Partial Knee Replacement

What is partial knee replacement? 

Partial knee replacement is one of the knee replacement surgeries to repair a damaged knee.

Unlike in total knee replacement where the damaged cartilage and bone are completely replaced with plastic and metal components, in partial knee replacement, only the diseased section is replaced with a prosthesis.

The main cause of knee damage that might necessitate a partial knee replacement is osteoarthritis. Partial knee replacement is more common among young and active people.

The procedure allows them to resume their active lifestyle once more. It is a quick and painless procedure and because the incision involved is smaller, recovery is also faster.  

Who needs a partial knee replacement?

A partial knee replacement procedure seeks to improve your knee functionality and relieve pain. It is also useful in reducing inflammation and improving knee alignment.

Partial knee replacement surgery is frequently used as a treatment for osteoarthritis. 

Partial knee replacement surgery may not be suitable for everyone. The procedure is only suitable for an individual with a damaged inner compartment of their knee, usually referred to as the medial.

The knee entails three key parts:

• Lateral compartment – This is the outermost part of your knee

• Patellofemoral compartment – This is situated behind your kneecap

• Medial compartment – This is the innermost section of your knee

Your healthcare provider may recommend partial knee replacement under the following conditions:

• In case your knee has a good range of motion

• If a section of your knee has been affected by osteoarthritis

• People with no symptoms of inflammatory arthritis

The partial criteria used by your healthcare provider to determine who qualifies for partial knee replacement will differ based on an individual’s circumstances.

Your healthcare provider will also take into consideration the effects of daily activities on your pain levels and surgery expectations. 

Patients with the following characteristics are ineligible for partial knee replacement:

• Considerable knee stiffness

• Inflammatory arthritis

• Damage to the ligament

With advances in technology and proper patient selection, it is now possible to achieve excellent results in partial knee replacement surgery among young and older patients. 

Preparing for partial knee replacement surgery 

Before a partial knee replacement procedure, an orthopedic surgeon will take you through a detailed evaluation process.

The goal of such an evaluation procedure is to establish if you are an eligible candidate for this type of surgery. The evaluation procedure will entail the following steps: 

Medical history

Your orthopedic surgeon will ask you various questions regarding your general health. Other questions revolve around your functionality and the extent of pain in your knee. In particular, the orthopedic surgeon is interested in the location of your pain.

In case the doctor identifies the pain as coming primarily from the outside or inside your knee, you may be eligible for a partial knee replacement. In case of pain in the front or across your entire knee, this may lead to total knee replacement. 

Physical examination 

Your orthopedic surgeon will carefully assess your knee. The goal of such a physical examination is to allow the surgeon to identify the location of pain. 

Your doctor will assess the ligament quality and range of motion on your knee.

In case of weak or torn ligament, or a very stiff knee, your orthopaedic surgeon may not recommend partial knee replacement. However, you may still qualify for a total knee replacement. 

Imaging tests 

Your healthcare provider will order the following imaging tests: 

Magnetic resonance imaging (MRI) scans

MRI scans are helpful because they will assist your surgeon in having a closer assessment of the cartilage. 

X-rays

An X-ray test is useful because it allows your orthopedic surgeon to establish the extent of deformity and damage in the knee. Your surgeon may order a few X-rays of the affected knee to have a better understanding of the pattern of arthritis. 

If you are on a blood thinner or other medication, let your doctor know about it. You may have to stop taking certain medications as they can increase the risk of complications during the procedure.

You will be asked not to drink or eat anything past midnight on the day of the surgery.

What happens during partial knee replacement surgery?

You will be asked to sign a consent form that gives your orthopedic surgeon and the rest of the surgical team permission to proceed with the surgery.

Make sure you have read through this form carefully before signing. If you have questions, have the surgical team clarify them before the procedure.  

Before partial knee replacement surgery, your anesthetist will explore the various forms of anesthesia available to you.

Your orthopedic surgeon will also have discussed these alternatives with you during the preoperative appointment. The main anesthesia options are: 

General anesthesia

This involves a combination of inhaled gases and intravenous medicines that will put you to sleep during surgery. 

Peripheral nerve block

This is a form of regional anesthesia. The anesthetist will inject numbing medication near a particular nerve.

The objective of peripheral nerve blocks is to block pain sensation from a particular part of the body.

