Ask Dr. Breien: Is A Partial Knee Replacement A Good Option For Me?
Dr. Breien describes the patients who benefit most from a partial knee replacement.
When knee arthritis causes pain and limits your daily activities, you may want to consider surgical treatment. There are several surgical approaches you can consider, ranging from arthroscopic repairs and partial knee replacement to total joint replacement. Which option is best for you? We asked knee and arthritis specialist Dr. Kristoffer Breien to explain when a partial knee replacement is the right solution for knee arthritis.
Patient age is a factor when considering partial knee replacement
“Research clearly tells us that knee replacement is a safe and effective surgery,” says Dr. Breien. “But knee implants don’t last forever.” The life of an implant varies with the stress placed on it. When a 60- to 70-year-old patient has a total knee replacement, it will probably never have to be replaced. But when arthritis strikes early, the prognosis changes significantly.
“Weight and activity significantly affect implant longevity,” observes Dr. Breien. “A 30-year-old usually lives a much more active life than a patient over 60 years of age. That’s why a total knee replacement in a 30-year-old might only last 15 years. When the implant wears out, replacing a total knee with another total knee is a major redo. And the outcome for the second total knee replacement is never going to be as successful as the first one. That now-50-year-old still has a lot of life to live. How do we keep that knee functioning in the second half of this patient’s life?”
Partial knee replacements are part of a long-term care strategy
For these reasons, Dr. Breien takes a very strategic long-term approach to treating younger patients with advanced arthritis. “A total knee is not an ideal solution for a young patient,” he explains. “If only a portion of the joint is damaged by arthritis, a partial knee replacement can be an excellent option.”
Arthritis can affect three distinct areas of the knee joint
The knee is one joint with three different components that rub against each other.
- “Your kneecap rides in a groove of bone at the end of the thigh bone,” says Dr. Breien. “When it rubs on the end of your thigh bone, it can cause that portion of the joint to become arthritic.”
- Medial condyle. “The end of your thigh bone has two projecting nubbins, just like any bone on any cartoon,” Dr. Breien describes. “You have one nubbin called the medial condyle on the inside part of your knee. That inside knee joint component can wear out.”
- Lateral condyle. The other nubbin is called the lateral condyle. It is located on the outside part of your knee, and is also subject to wear and arthritic damage.
“When a patient has knee pain, we evaluate the entire knee,” says Dr. Breien. “If only one component of the joint is arthritic, we can do a partial knee replacement. I don’t need to cut out and replace the entire joint. I can replace only the damaged portion of the joint and leave the rest of the healthy knee untouched.”
Advantages of a partial knee replacement
“The nice part about a partial knee procedure is that your knee will feel more normal following surgery,” says Dr. Breien. “With a partial knee replacement of a kneecap, for example, we leave the ACL and the PCL ligaments intact. Those ligaments send tension and flexion messages to the brain. After surgery, those ligaments in the knee are still speaking to the brain. Postsurgical patients report that their knee feels the same, minus the pain.”
Total knee replacements, on the other hand, take some getting used to. “After a total knee, the implant doesn’t talk to your brain as your old knee used to,” observes Dr. Breien. “And the younger you are, the less you’ll probably love how a total knee replacement feels. My 70- and 80-year-old total knee replacement patients are just thrilled to walk without pain. The satisfaction of patients in the 60-year-old category will depend on individual activity levels. An active 50-year-old will be happy that their knee doesn’t hurt anymore, but it’s a challenge to become accustomed to the way the implant feels. The younger you are, the more difficult it is to adapt to the sensation of a total knee replacement.”
Disadvantages of partial knee replacements
“Historically, a partial knee replacement doesn’t last quite as long as a total,” Dr. Breien points out. “Certain partials are still functioning at about 85 percent at the 20-year mark. In most cases, when they fail, it’s not because the implant comes loose. It’s because the rest of the knee has deteriorated during the intervening years. At that point, we convert from a partial knee replacement to a total knee. That’s a much more straightforward transition compared to converting a failed total knee replacement into another total knee replacement.”
Younger patients benefit from partial knee replacements
“Younger patients with arthritic knees are the best candidates for a partial knee replacement,” states Dr. Breien. “We generally use a partial knee replacement to preserve knee function for patients between the ages of 30 and 60. Then we can convert to a total knee replacement. With this care strategy, patients can look forward to continued function for the remainder of their lives.”
When to seek treatment for your arthritis
Arthritis doesn’t have to spell the end of an active life. If you are experiencing worrisome symptoms or persistent pain, the renowned arthritis specialists at Summit Orthopedics can help. We work with you to confirm a diagnosis and develop an appropriate conservative treatment plan. If nonsurgical treatments fail to support your lifestyle goals, fellowship-trained orthopedic surgeons will consult with you and discuss appropriate surgical options. Summit is home to innovative joint replacement options. Our Vadnais Heights Surgery Center is one of only two surgery centers nationally to receive The Joint Commission’s Advanced Certification for Total Hip and Total Knee Replacement.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.
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