Who are candidates for a knee replacement
Hello. I'm Bill Bryan, orthopedic surgeon.We're often asked, quot;Who are candidates for partial knee replacementé Full knee replacementéquot;Or even the less common, Patellofemoral kneecap replacementé This all depends on which partof the knee is worn out. If the inside part is worn out, the medial side of the knee isworn out, and more than likely you'll notice you'll be bow legged. If the xrays and sometimesaided by MRI information, it will be possible and desirable to perform a partial knee replacement.The advantages of a partial knee replacement are that it's less invasive and often thisis a same day surgery with the patients being discharged home that afternoon.
There is less tissue dissection, the discomfortis less and the recovery is more rapid when compared with a total knee replacement. Forpartial knee replacements to work, the remainder of the knee has to be intact. That is thespace between the kneecap and the femur, the patellofemoral joint, and the lateral compartment,the outside compartment. Many patients, however, come to us in the advanced stage of arthritiswhere all three compartments are worn out. You may say, quot;What do you mean about compartmentsbecause the knee is one spaceéquot; But it truly is, but as physicians and surgeons, we breakit down in our minds to look at the space between the kneecap and the femur, the insidecompartment, the medial compartment, and the
outside compartment, the socalled lateralcompartment. And if the xrays and or the MRI scan showthat two out of three of these compartments are badly damaged, a total knee replacementis the best option. A total knee replacement has great advantages and some disadvantages.Because it provides a smooth bearing surface between the metal and the plastic, the nerveendings are not stimulated and pain relief in walking is pretty much relieved. This isthe primary goal of total knee replacement. To return you to your basic activities ofdaily living, walking and doing the things that you enjoy the most.
Total knee replacements have not yet beenperfected to where they will allow vigorous activity. For example, we feel that such activitiesas Lacrosse or football, or basketball are really not desirable with total knee replacements.The reason are several fold. A very active patient will be putting stress on the softtissues around the knee, and we found that patients with total knee replacements whoattempt to return to some of those youthful sports have a great deal in discomfort. Secondly,the materials do have potential for wear. Now don't get me wrong, the materials theyprovide us are very sturdy but, with normal use, should last decades.
However, if you attempt to run or play basketballor football, the wear of the plastic component in the total knee replacement is at risk.For many patients, the primary problem with their knee is advanced wear of the patellofemoralarea. This is the area behind the kneecap and either the cartilage on the back of thekneecap or the area of the femur where it rides, the socalled trochlea, shows significantwear. Those patients have a great deal of pain in simple things like getting up outof the chair or climbing stairs. And yet, the rest of their knee joint is intact bothon al exams, xrays or MRI scan. Scientists have provided us with a joint replacementto address just the patellofemoral problem.
This surgery is often done in day surgerywith discharge that afternoon or the next morning. It is less painful than a full kneereplacement. And if the remainder of the joint is intact, it may be your option.
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