Unicondylar Knee Replacement – Dr. Dhariwal QaedjoharDr. Dhariwal Qaedjohar
Total knee replacement is an excellent surgery. It has evolved over the decades to become one of the most successful procedures in all of medicine. Patients are cured of pain and disability. They regain their ability to walk normally, without a limp or support. They can resume living normal lives again. Without surgery, they are stuck in a rut of suffering and handicap with lifelong dependency on kidney destroying medicines.
However, total knee replacement comes with a bag of its own problems. It is not without reason that patients fear the surgery. The foremost fear is that surgery is a major surgical adventure.
Major surgery means more risk! The risk of an adverse event in the peri-operative period is always lurking round the corner.
Major surgery means more pain! Post operative pain is dreaded! Only recently have we truly succeeded in pain control with the use of ultrasound and nerve locator guided nerve blocks and LIA (local infiltration analgesia).
Major surgery means more weakness! Patients routinely require a walker to walk for a week or two after surgery.
Major surgery means a longer recovery! Patients take up to 3 months to return to normalcy and actually start experiencing the benefits of the surgery.
What is a half knee (or partial knee) replacement? The knee is made of 3 different compartments. Two compartments are between the thigh and leg bone and the third compartment is between the knee cap and the thigh bone. In total knee replacement, we replace all three compartments and sacrifice two ligaments (out of 4) and both menisci (natural shock absorbers found in the knee). However, arthritis does not damage all compartments equally. Most of the times, it is only the medial or inner compartment that suffers the brunt of the destruction. In partial knee replacement, only this compartment is replaced with the sacrifice of a single meniscus. Two compartments, all 4 ligaments, and one meniscus are preserved. Many studies have shown this procedure to be as effective in relieving pain as total knee replacement. The survival of partial knee prosthesis is also as good as total knee prosthesis.
By doing this selective procedure we gain many advantages. This surgery is done by a minimally invasive technique. It involves less cutting of skin, muscle, tissue, and bone. Most of the knee is left untouched as it is healthy. Hence this is not major surgery.
Risk of an adverse event is less!
Pain is very less! Lesser volume of trauma coupled with modern pain management makes post op pain negligible.
Less muscle cutting means minimal weakness! Patients can stand and walk without a walker on the same day, a few hours after surgery. All this translates into a faster recovery. No longer do patients have to wait for 3 months to get back to normal.
Partial knee replacement or unicondylar knee replacement is a natural evolution of a total knee replacement. It retains all the effectiveness of a total knee and brings with it significant advantages! I have pointed out the advantage of less risk and quicker pain-free recovery in this article…..but it doesn’t stop here! Stay tuned for the next article.
As we have seen in the previous article, unicondylar knee replacement is a natural evolution of total knee replacement. It has advantages. It is done using a minimally invasive technique. There is less cutting of skin and tissue. Muscles are not cut. This results in a faster recovery and little postoperative pain and swelling. The amount of bone removal and blood loss is less. The surgery is safer than traditional knee replacement.
The incision for the unicondylar knee is half the length of a total knee replacement. The surgery is done using special instruments designed for minimally invasive surgery (MIS). The quadriceps (thigh muscle) is spared. The muscle strength remains intact after surgery. Patients can walk comfortably without a walker. As against this, the quadriceps is cut in total knee replacement, which results in weakness post-surgery. After traditional knee replacement, all patients need a walker to help them walk surgery for as long as 3-4 weeks.
Safety has been a long standing concern of total knee replacement, especially because the surgery is performed in elderly patients. The cutting of muscle, removal of bone and blood loss puts a stress on the body. This stress becomes significant in those who have preexisting compromises like a weak heart, lung or kidney. Surgeons are worried for infection with diabetic patients. With Unicondylar surgery, the stress is reduced. More patients are now eligible for knee replacement with much less risk!
To be able to sit on the floor is important for our religious customs and traditions. This vital function was snatched away from patients after traditional knee replacement! It is the primary reason for dissatisfaction. Do we finally have an answer?
Ligaments play an important role in knee function. They give the knee stability and allow people to do high demand activities like running, squatting and sitting on the floor. In a traditional knee replacement, the ligaments (anterior cruciate ligament & posterior cruciate ligament) are cut. This I strongly believe is a loss. It is the absence of ligaments after traditional knee replacement, which does not allow patients to squat in an Indian toilet comfortably or sit on the floor. In unicondylar knee replacement, both ligaments are preserved (ACL and PCL). Preserving the ligaments has advantages. After surgery, the knee feels like the natural knee. It remains stable and strong. Unicondylar surgery gives the patient the confidence to perform all daily activities in a normal fashion just like they used to when they were younger! It is a cure in the true sense. After this surgery, patients are allowed to sit on the floor, sit cross legged and even squat in an Indian toilet!
So can all arthritis patients benefit from this surgery? Ligaments are not only preserved in this surgery, they are also crucial for the success of this surgery. Unfortunately, in the arthritis process, sometimes ligaments are also damaged along with the cartilage. In patients with damaged ligaments, Unicondylar surgery does not work. For them, traditional knee replacement remains the only way out. Your doctor will be the best judge to decide if you can benefit from Unicondylar surgery. Knee Replacement is a revolutionary surgery. It gives patients a miraculous cure from severe knee pain and deformity. Patients achieve a lasting and complete relief from pain. It is a boon for patients handicapped by knee arthritis. It is one of the most successful surgeries in all of medicine.
In an effort to continuously improve, science makes breakthroughs all the time. The knee is made of 3 compartments. Arthritis damages these compartments but often not uniformly. When we as surgeons are doing a total knee replacement, we often find that one compartment is badly damaged whereas the other compartments are well preserved. In total knee replacement, we replace all the compartments irrespective of the damage. The knee also has two important ligaments called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These ligaments are removed in a total knee replacement. Replacing all compartments leads to much bone loss and bleeding. In order to do a good knee replacement, we need to take a big incision (cut) in the skin and the muscle. Big cuts result in more pain and slower recovery. Patients need supervised physiotherapy to regain knee function. After total knee replacement patients can walk freely and comfortably, however, the absence of ligaments doesn’t allow them to sit on the floor or squat easily.
Scientific research has led to the evolution of Unicondylar Knee Replacement (UKA) to solve these issues. The principle of UKA is to replace only the damaged compartment. Only one of the three knee compartments is replaced. There is a minimum cutting of bone and less blood loss. Patients feel much less pain and recover quickly. No painful physiotherapy is required after surgery. My UKA patients are walking comfortably just a few hours after surgery. They hardly feel postoperative pain. The surgery is done through a small cut in the skin using special instruments with a minimally invasive technique. Both ACL and PCL are preserved. After UKA patients are able to easily squat in a toilet and sit on the floor. UKA feels like a natural knee. The long term results of UKA are comparable to total knee replacement. UKA is just as durable and will give a patient many years of pain-free knees.
Not all patients are eligible for UKA. It cannot be done in very advanced arthritis where all compartments are damaged. It also cannot be done in patients who have damaged ACL or PCL ligaments. Even so a large number of arthritis patients can benefit from this modern surgery. Your doctor is the best judge of whether you are eligible for UKA.
UKA is a bone, muscle, and ligament preserving surgery done through a minimally invasive technique with advantages of fast recovery, less pain and better function. It is a spectacular gift of modern scientific research.