If only one part of the knee joint is affected with arthritis then you may be suitable for a partial knee replacement. The criteria for doing a partial knee replacement is a lot more strict than for a total knee replacement and Nigel will give you the option of partial knee replacement if you meet those criteria. Show
Partial Knee Replacement VS Total Knee ReplacementThe benefits of partial knee replacement compared with total knee replacement are:
Partial Knee Joint ReplacementOtherwise known as uni-compartmental knee replacement (UKA).It is an operation performed to alleviate pain, stiffness, swelling, instability, and disability in those patients who suffer from osteoarthritis (wear and tear). Having a partial knee joint replacement is a big deal. It requires an open and at times quite frank discussion between Nigel and the patient about:
Why do a partial knee replacement?Knee osteoarthritis is progressive and it will get worse with time. All other forms of treatment decrease the symptoms and may make them more manageable such that you may not need a partial knee replacement, but in the majority of cases this only helps for a short period of time. Only a partial knee replacement will get rid of the arthritis ultimately in that part of the joint. It will not stop arthritis from developing in the other parts of the knee. Partial knee replacement is done to eliminate pain first and foremost. You may well still be left with residual pain as a result of the surgery but it should be far less than what you had prior to surgery. Other reasons to do a partial knee replacement are:
What is a partial knee replacement?
The Benefits of Partial Knee Replacement
It must be remembered that although these are the ideal goals of partial knee replacement, not everyone will be able to achieve these goals and problems do arise. How a partial knee replacement worksThe partial knee replacement aims to reproduce what you had prior to the development of arthritis, as normal a (native) knee as possible. Your new knee works by allowing it to act as it did before, like a modified hinge joint. The polyethylene (plastic) insert allows the femoral (thigh) component to move in all three planes. However a partial knee replacement although being extremely effective and allowing you to be able to do a lot of normal activities will never be the same as a native knee. There are so many factors as to why an artificial knee will not be quite the same as a native knee - the design, the geometry, the loss of feedback between the knee and the brain, and it is an artificial joint. It is a major surgical procedure to remove only the damaged area of the joint and replace them with an artificial joint. Only the worn-out surfaces of the joint are replaced. Nigel replaces the end of the femur (thigh bone) and the top of the tibia (shin bone). Surgical ProcedureDuring partial knee replacement, a straight incision is made toward the inside of the knee, exposing the joint. Nerves, blood vessels, muscles and the patella are carefully moved aside. Femur: Surgical tools are used to remove the worn-out surface and shape the end of the femur. The metal component, similar in size and shape to the end of the femur, is cemented to the bone. Tibia: The tibia is cut flat across the bone. A metal plate is attached to the top of the tibia and cemented in place. A plastic component is then inserted to act as a cushion; it is attached to the metal plate. Ligaments: The ligaments are preserved so the new joint can move as normally as possible. Once the components are inserted, Nigel checks that they fit properly and that the new joint moves correctly. The skin will be closed with absorbable sutures. The operation takes about one hour to complete. Pre-surgery and Post-surgery information – Partial Knee Joint ReplacementWhat to Expect Before the OperationPrior to the surgery itself, Nigel will ask you to see the following Health Professionals:
Anaesthetist
PhysicianNot everyone will need to see a physician. Those that do, will do so to make sure you are on the correct medication and that your medical condition/s are optimised for surgery. The surgery will be carried out at an appropriate hospital that has an appropriate level of cover for you. To minimise any risk to you Nigel may require you to have:
Other radiology: You may require other imaging of your knee, which may include MRI scan, CT scan, or a Bone Scan. Blood tests: This will depend on what kind of operation you are having, medical conditions you have, your gender, and what age you are. MedicationsBefore the operation it is important to tell Nigel, the Anaesthetist, and if you have seen a physician what medications you are taking. If you are taking a medication particularly one that affects blood clotting such as:
Aspirin does not need to be stopped but Warfarin and Clopidogrel do need to be. If you have a history of blood clots the medical team needs to know as we will have to take important steps to make sure that your blood is thinned enough to stop clots from occurring. All other medications need to be mentioned even natural remedies / medications as they can interfere with medication being given to you in hospital, such as antibiotics, painkillers and anti-inflammatories. Length of StayYou will be in hospital for 2-5 days generally. This is only a guide. There is no race. You have to be safe before you are sent home. To be safe you need to be independent with:
The Physiotherapists and nursing staff are the most important people in the immediate post-surgery phase to get your knee moving and your leg working. What to Expect on the Day of Surgery
What to Expect Immediately After the Surgery
What to Expect on the Ward - Day 0A nurse will be looking after you and your observations will be monitored:
You will be offered pain relief.
