Partial Knee Replacement Surgery

Compared to total knee replacement surgery, partial knee replacement surgery better preserves range of motion and knee function because it preserves healthy tissue and bone in the knee. For these reasons patients tend to be more satisfied with partial knee replacements compared with total knee replacements and they are still candidates for total knee replacement should they ever need it in the future.

Patients with medial, lateral, or patellofemoral knee osteoarthritis can be considered for a partial knee replacement. “Medial” refers to the inside compartment of the joint which is the compartment nearest the opposite knee, while “lateral” refers to the outside compartment farthest from the opposite knee. Medial knee osteoarthritis is commonly caused by damage to knee cartilages known as the menisci.

Patellofemoral osteoarthritis is osteoarthritis of the joint between the kneecap (patella) and the lower leg bone (tibia). This type of knee osteoarthritis is more common than lateral compartment knee osteoarthritis.

Professor Kohan will ask you to identify the area of pain in your knee then check your range of motion and the knee’s stability. An X-ray of the knee will determine your eligibility for partial knee replacement surgery.

To be a candidate you must have an intact anterior cruciate ligament, a sufficient range of knee motion, limited inflammation, minimal pain at rest, damage to only one compartment, and no calcification of cartilage or knee dislocation.

Further testing may be required if the diagnosis is not clear:

• X-Ray – this needs to be weight bearing. The use of a weight-bearing x-ray can determine the extent of the degeneration in the joint.
• Blood Test – This may determine if there is inflammatory arthritis or infection in the hip.
• Scanning and MRI can determine if you have avascular necrosis.
• Bone Mineral Density determines the condition of the bone or the presence of osteoporosis.
• Arthroscopy

If your knee pain persists despite anti-inflammatory medications and maintaining a healthy weight you may want to consider a partial knee replacement.

Partial Knee replacement is considered ‘retread’ surgery. This means the diseased bone is resurfaced only, leaving the rest of the joint untouched. The device is small consisting of metal and plastic components and the operation itself is less invasive.

The main advantages of a successful partial knee replacement procedure are:

• • Smaller Incision: The incision itself is approximately 10cms long.
  • Less Blood Loss: artial knee replacement surgery is considered minimally invasive surgery and eliminates the need for blood transfusion.
  • Less Bone Removed.: Partial knee replacement surgery means ‘retreading’ the bone with metal on plastic. Therefore, only a small amount of bone needs to be removed, approximately 3 – 4mm, to fit the device. Total knee replacement requires the loss of approximately 10mm from all compartments.
  • Lower Morbidity: Partial knee replacement surgery greatly reduces the disruption to the joints, providing a shorter recovery period and a decrease in complications.
  • Shorter Recovery Time: Most Partial knee replacement patients are walking 2 – 3 hours after surgery. Total time spent in hospital approximately 6 – 8 hours & within 2 weeks patients are back driving, playing golf, or resuming normal activities

A partial knee replacement implant is much smaller than a total knee replacement implant and does not disturb the healthy tissues of your knee. Most implants are metal-on-plastic and resurfaced with a cobalt chrome implant that conforms precisely to the anatomy of the knee. The tibial component would be made of polyethylene and only require minimal bone removal to secure the implant.

If only a single compartment in your knee is to be replaced, Professor Kohan will use a unicondylar (UNI) fixed bearing knee implant, the most commonly used prosthesis, or a unicondylar mobile bearing knee implant. The advantage of these types of implants are such that only the arthritic portion of your knee to be covered by the implant needs to be removed.

In joints with mobile bearings, the plastic spacer isn’t fixed but allowed to move back and forth with the action of the joint. Many believe that this allows greater freedom of movement in the joint and also reduces the amount of wear that could take place. Traditional partial knee replacements however retain good movement even in joints with fixed bearings and demonstrate a limited history of wear.

If osteoarthritis has progressed to more than one compartment of your knee we now have the ability to remove two (bicompartmental) or even three (tricompartmental) components of your knee joint and replace them with partial knee implants.

The advantage of a partial knee replacement rather than a total knee replacement is less damage to healthy ligaments during the procedure and the likelihood that your repaired knee will function and feel more like your natural knee.

Partial Knee Replacement surgery requires resurfacing of the damaged surfaces of the knee joint. A partial artificial knee joint is designed to fit over the edges of the damaged joint and to replace the damaged areas with one that can be used pain free.

The procedure is usually performed on an outpatient basis (no overnight hospital stay required). Discharge from hospital (as long as you feel well enough) will be 4 – 6 hours after surgery.

The operation will take approximately 1.5hrs plus approximately 45 minutes to an hour in recovery. You will be out of bed and walking 2 – 3 hours after surgery.

The incision is approximately 10cms and is made down the middle of your knee over the top of your kneecap. The scar line may not be completely flat immediately after surgery but will settle down after a few weeks. A tourniquet is placed around your thigh during surgery; this may cause bruising from your thigh down into your foot.

When you wake up, you will have a drain in your knee. This will be removed before you go home. A knee brace will be in place for 48 hours after your operation.

The operation will be performed under general anesthesia. Dr D Kerr will discuss the anesthetic and pain control with you. It is important you make an appointment to see Dr Kerr approximately 1 week prior to your operation.

There are two main techniques in partial Knee replacement surgery; the Repicci Method and the Oxford Method.

Immediately after surgery, you will wake up in the recovery room. You may feel a bit groggy. Professor Kohan and his staff will monitor you, checking your blood pressure, temperature and pulse. Dr Kerr will also assess your pain level. Post-operative x-rays will be performed in recovery.

