The debate: partial v total knee replacement

Total Knee ReplacementThere’s been an argument raging amongst the medical community for a while now, and I’ve been following it with interest. It’s been a long-held view that a total knee replacement is better than a partial one – for reasons we’ll go into later – but recent high-profile developments may suggest that the tide is beginning to turn back to the partial side.

The case for total knee replacement

While total knee replacement – the replacement of both ends of the bones in the knee with metal and plastic – is most commonly used on older patients, who have usually already undergone less drastic (and ultimately less effective) treatment. It has been viewed for a long time as the cure-all procedure, as it theoretically eliminates any further problems in that area, especially when the client suffers from severe three-compartment (inside, outside and front-of-knee) arthritis.

It’s also a much easier procedure for the practitioner to perform: after all, taking the entire engine out is a lot less hassle than extracting a few valves and cogs. There has also been a greater reliability rate with the total knee replacement over the years, despite the longer recovery time.

The case for partial knee replacement

However, the tide may be turning towards the partial approach. Despite its undeniable success rate, there are many downsides to total knee replacement: the loss of feeling, the long and arduous recovery period, the fact that half of all patients experience pain in the knee area after a decade or so, and the sheer cost of the procedure. Consequently, as developments in knee repair technology are starting to catch up, the decision to go partial or full is starting to get trickier.

There have been huge advances in pain and bleeding control, risk management and physical therapy of late which suggest that partial knee replacement is making a comeback. The most newsworthy non-sporting knee surgery of the decade so far – George W Bush’s unicompartmental procedure on both knees in 2014 – allowed him to take up his cycling hobby again within a few months, something that would have been difficult at best with a total knee replacement. Once seen as a bit of a punt in the hope that further deterioration won’t happen and some feeling will remain – or the delaying of the inevitable for a few years – the partial procedure has developed a new lease of life.

Which knee replacement surgery is best for you?

The short answer, as always: it depends on many factors. If you’ve kept your weight down, are in good health and are still physically active, you stand more chance of a successful partial replacement. If you’re overweight and inactive, you may be pointed towards a full replacement. My job is to assess the requirements and expectations of the individual patient and recommend the best option for them.