Peripheral nerve blocks may be administered alongside spinal or general anesthesia.

Spinal anesthesia

The anesthetist injects a local anesthetic drug into your lower back. The drug will numb your body from the waste going down.

Your Surgeon will put an identifier or market on the knee being operated on. This helps in the verification of the surgical site. 

It takes 1-2 hours to administer a partial knee replacement surgery.

Your orthopedic surgeon will inspect the knee joint. This begins with an incision at the knee front.

The surgeon assesses the three knee compartments to make sure there is no damage to the ligament and that the cartilage damage is confined to one compartment.

In case the surgeon feels you are not fit for a partial knee replacement, he/she may recommend a total knee replacement procedure instead.

Your orthopedic surgeon shall explore all such plans with you before surgery to get your consent.

Partial knee replacement is administered in three main steps:

Your orthopedic surgeon removes cartilage from the damaged knee compartment using special saws.

The surgeon replaces the diseased bone and cartilage with metal coverings. Such metal coverings aid in recreating the joint surface. The surgeon uses cement to hold the metal parts to the bone.

If the fixation does not involve any cement, the surgeon will press-fit the metal parts to the bone and let the bone marrow onto the metal parts.

The third surgical step involves inserting a spacer. This is a plastic spacer that is placed between both metal components. The spacer forms a smooth gliding surface. 

Recovery 

After partial knee replacement, you will wake up in a recovery room. The surgical team will continue monitoring your vitals and checking for signs of complications.

You may be allowed to go home on the same day as soon as you are stable. 

Most patients who have undergone partial knee replacement can resume their daily activities after about 6 weeks.

You may feel pain or swelling around the site of the incision but this is normal. Such pain or swelling can last for a few months.

Your surgeon will prescribe non-steroidal anti-inflammatory drugs (NSAIDs) and opioids to manage the pain. 

Your surgeon will recommend that you start putting weight on your knee as soon as the procedure is completed.

During the first few weeks, you will require crutches or a walker until you can comfortably walk without the need for such assistance.

Your orthopedic surgeon will arrange for physical therapy to minimize complications and assist with your recovery. Rehabilitation exercise restores your strength while also maintaining your range of motion.

Your orthopedic surgeon will arrange post-surgical follow-up appointments at regular intervals so that they can closely monitor the progress of your knee.

During such visits, the surgeon can also identify any complications in good time.

Benefits of partial knee replacement

Partial knee replacement surgery comes with the following benefits:

• Less invasive procedure

• Quick recovery compared to total knee replacement surgery

• Minimized blood loss

Risks/Complications 

It takes less time to administer a partial knee repayment procedure

The risks or complications associated with a partial knee replacement procedure are minimal compared to a total knee replacement.

Some complications that might accompany partial knee replacement are:

Infection

The wound may get an infection after surgery. Alternatively, the skin around the wound could also be infected.

The surgical team will administer antibiotics before conducting a partial knee replacement procedure.

You will receive another dose of antibiotics 24 hours after the procedure to minimize the risk of an infection.

Blood clots

You may have blood clots in the veins of your leg after knee replacement surgery. Blood clots can also form in the pelvis.

Your surgeon will prescribe injections or blood thinners to take care of the blood clots. 

Vessels or nerve injury

Blood vessels or nerves could be stretched or injured during partial knee replacement but this rarely happens.

Other risks of partial knee replacement surgery are:

• Reaction to anesthesia

• Continued pain Knee stiff joints

• Loosening or failure of prosthesis

Cost of partial knee replacement in India 

The cost of partial knee replacement surgery in India ranges from Rs. 1,50,000 to Rs. 3,50,000.

Some factors that determine the cost of partial knee replacement surgery in India include:

Type of hospital

Private hospitals charge more for a partial knee replacement procedure than public hospitals.

Location of hospital

In case the hospital where surgery takes place is located in a metro city, you will probably pay more than if the same procedure were to take place in a tier II or tier III city.

Surgeon’s fee

The fee that your orthopedic surgeon charges for partial knee replacement will be determined by their level of experience and skills possessed.

Patient’s comorbidities

If you have a preexisting health condition such as diabetes or hypertension, you are at a higher risk of developing complications during the procedure. This may increase the cost of surgery.

References

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