After 45 minutes – 1 hour you will then be transferred back to your room on the ward.

When you arrive to your room, you will have:

• A compression garment around the operation site to apply pressure there. This is removed 24 hrs after surgery.
• A pain catheter which will be removed before discharge. We inject local anaesthetic through this to maintain the pain relief.
• TED Stockings (knee high white stockings) on your legs which must be worn for 2 weeks post procedure.
• A drip in your arm. This will provide hydration and blood if you need it

In the first week following surgery you may experience:

• • • • Swelling – From your thigh down into your foot is common. This at times may be quite marked. The swelling will increase for the first few days after surgery and will gradually diminish. Some swelling can be present for 12 months or so. The swelling may be diminished by walking as the muscle function will push the fluid away. When you stop walking, the limb should be elevated above the level of the hip.
      • Bruising – Marked bruising can be found in some patients. This can be found from your thigh down into your foot. At times the bruising can be quite dramatic but it will resolve. It is the result of some residual bleeding making its way to the surface. The body will eventually remove the bruising. It is also the result of the blood thinning tablets you will be taking.The blood thinning tablets will tend to make the bleeding after surgery a little more marked because the blood clotting is impaired. This is however preferable to developing a blood clot.
      • Blistering – On occasions blisters will develop near the operation and possibly above it. The blistering is due to surface fluid. It looks dramatic but it is of no consequence and always resolves. One cause may be the bandage rubbing on the skin. Sometimes, when the blood dries in the bandage it can be like cardboard and rub on the skin producing these blisters. We change the bandage after about a week but would prefer not to interfere with that earlier because of the risk of infection. After about a week the wound is sealed enough to be a reasonable barrier against infection. Another cause for the blistering is tissue swelling. This is associated with the bruising and is a result of fluid leaking into the skin. These blisters always go away. They may burst and leak fluid and again the appearance may be dramatic. Sometimes if they are large we may burst them. This is so that the dressings sit more comfortably.
      • Muscle soreness – Your muscles can feel stiff and sore to touch. During the operation some stretching and pulling of the muscles occurs. This may result in some pain like a corked thigh. Occasionally you may feel cramps and spasms. The discomfort however will resolve and activity such as walking, stretching, physiotherapy, etc, will help to speed the improvement.
      • Heat – The operated site may feel hot and the heat may last for 12 months. As part of the healing process the operation site requires more blood supply from the body and it is this extra blood supply which is the cause of the local heat.

For the first 2 weeks after surgery your activity level is usually limited however you will be able to walk independently, use the bathroom and perform normal activities of daily living. It is important however, to keep on trying to use the knee as normally as possible.

After 6 weeks you will be able to engage in moderate activities, i.e. driving a car and climbing stairs.

Within 8 weeks you will have resumed most of your normal activities. Complete surgical healing takes 6 – 8 weeks but sometimes longer if the arthritis was very severe or the knee very deformed. During this time some swelling and discomfort is normal and should be manageable with the prescribed medication.

Precautions to take following knee surgery include:

• • • Avoid chairs that are low.
    • Avoid slippery surfaces.
    • Avoid twisting your knee for 6-8 weeks after surgery.
    • Avoid siting in the same position for long periods. 45 minutes at a time should be enough. Sitting for long periods increases the likelihood of stiffness.

Incision Care

The incision is sutured with skin staples which will be removed 10-12 days after surgery. You will have a firm bandage from your foot to your thigh following surgery which is usually removed on day 5 at your first post op appointment.

The nurses in the hospital will help you change the dressing if needed before you leave the hospital.

You must not get the incision wet until the staples are removed – a sponge bath instead of a shower is therefore recommended for 5 days post surgery.

You may shower after the sutures are removed but may not bathe or swim for 2 more weeks after that.

Your second post-op appointment is to remove the skin clips from your wound. Some swelling and warmth on and around the incision area is expected. If you develop increased redness, drainage or a fever please call the office immediately.

Bruising around the thigh area is also common. It may extend down into your ankle and should resolve in 10 – 14 days.

You may apply Vitamin E or some moisturizing lotion on and around the incision area after the staples have been removed.

Walking

Upon discharge from hospital you will be walking with crutches. You may discontinue using crutches after being assessed by Professor Kohan at your postoperative visit. After this time you may use a cane or if you feel confident you may discontinue using any walking aids at all.

For the first 2 weeks following your procedure you may go up and down stairs as needed but only straight legged. After this time there should be enough flexibility and repair from the muscles around your knee to walk relatively normally.

Expectations

Each individual has his/her own set of expectations. Each patient is treated as an individual with general health, age and attitude considered.

An important thing to remember is that you are not sick. You have a problem with your knee that needs to be fixed.

Getting back on your feet after surgery is the most important goal. ‘Motion is Lotion.’

Generally our ‘Estimate of Fees’ is accurate however, on occasion unforeseen circumstances can arise during the operation which may require additional medical services or a different, more costly prosthetic device to be used. If this happens there may be additional costs to you that are not covered by the estimate.

This will be fully explained to you after the operation should it occur.

Professor Kohan’s Surgical Fees
Medical Item No: 49517

Surgical Assistant Fees
The surgical assistant fees will either be billed to you directly or Professor Kohan will bill you on his behalf.

Anesthetic Fees
You will meet with Dr Kerr, the anaesthetist before your operation so that you can obtain an estimate of his fees. These will be billed to you directly.