knee. When a partial knee replacement fails, it can be converted to a full knee replacement with an excellent degree of success. The surgery and recovery may be more involved, but the overall outcomes are highly successful.

Total Knee Replacement

This procedure has been revolutionary to orthopaedics giving many patients the ability to return to function and enjoy their lives with implants lasting about 10-15-years. While the surgery is longer, there is a higher rate of complications and greater cost, the lifetime of the implants is much greater than in partial knee replacements. Physiotherapy is tougher early on, and the knee ultimately doesn’t quite feel the same as your own knee. Despite these potential limitations, patients who are good candidates for total knee replacement have great patient satisfaction, high functional scores and longer-lasting replacements. In the United States, over 90% of knee replacement surgeries are total knee replacements; while 10% or less are partial knee replacements. However studies from Oxford have shown that one of the most important factors in your success is the skill and experience of your surgeon. Those surgeons who are doing a higher proportion of partial knee resurfacings have a better patient satisfaction and long term outcomes. It has also shown that nearly 50% of those treated in England with a total knee replacement could have been a candidate for a partial knee resurfacing or replacement.

Overall Outcomes

Both partial and total knee replacements can be highly successfully for patients who are good candidates. If you take care of your total or partial knee replacement it will provide you with the greatest longevity possible.

Source data from the AAHKS

Is My Knee Pain Caused by Osteoarthritis or a Torn Meniscus?

A torn knee meniscus and knee osteoarthritis can present in similar fashions, This can make it difficult to know what the cause of your pain might be

Common symptoms of both osteoarthritis (OA) and a torn meniscus include:

• Pain around the knee joint, worse after activity. Walking, running, or climbing stairs can make the knee pain worse.

• Swelling and fluid in your knee. This occurs because of inflammation and may make the knee painful to the touch because it is tense and streches the lining of the knee joint.

• Knee locking. True locking is when the knee often wont come out fully straight. It will often bend fine.

A knee meniscus tear and knee osteoarthritis affect different types of cartilage in the knee:

• Knee osteoarthritis or OA refers to damage to articular cartilage. Articular cartilage is a very specialised coating that covers the ends of the bones in the knee joint, the femur (thigh bone) the top of the tibia (shin bone) and back of the patella (knee cap).

• A torn meniscus refers to damage to a small C shaped wedge of rubbery cartilage that sits between the joint like a shock absorber and to transition between the very curved surface of the femur and the flat surface of the tibia.

Here are a few questions to ask yourself when determining the cause of knee pain. This is the thought process we at wessex knee would go through to diagnose your pathology.

When did the pain start?

The biggest difference between arthritis and a torn meniscus is how acute the pain comes on. osteoarthritis pain comes on gradually and will often not have an injury or event to set it off. A meniscal injury requires some kind of force or twist and a very specific event.

• If your knee pain increases gradually and cannot be placed back to a specific injury it is more likely to be arthritis.

• If your knee pain arose suddenly, you may have a meniscus tear. Sporty and very active people are more likely to experience the type of injuries that cause meniscus tears. Skiing and football are very common means of causing a meniscal tear.

It is possible for a meniscus to break down slowly, but this is less common and is secondary to osteoarthritis rather than a true acute injury.

What does the pain feel like?

Another difference between arthritis and a torn meniscus is the pain.

• Osteoarthritis tends to be an intermittent, dull, or aching pain. Often described as a tooth ache type pain. The breakdown of cartilage may cause bone rubbing on bone when moving, which can cause a feeling of stiffness or produce a grinding noise.

• People with a torn meniscus often complain of acute and sharp, immediate pain following an injury. It is often swollen and stiff the next day. Tenderness to the inside or outside of the knee alone the joint line between the bones may indicate a meniscus tear.

Diagnosis of a Meniscal Tear?

Diagnosis of a meniscal tear requires us to examine your knee and carry out some investigatiosn such as an X-Ray to see narrowing of the joint in osteoarthritis. An MRI is best to see the cartilage layer and the little disc of cartilage the meniscus. If you have a meniscal tear it can be an emergency and we are now able to repair them rather than remove them. Having a consultation and MRI within 3 weeks is important to maximise the chances of healing and repair of your meniscus which would be done arthroscopically.

If you have early osteoarthritis an injection may be useful for you and one of the best is Hyaluronic acid which is a viscosuppliment ans acts as a gell lubricant within the knee to help reduce pain and inflammation.

