Weighing Up Partial vs Total Knee Replacement
If your knee arthritis is affecting how you go about everyday activities such as walking, stairs, sleep and work, or it’s impacting your lifestyle and ability to travel, the first step your doctor will likely take is to arrange imaging.
Pending these, you may be referred for specialist assessment, treatment and management, which could include a partial or total knee replacement.
If your GP is arranging X-rays, or you have already been told your knee arthritis has progressed, ask about a referral to Dr David Kitchen, Adelaide-based Orthopaedic Specialist. Dr Kitchen provides expert assessment and surgical experience to match your symptoms, scans, knee structure and activity goals with the treatment option that fits your knee.
About partial knee replacement
Partial knee replacement procedure:
A partial knee replacement resurfaces only the affected part of the knee, suitable only when damage is isolated to one part of the joint.
A total knee replacement resurfaces the damaged joint surfaces across the knee when arthritis affects more than one area or where it has spread across the knee.
The right choice is not based on which operation sounds smaller. It comes down to where the arthritis is, how the knee moves, the condition of the ligaments, your alignment, your symptoms and what you need your knee to do day to day.
Who may be suitable for partial knee replacement?
Partial knee replacement is for a selected group of patients, considered when:
- Arthritis is confined to one compartment of the knee
- The cruciate ligaments are intact
- Knee movement is reasonably well preserved
- The knee condition is not severe
- Symptoms match the localised area of damage seen on imaging
For suitable patients, partial knee replacement offers can offers a smaller incision, less bone removal, lower blood loss, a quicker early recovery and a more natural feel to the knee because more of the original joint structure is preserved.
What are the trade-offs with partial knee replacement?
The main trade-off for partial knee surgery is revision risk.
Partial knee replacement has a higher revision rate than total knee replacement over the long-term, usually because arthritis may progress into the previously preserved parts of the knee.
It does not mean partial knee replacement is a poor option, but that patient selection matters, as a partial knee replacement in the wrong knee is likely to underperform.
This is why imaging, examination and symptoms need to line up before the decision is made.
About total knee replacement
Total knee replacement procedure:
Total knee replacement is used when arthritis affects more than one compartment of the knee, or when the joint damage is too advanced for partial replacement.
The worn cartilage and bone surfaces of the femur, tibia and usually the back of the kneecap are replaced with prosthetic parts. This recreated a smoother functioning joint surface to help reduce the pain caused by bone-on-bone arthritis.
Who may be suitable for total knee replacement?
Total knee replacement is suitable for a broader range of patients than partial knee replacement, and may be recommended when:
- Arthritis affects more than one compartment
- The knee has significant bow-legged or knock-kneed alignment
- The cruciate ligaments are damaged or unreliable
- The kneecap joint is significantly worn
- A previous partial knee replacement has failed
- The arthritis pattern makes partial replacement unsuitable
Total knee replacement is a more reliable choice when the arthritis is not confined to one part of the knee.
What are the trade-offs with total knee replacement?
The main trade-off for total knee replacement is a longer recovery and the procedure involves resurfacing more of the joint.
Recovery can take longer than partial knee replacement, simply because more bone and joint surface has been treated. The knee may also feel less natural for some patients as more of the original joint structure is replaced.
When suitable, total knee replacement can be the more reliable choice. The decision is not about choosing the smaller operation. It is about choosing the operation that matches the arthritis pattern, ligament function, alignment and symptoms.
Can I choose which surgery?
You can ask about both, the conversation is open, but suitability is based on your knee.
Sometimes patients ask if they can choose a partial knee replacement because it sounds smaller… Wanting a smaller operation is understandable, especially if you are worried about recovery, time off work, getting around the house or needing help at home. But partial knee replacement only works well when the arthritis pattern and knee structure are right for it.
If the wrong procedure is chosen, the knee may remain painful, wear may progress elsewhere or revision surgery may be needed sooner.
Dr Kitchen will review your imaging, examine your knee and talk through what your symptoms are stopping you from doing before recommending partial, total, robotic-assisted or patient-specific knee replacement.
What is robotic-assisted or patient-specific knee replacement?
Robotic-assisted surgery and patient-specific planning are tools used to support surgical planning and implant positioning.
In partial knee replacement, Dr Kitchen uses robotic-assisted Mako technology. This system creates a 3D map of the knee before surgery and provides real-time guidance during the operation.
Patient-specific knee replacement uses detailed 3D planning and custom guides designed around your knee anatomy. It is used more in total knee replacement, and useful when the knee structure is more complex or a more individualised plan is needed.
These technologies do not make the decision for you. The decision still comes back to your knee arthritis pattern, anatomy, movement, ligament function, health and goals.
What to expect at your knee replacement consultation
A consultation is not a commitment to surgery. In your first appointment, Dr Kitchen will review imaging, reports and discuss details with you to understand what is happening inside your knee. Assessment includes:
- Where your pain is felt
- How symptoms affect walking, stairs, sleep, work and activity
- Review of your X-rays, imaging, reports and medical history
- Examine your knee for movement, alignment and stability
- Discuss the pattern of arthritis in the knee
- Talk through all appropriate treatment options
If surgery is suitable, he will explain which type of knee replacement fits your knee and what it may involve, including risks, recovery and expectations.
When should you ask your GP for referral?
If knee arthritis is affecting walking, stairs, work, sleep, sport, travel or independence, and non-surgical treatment is no longer giving enough relief, speak with your GP about specialist referral.
In Adelaide, you can ask for a referral to Dr David Kitchen, Orthopaedic Specialist. Dr Kitchen consults privately at sportsmed Stepney, Henley Beach and The Specialist Clinic Port Pirie.
*This article is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment, and does not establish a doctor-patient relationship. All surgical procedures carry risks and results vary between individuals. Consult with Dr David Kitchen MBBS MA (Cantab) BA Hons PhD FRACS FAOrthA (MED0001951664), Orthopaedic Specialist, for a personalised treatment plan.