Do You Need a Total Knee or Just a Partial?

Do You Need a Total Knee or Just a Partial?
Dr. Barry S. Kraushaar Sports Medicine Specialist Nanuet, NY

Dr. Barry Kraushaar is an Orthopedic Sports Medicine and Total Joint Replacement Surgeon in Nanuet, NY. As a Sports Medicine Surgeon, Dr. Kraushaar is trained to assess, diagnose, prevent, and treat sports injuries in patients of all ages. He is the Team Doctor and Director of Sports Medicine at the Dominican College in... more

As an orthopedic surgeon with a practice that combines sports medicine with joint replacement, I often find it valuable to offer patients a broad set of choices to treat the same pattern of injury in different people. The common goal is to keep people as active and in as little pain as possible, but the way to achieve these goals needs to be individualized.

In general, there are three categories of treatment for most people. (credit, Robert Nirschl, MD)

  1. You can live with the problem, making adjustments in your lifestyle to accommodate the knee pain.
  2. Treat non-operatively such as with pills, injections, therapy and a brace.
  3. Surgery - this can include arthroscopic procedures, partial joint replacement or total joint replacement. Total Joint replacement is not for everybody, and the surgeon advising you needs to help you find out where you fit in the spectrum of care.

Non-surgical care should be explored thoroughly before any operation is decided. Sometimes it is obvious that surgery is the best choice, but the thought process needs to cover the choices. Therapy is often more than just a checklist item. Therapy addresses things that surgery does not, such as tight tendon contractors, muscle atrophy and imbalances, and coordination issues. Many people have lost these elements of function and need them restored.

Surgically, arthroscopy through two small incisions is the least invasive. It is a procedure that involves introducing a fiber-optic camera in the knee and cleaning or trimming torn and rough edges. Sometimes repairs of ligament and cartilage can be accomplished this way. Bone and cartilage grafting can sometimes be performed with this form of microsurgery. Unfortunately there are many cases when this cannot really help a badly worn knee. When a cleanup will not do, it may be time to replace. 

Total knee replacements are performed on patients who have bone-on bone arthritis and fail non-surgical treatment attempts.Up to 700,000 of these procedures are done in the USA annually. Not everyone in this group needs a total knee.

If you have arthritis only on the inner part of the knee, a partial replacement may be for you. Ideally, you should not have arthritis behind the kneecap or on the outer part of the knee, but some exceptions can be made. The ligaments, including the ACL should not be torn if this is to be successful. It is okay for the meniscus cartilage to be torn in the location you are having replaced, but not the other side of the knee if you want a partial.

Partial or "UNI" / Uni-compartmental knees tend to feel more natural than total knee replacements.  They can someday be converted to a total knee but until then are considered the more bone-conserving procedures. The incision is smaller, and the recovery faster. Many patients go home the same day.

Of course the usual risks of joint surgery apply, but the benefits of partial knee replacement done in the right patient are amazing and the trend nationally is that more are being done than ever before. Some surgeons even use robotic surgery to optimize this type of joint replacement.