Ortho Dx: How does partial and total knee replacement compare? - Clinical Advisor

Ortho Dx: How does partial and total knee replacement compare?

Slideshow

  • Anteroposterior radiograph showing medial compartment arthritis of the right knee in a 53-year-old woman with right knee pain.

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    Anteroposterior radiograph showing medial compartment arthritis of the right knee in a 53-year-old woman with right knee pain.

  • Lateral radiograph of the patient’s right knee.

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    Lateral radiograph of the patient’s right knee.

  • Sunrise radiograph of the patient’s right knee.

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    Sunrise radiograph of the patient’s right knee.

A 53-year-old woman presents with a several-month history of right knee pain. She underwent anterior cruciate ligament reconstruction with medial meniscectomy 15 years earlier. Conservative treatment, including nonsteroidal anti-inflammatory drugs, intra-articular steroid injections, and viscosupplement injections, over the last several months has failed to relieve the pain. Anteroposterior, lateral, and sunrise radiographs show medial compartment arthritis of the right knee. Magnetic resonance imaging of the knee also shows isolated medial compartment arthritis. The articular cartilage of the patellofemoral joint and lateral compartment remains intact. The lateral meniscus is also intact. The patient has been told she is a candidate for partial knee replacement and would like additional information on the procedure. 

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

The knee is divided into 3 compartments: the lateral, medial, and patellofemoral compartments. In a partial or unicompartmental knee replacement, only 1 compartment of the knee surface is replaced. In total knee arthroplasty, all 3 compartments of the knee are...

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The knee is divided into 3 compartments: the lateral, medial, and patellofemoral compartments. In a partial or unicompartmental knee replacement, only 1 compartment of the knee surface is replaced. In total knee arthroplasty, all 3 compartments of the knee are replaced.

Unicompartmental knee replacement is most commonly performed in the medial compartment. Unicompartmental knee replacement is performed infrequently, accounting for 5% of surgeries in which knee arthroplasty is indicated. Unicompartmental knee replacement has advantages over traditional total knee replacement, including faster recovery, less morbidity, and improved preservation of normal knee kinetics.

 

The 10-year survival rate for unicompartmental knee replacement is 1% to 4%, which compares favorably with reported results for total knee replacement. However, survival of the unicompartmental knee replacement implant diminishes after 10 years, and long-term revision rates are higher than for total knee replacement.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Hatch D. Unicompartmental Knee Replacement. Orthobullets website. http://www.orthobullets.com/recon/5020/unicompartmental-knee-replacement. Updated March 12, 2016. Accessed June 27, 2016.
  2. Berger RA, Meneghini M, Jacobs JJ, et al. Results of unicompartmental knee arthroplasty at a minimum of ten years of follow-up. J Bone Joint Surg. 2005;87(5):999-1006.
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