Knee Resurfacing, aka Partial Knee Replacement, vs. Total Knee Replacement

Orthopaedic & Spine Center
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by Boyd W. Haynes III, MD

As an Orthopaedic Surgeon, I am often asked to compare and contrast the pros and cons of one surgical procedure over another and to make recommendations for patients regarding which treatment option would be the most appropriate for their certain condition.  This regularly happens when patients with knee pain caused by arthritis are considering what to do when all conservative treatments, such as Physical Therapy, steroids (both oral and injectable), and visco-supplementation have reached their therapeutic limits.  In this article, I will discuss both surgical procedures and highlight the benefits and drawbacks of each.  I will also review which patients are and are not appropriate candidates for each procedure.

Knee Resurfacing or Partial Knee Replacement

The knee joint is made up of three compartments, the kneecap (patella) and the inner (medial) and outer (lateral) side of the joint.  Any or all of these areas can be damaged by arthritis or injury.  However, if only one or two areas are damaged, doesn’t it make sense to only resurface or replace the damaged areas, leaving the rest of the knee intact and in its natural state?  This is the rationale behind partial knee replacement.

Benefits:

  • Outpatient surgery, except in rare cases
  • Smaller incision, less surgical trauma and blood and bone loss
  • Much less recovery time
  • Post-surgical rehab rarely needed
  • Less pain during recovery
  • All knee ligaments and tendons remain after surgery
  • More natural feeling knee and movement after surgery

Disadvantages:

  • Patient may require more surgery later if other knee compartments develop arthritis

Who is a good candidate for this procedure?

  • Persons under 50
  • Active persons under 50 who want to remain active
  • Older patients who only have arthritis in one or two areas
  • Patients who have pain in one or two specific areas

Who is not a good candidate?

  • Those with inflammatory disease, such as rheumatoid or psoriatic arthritis
  • Those with instability of the knee

How do I find out if I qualify for this surgery?

  • Make an appointment with one of the OSC Orthopaedic Surgeons who specializes in knee replacements
  • Review medical history, prior treatments and knee x-rays and MRIs

Total Knee Replacement

Millions of people get a total knee replacement every year, in the United States alone.  When the pain and dysfunction of knee arthritis becomes intolerable and other treatments have no efficacy, knee replacement is the treatment of choice.  In total knee replacement, all 3 compartments of the knee are replaced with a metal alloy and polyethylene implant system, which closely replicates the natural anatomy and movement of the knee joint.

Benefits:

  • Predictable pain relief
  • Replaces all compartments of the knee at one time with one surgery
  • Can be done as Outpatient surgery if patient qualifies
  • Implants can last for 20 years or more

Disadvantages:

  • Inpatient surgery (in most cases) requiring at least one overnight stay in the hospital
  • Larger incision, more surgical trauma and blood and bone loss
  • Longer recovery time
  • Post-surgical rehab (Physical therapy) needed
  • More pain during recovery
  • Most knee ligaments and tendons are removed during surgery
  • Less natural- feeling knee

Who is a good candidate for this procedure?

  • Older, less active patients
  • Older patients who have arthritis throughout the knee
  • Patients who have pain all over the knee
  • Those with inflammatory disease, such as rheumatoid or psoriatic arthritis
  • Those with instability of the knee

Who is not a good candidate?

  • Patients in poor health with co-morbidities, i.e., heart disease, diabetes for whom having surgery would present a significant risk
  • Patients who are morbidly obese
  • Patients who are not motivated to complete the rehabilitation required after srugery

How do I find out if I qualify for this surgery?

  • Make an appointment with one of the OSC Orthopaedic Surgeons who specializes in knee replacements
  • Review medical history, prior treatments and knee x-rays and MRI