Our Summary

This study examines knee replacement surgery options for patients with a specific type of knee arthritis. One option is to replace the entire knee joint, but another is to replace only part of it (unicondylar knee replacement). However, this second option only works if certain conditions are met, such as having healthy ligaments and cartilage in the knee, and being able to bend the knee more than 100 degrees during surgery.

There are also several conditions that would prevent this type of surgery like certain deformities, previous failed surgeries, rheumatoid arthritis, and certain cartilage defects. If these conditions are present, it could lead to disease progression and complications.

Despite these restrictions, when the surgery is performed on eligible patients, it has been shown to have excellent long-term results. However, the researchers caution against expanding these criteria without careful evaluation of the risks and benefits. They also note that patients should be informed of the lack of long-term data and the possibility of higher complication risks.

Interestingly, the researchers found that factors such as a patient’s age, activity level, weight, and specific types of knee pain don’t affect the outcome or longevity of a certain type of knee replacement (mobile-bearing prosthesis). The criteria used to select patients for this surgery, originally set by Kozinn and Scott, were found to be irrelevant for this type of procedure.

FAQs

  1. What are the two types of knee replacement surgery options discussed in the study?
  2. What conditions must be met for a patient to be eligible for a unicondylar knee replacement?
  3. Do factors like age, activity level, weight, and specific types of knee pain affect the outcome or longevity of a mobile-bearing prosthesis knee replacement?

Doctor’s Tip

In addition to the specific criteria mentioned above, a doctor might also advise a patient considering knee replacement surgery to maintain a healthy weight, engage in physical therapy both before and after surgery, and follow a prescribed exercise regimen to strengthen the muscles surrounding the knee joint. It’s also important to follow post-operative instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding high-impact activities that could put stress on the new joint. By taking these steps, patients can help ensure a successful outcome and improve their overall quality of life.

Suitable For

Typically, patients who are recommended for knee replacement surgery are those who have severe knee arthritis that is causing significant pain, stiffness, and limited mobility. They have tried nonsurgical treatments such as medications, physical therapy, and injections without success. Patients with osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis are common candidates for knee replacement surgery.

In addition, patients who have exhausted conservative treatment options and are experiencing a decrease in quality of life due to their knee pain are also recommended for knee replacement surgery. It is important for patients to be in good overall health and have realistic expectations about the outcomes of the surgery.

Overall, the decision to undergo knee replacement surgery is individualized and should be made in consultation with a healthcare provider based on the patient’s specific condition, symptoms, and goals.

Timeline

Before knee replacement surgery:

  1. Patient experiences chronic knee pain, stiffness, and swelling.
  2. Patient undergoes various tests and evaluations to determine eligibility for surgery, including X-rays, MRIs, and physical examinations.
  3. Patient may try conservative treatments such as physical therapy, medication, injections, and lifestyle modifications.

After knee replacement surgery:

  1. Patient undergoes pre-operative education and preparation for surgery, including discussions with the surgical team, physical therapy, and pain management.
  2. Patient undergoes knee replacement surgery, which involves removing damaged cartilage and bone and replacing it with artificial implants.
  3. Patient begins post-operative rehabilitation, including physical therapy to regain strength, range of motion, and function in the knee.
  4. Patient may experience temporary pain, swelling, and stiffness after surgery, but these symptoms gradually improve over time.
  5. Patient gradually resumes normal activities and experiences improved knee function and reduced pain in the long-term.

What to Ask Your Doctor

Some questions a patient should ask their doctor about knee replacement surgery include:

  1. Am I a candidate for a unicondylar knee replacement or would a full knee replacement be more appropriate for me?
  2. What criteria do I need to meet in order to be eligible for a unicondylar knee replacement?
  3. What are the potential risks and complications associated with both types of knee replacement surgery?
  4. What is the long-term success rate of unicondylar knee replacement compared to full knee replacement?
  5. How will my age, activity level, weight, and specific knee pain affect the outcome of the surgery?
  6. Are there any specific conditions or factors that would make me ineligible for a unicondylar knee replacement?
  7. What is the recovery process like for both types of knee replacement surgery?
  8. What type of post-operative care and rehabilitation will I need to undergo?
  9. Are there any alternative treatments or therapies that I should consider before opting for knee replacement surgery?
  10. What is the experience and success rate of the surgical team in performing both types of knee replacement surgeries?

Reference

Authors: Walker T, Streit MR, Streit J, Gotterbarm T, Aldinger PR. Journal: Z Orthop Unfall. 2015 Oct;153(5):516-25. doi: 10.1055/s-0035-1546237. Epub 2015 Jul 13. PMID: 26167771