A Physiotherapist will come and see you and if your observations have been good, will get you to stand and maybe take a couple of steps. Nigel will come to see you at the end of his operating list and tell you how the operation went. What to Expect on the Ward - Day 1
What to Expect on the Ward - Day 2 to Discharge
What to Expect on the Day of Discharge
What to Expect in the First 6 Weeks
Nigel will see you at the 6-week mark and at that stage will hopefully be able to give you indications regarding:
What to Expect - 6 Weeks to 1 Year
Nigel's ExpectationsI expect you to have a nearly completely pain free knee that moves at the same degree if not slightly better than what you had prior to the operation. To have a knee replacement that allows you to do all your daily activities, most leisure activities, and certain sports without feeling pain, giving you the freedom in your life, to recapture and enjoy your life, those around and close to you, without worrying about your knee. Patient's ReactionsIt is difficult to know who will do well and who will not do well. It never fails to amaze me how when I think someone will do well and they do not and then when you are dreading the result of someone else how well they do. I believe in providing a well informed approach is the key to how well a patient does, giving them no illusions, being realistic, and providing plenty of encouragement to the patient from all members of the team. As many patients tell me, it is their knee, if they want to do well, they will. I also believe that it is important for you to discuss with your family and friends that you are having a knee replacement and to ensure that you have the appropriate level of help on discharge. Seek out people who have had a knee replacement, as they will be able to tell you what their experiences are. How Long Will it Last?This is the one question I always get asked, especially by younger patients. Generally speaking if you are over 65 your new knee will last you out. If you are under 65 you may well need to have part or all of your knee revised at some stage.The kind of partial knee replacement I use is still in 92% of people at 10 years and is the best performing partial knee replacement in the Australian Orthopaedic Association Joint Registry. Complications - GeneralAs with any operation the benefits of the operation do outweigh any risks, but there is always a potential for complications to arise, orthopaedic or otherwise. Nigel will discuss the orthopaedic complications when he consents you outlining in detail what these are and when they are likely to occur. He will give you a general complication rate but will also mention his complication rate. Complications –Partial Knee Joint Replacement SurgeryInfection
Deep Vein Thrombosis (DVT)
To prevent a DVT from occurring Nigel will assess your risk profile for DVT and grade you high, medium, or low risk according to the American Academy of Orthopaedic Surgeons guidelines on DVT prevention. Once this assessment is completed you will either be given aspirin, or an injection of an anti-coagulant (blood thinning) medication whilst in hospital and on discharge from hospital.
Pulmonary Embolus (PE)
Aseptic Loosening
Pain
Stiffness / Lack of Movement
Swelling
Damage to nerves and blood vessels
Blood transfusion
Other RisksThere are general risks of having a knee replacement that are non-orthopaedic related. The Anaesthetist will be the best person to answer these questions but generally include:
Report to your Nigel or GPIf you develop any of the following:
View Case Study – Partial Knee Replacement When does the pain go away after partial knee replacement?Four to six months is the period where most people feel able to get back to normal activities. By now you should be much more stable on your feet and, hopefully, feeling able to tackle longer walks and more varied forms of exercise.
Why do partial knee replacements hurt?Loosening of the implant from the underlying bone can cause significant pain. Factors such as high-impact activities, excessive body weight, and general wear-and-tear of the plastic spacer between the two metal components of the implant can cause the implant to become loose.
How long does it take to fully recover from partial knee surgery?People who have a partial knee replacement recover faster than those who have a total knee replacement. Many people are able to walk without a cane or walker within 3 to 4 weeks after surgery. You will need physical therapy for 3 to 4 months.
How long is the pain severe after a knee replacement?The first few days after surgery should include the highest level of pain, but your doctor will send you home with pain medication adequate for your pain level. Most people fully recover from knee replacement surgery in about six months.
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