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Patients with arthritis of the knee that cannot be controlled using medication can undergo different types of knee replacement surgery. This article outlines the four major types of knee replacement surgery that arthritis patients can undergo.

Patients with arthritis suffer from joint stiffness, pain, and inflammation. Individual patients with arthritis experience the disease in different joints of the body, but the joints of the knee are often affected. Fortunately, while there is no cure for arthritis, there are several different treatment methods that can help reduce symptoms and improve quality of life. One of the treatment methods for arthritis of the knee is undergoing a knee replacement surgery.

Knee replacement surgeries can be divided into four main types. You should consult with your surgeon to the pick the best surgical treatment for you. These are the different types of surgeries:

1. Total knee replacement

For a total knee replacement, surgeons replace the joint surface at the end of the thighbone as well as the joint surface on the top of the shin bone. Sometimes, the surgery can also involve replacing the under-surface of the kneecap with a dome that is made of plastic. However, most surgeons tend to prefer keeping the natural kneecap if it is possible. Generally, the new components of the knee are put in place using cement. However, some surgeons can use other methods of fixing the new knee such as coating the part that is facing the bone with a compound that will encourage the bone to adhere to it and form a natural bond. One of the other ways to put the knee in place is to use a mobile plastic bearing that isn’t completely fixed to the metal parts.

2. Unicompartmental (partial) knee replacement

For patients whose arthritis only affects one side of the knee (usually the side that faces inwards), patients can undergo what is known as a partial or a half-knee replacement. This is beneficial as it involves less interference with the functioning of the knee compared to a total replacement. It also means that you recover faster and have a better knee joint function. Compared to a total knee replacement, a partial knee replacement involves making a smaller cut. This is generally done using a technique known as reduced invasive or minimally invasive surgery. It is postulated that smaller incisions reduce the recovery time post-surgery.

There are some disadvantages to a unicompartmental knee replacement. First of all, a unicompartmental knee replacement is not for all patients as it requires having strong, healthy ligaments within your knee. Unfortunately, this is not often known until you actually undergo surgery and the surgeons can have a better look. Furthermore, studies have shown that patients who undergo partial knee replacements are actually more likely to have to have their knee replacement revised (meaning a repeat surgery) compared to patients who go ahead with a total knee replacement. The rate for patients who have to undergo a revision after a partial knee replacement is as high as one in 10 people a decade post-surgery. Thus, even though it may seem like a better option initially as it is followed by a quicker recovery period, your surgeon may still opt to have the total knee replacement.

Surgeons can do a partial knee replacement in patients of any age. It can be beneficial for young people as it allows the perseveration of more bone compared to a total knee replacement, especially if you need to a revision surgery later. However, it can also be beneficial for older people as the partial knee replacement is less stressful and is associated with reduced bleeding and pain.

3. Kneecap Replacement (patellofemoral arthroplasty)

A kneecap replacement surgery or patellofemoral arthroplasty (also known as patellofemoral joint arthroplasty) involves the replacement of the surface beneath the kneecap and its groove as long as these are only the regions that are affected by the arthritis.

Unfortunately, while this procedure is simpler, it actually has a higher rate of failure compared to a total knee replacement. This is because arthritis can actually progress to involve other regions of the knee besides the kneecap. Hence, some surgeons may choose to conduct a total knee replacement. However, others believe that it is better to preserve as much as of the knee joint as possible.

Kneecap replacement surgery can only take place in a very specific subpopulation of patients with arthritis. In fact, only about one in 40 people who are diagnosed with osteoarthritis are actually eligible for this surgery.

Talk to your surgeon about the potential benefits of undergoing a kneecap replacement versus a total knee replacement if only your kneecap is affected.

4. Complex or revision knee revision

This type of surgery, known as a complex knee replacement, is conducted if you need to have a second or third joint replacement in the same knee. This can also be conducted in patients whose arthritis is quite severe.

When it comes to having a second or third knee replacement, patients who undergo this surgery tend to be more complex cases. For example, patients experience major bone loss due to arthritis or fracture, have a major knee deformity, or have weakness in the ligaments of the knee.

When conducting a knee replacement, surgeons will generally use components that have a longer stem that allows the components to be more properly or securely fixed into the bone. Surgeons may also make use of extra metal or plastic to replace any bone that has been damaged or removed.

  • Bachmeier, Clarissa JM, et al. "A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery." Osteoarthritis and cartilage 9.2 (2001): 137-146.
  • Keefe, Francis J., et al. "Analyzing pain in rheumatoid arthritis patients. Pain coping strategies in patients who have had knee replacement surgery." Pain 46.2 (1991): 153-160.
  • Bongartz, Tim, et al. "Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis." Arthritis Care & Research 59.12 (2008): 1713-1720.
  • Photo courtesy of SteadyHealth

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