If it is very severe arthritis joint resurfacing could be an option rather than a full total kee replacement. It has been shown in studies that nearly half of those treated with a full total knee replacement could have been candidates for a partial knee resurfacing. This is a smaller procedure, preserves your ligaments and gives you a more normal feeling knee. It also carries a lower surgical risk.

Getting a Diagnosis and Treatment for Knee Pain

Whether you think you have knee arthritis or a torn meniscus, your best bet is to visit us here at Wessex Knee and Mr Frame. Early treatment can prevent your symptoms from worsening and, in some cases, help you avoid future surgeries.

We hope this information has been useful. Please feel free to share it or link to it.

Thanks

Mark

COVID Lockdown - 5 Great Tips for Avoiding Knee Injuries and Pain!

No one wants to be in pain or have an injury, but much like lots of things in life its unavoidable at some point. How can you avoid doing yourself harm and reduce the risk of having a knee problem!

The lockdown has been a world-wide phenomenon and we all have experienced this collective want and desire to get out and feel a little bit of freedom. Exercise has long been shown to help reduce anxiety and be very powerful in boosting your feel-good chemicals in the brain - dopamine - to help with your mental health as well as being good for your physical health.

Everyone is on a different level with regards to their fitness level. What's super important is to not worry about that and get out and do something. Every little helps. Taking a walk when you would have driven, run when you might have walked. Bump up your normal exercise regime a notch.

This is when we need to get into some tips to avoid doing harm.

1. Choose your Exercise Wisely

We want this to be the opportunity to change your habits for good, not just a quick burst of enthusiasm and then back to the old ways. Choose an exercise you love doing so it’s fun and not a chore. You want to be looking forward to it. If you have a knee problem already its best to avoid impact type activities such as running. Stick to a bike or swimming - but avoid the breaststroke as this is often uncomfortable with osteoarthritis. If you love running but struggle, try soft forest runs rather than the road. Remember the benefit from doing the exercise will far outweigh any harm.

2. Buy the Gear!

We all love buying new shiny things! This provides us with just that opportunity. Having the right equipment is vital to prevent harm. Those trainers you bought in the 80s are good for the bin, splash out on a new pair that will cushion, support and protect your feet. If you really get into your exercise, pay a visit to a good running shop or sports shop and have then fit your shoes properly to your sport and feet. We are thankfully all different and that includes your legs and feet! The same goes for your clothes. The more comfortable you are the more you will enjoy the activity.

3. Warm Up!

As much as you are raring to go and can't wait to do that Iron Man or Olympic standard triathlon, slow down a little and warm up first. Stretching and gradual progression into the exercise with allow you to do more, achieve bigger gains in fitness and prevent harm. This also counts for building up to the bigger and faster forms of exercise gradually when your body is ready. If you move it up and you struggle, don’t despair, click it back down for a while longer and try again later. It’s better to move back a level than to hurt yourself and have to give up!

4. Stay Hydrated

The old adage of no pain no gain does not fly in the orthopaedic world! Pain is bad! Make sure you feed your body what it needs. The number one need is water when exercising. Without it you are asking a lot from your kidneys and muscles. Post exercise muscle pain is not fun and keeping hydrated will help them recover more quickly and allow you to get back to that next run faster. Cramp is bad and your bodies way of telling you to drink more. No need for fancy supplements, good old tap water frequently is all that’s needed. Oh, and maybe a cool new bottle to put it in to make you feel great!

5. Vary your exercise and know when to stop!

As you do more and your body gets fitter, what on day one was a struggle becomes a breeze! This is fab, it means all the hard work is paying off! However, our bodies are great at building muscle and stamina for that particular exercise. If you want to really challenge your body and have all round fitness vary the type of exercise you do! Another fantastic excuse to buy that carbon road bike you’ve always wanted, or that new tennis racquet! Equally know when to stop. Those happy chemicals in your brain from that exercise can get addictive and push you to want to do more and more. We all have limits, listen to your body and work as a team. If it says stop, STOP! If you do have an injury remember RICE, Rest, Ice, Compression and elevate! Ice packs and cold compression devices are brilliant for a situation just like this.

I hope these small tips are useful and help you get to the level you want. If you do ever have an issue or injury, we here at Wessex Knee are happy to see you and help you back to where you want to be. Happy exercising!