The argument between total knee replacement and partial knee replacement is one that has been raging for some time amongst the medical community. And so far, the battle is being won by the total replacement adherents: out of the 98,147 instances of knee replacement surgeries carried out in the UK in 2016, 91% of them were total knee replacements.
However, a new report conducted by researchers from Oxford University may start to turn the tide: according to their findings, many more people than first thought who are facing surgery for knee problems would be better off with a partial rather than total knee replacement.
As we know, partial replacements have long been seen as the suitable procedure for people who have suitable for people who have arthritis in just one side of the knee – usually the inner side, and only when the ligaments inside the knee are still strong. The benefits of partial knee replacement surgery are obvious: the patient has to contend with a smaller incision and minimally invasive surgery. However, the general rule of thumb has always been: if in doubt, take it all out in the form of a full knee replacement.
The case for partial knee replacement surgery
Recently, though, the research team – from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) – examined real data from a very large range of patients about their operations, their GP visit and their own reported quality of life outcomes, and concluded that partial knee replacements can be better for certain patients and could save the NHS a fortune.
The key finding was that the choice between a partial or total replacement varied from surgeon to surgeon – as did the success of the operation. And the surgeons who carried out more partial replacements had better outcomes from them than surgeons who performed fewer of them. As Co-Lead researcher Prof David Murray pointed out, this was a very important finding.
“If surgeons aim to use partial knees in a quarter or more of their knee replacements this will substantially improve the results of knee replacement and will save money,” said Professor Murray. “In addition, more partial knee replacements will be done and more patients will benefit from this procedure.”
One size knee op may not fit all
According to the research team, the next step is to investigate the potential benefits of partial knee surgery in more cases. However, they are keen to stress this shouldn’t be an across-the-board mind-set: they went to great lengths in the report to stress that while their research demonstrates that partial knee replacements can be better and cheaper for patients over 60, the long-term benefits for partial surgery in the under-60 bracket are less clear when compared to those of total knee replacements.
The cost benefits offered by partial knee replacement surgery are obvious – less theatre time, less equipment needed, and a patient occupying a hospital bed for an average of one day less. The benefits for the patient are similarly clear: less time in theatre, a quicker recovery time, and the fact that the patient feels more like they still have their own knee, instead of a ‘bionic’ one.
The lesson to be learned from this study is that surgery should always be tailored to the patient’s individual requirements which is the hallmark of Mr Jonathan Webb’s approach.