What are the different types of knee replacement surgery?
There are several different surgical methods and knee joints available in India. The orthopedic surgeon should help patients to choose the best option for the knee surgery. The four main types of knee replacement surgery are following:
Total knee replacement
Total knee replacement surgery may involve following procedures:
Replacing the joint surfaces at the end of patient’s femur (thigh bone)
Replacing the joint surfaces at the top of patient’s tibia (shin bone)
Replacing the under-surface of patient’s patella (kneecap) with a smooth plastic dome
Surgeons prefer to preserve the natural patella if possible. but sometimes they make a decision during the operation. If the patient had a patellectomy earlier to remove patella, this won’t stop him or her having a total knee replacement surgery, but it may affect the type of prosthesis the surgeon uses.
Either new parts are cemented or the surface of the component facing the bone is coated to encourage bone to grow into it. It forms a natural bond. Using a mobile plastic bearing is another technique. It isn’t firmly fixed to the metal parts. This may help to reduce wear on patient’s new joint. But it doesn’t provide better long-term results.
Partial (Unicompartmental) knee replacement
There are following Knee compartments:
- inner (medial),
- outer (lateral),
- kneecap (patellofemoral).
If arthritis affects only one side of the knee, it may be possible to have a partial knee replacement (half replacement). This surgery involves less interference with the knee. The recovery process is quicker than total knee replacement.
Minimally invasive surgical techniques are used in the partial knee replacement. It can be carried out through a smaller cut in comparison to total knee replacement.
The patient needs to have strong, healthy ligaments in the knee to undergo this procedure. People who have partial knee replacement treatment are more likely to have the knee revision surgery than people who have a total knee replacement. About 10% patients need further surgery after 10 years. Therefore, the orthopedic surgeon may prefer total knee replacement to patients.
Patients can undergo this surgery at any age. It offers the opportunity to preserve more bone to younger people which is helpful if he or she needs knee revision surgery later. It is a less stressful operation for older patients. It causes less pain and less bleeding risks. The type of arthritis decides the outcome of the surgery, rather than patient’s age.
Kneecap replacement (patellofemoral arthroplasty)
Arthritis affected under-surface of the kneecap and its groove can be replaced by patellofemoral joint arthroplasty or patellofemoral replacement.
This operation has a higher failure rate than total knee replacement. It may be caused by arthritis progressing to other knee parts of the patient. Some surgeons advise a total knee replacement. Some of them feel that it’s better to preserve the rest of unaffected knee joint. The operation is only suitable for 0.025% people with osteoarthritis.
Revision knee replacement or complex knee replacement
Some people may need a revision knee replacement because of,
- major bone loss due to fracture or arthritis,
- the weakness of main knee ligaments,
- major knee deformity.
Longer stem used in this knee replacement allows the component to be more securely fixed into the bone cavity. To make up for any badly damaged bone, extra pieces of metal and/or plastic may be used. If the patient is having a second or third joint replacement in the same knee, he or she need this replacement
ACL reconstruction is yet another commonly performed orthopedic procedure. It is conducted in patients with torn anterior cruciate ligament (ACL) located in the knee. It is an arthroscopic procedure. The torn ligament is completely removed and replaced with an artificial graft.
To replace damaged ACL, the tissue comes from patient’s own body or from a donor. A donor is a died person who chose to donate all or part of his or her body. Tissue taken from patient’s body is called an autograft. Tissue taken from a donor’s body is called an allograft.
knee arthroscopy is mostly used in this procedure in which a tiny camera is inserted into the knee through a small surgical cut. This tiny camera is connected to a video monitor in the operating room. The surgeon uses the camera to check the ligaments and other tissues of patient’s knee. The surgeon makes other small cuts around patient’s knee and inserts other medical instruments. The surgeon fixes any other damage found and then replaces the ACL.
- The torn ligament are removed with a shaver or other medical instruments.
- If the surgeon is using patient’s own tissue to make ACL, he or she will make a larger cut to remove autograft.
- The surgeon makes tunnels in patient’s bone to bring the new tissue through.
- The surgeon attaches the new ligament to the bone to hold it in place. The bone tunnels fill in time to time. This holds the new ligament in place.
At the end of the surgery, the surgeon closes the cuts with stitches and cover the area with a dressing. You may be able to view pictures after the procedure of what the doctor saw and what was done during the surgery.