Partial Knee Replacements

Resurfacing one, two or three cpmpartments is partial knee replacement.

  • Unicompartmental knee arthroplasty(UKA)
  • Patellofemoral Replacement
  • Bicompartmental knee arthroplasty

 

Why Partial Knee Replacement?

“JITNI GAADI CHALTI HAI CHALA LO”.

NOT ANYMORE AS WE HAVE OPTIONS NOW.

REPLACE ONLY THE PART WHICH IS DEFECTIVE

GETTING BACK TO SPORTS , HIGH IMPACT EXCERCISES AND RECREATIONAL ACTIVITY

PAINFREE ACTIVE LIESTYLE OF CHANGING URBAN INDIA, PEOPLE WHO DON’T WANT TO RELY ON OTHERS

NO FUTURE OPTION IS LOST, ALL BONE PRESERVED

GREATER RANGE OF MOTION

WHO ARE THE CANDIDATES FOR PARTIAL REPLACEMENTS?

  • YOUNG PATIENTS BETWEEN THE AGE OF 45-60 YEARS HAVING A DISEASE OF ONE OR TWO COMPARTMENTS ONLY
  • WANT TO PERFORM SPORTS ACTIVITY

  • WHO WANT TO DO HIGH FLEXION ACTIVITIES
  • VERY FRAIL PATIENTS OR DEFORMED KNEES WHERE TKA IS NOT A POSSIBILITY

 

WHAT ARE THE ADVANTAGES?

  • OPTION TO RELIEVE PAIN AT AN EARLY STAGE, DISEASE DOES NOT SPREAD TO THE SURROUNDING SOFT TISSUE
  • BONE PRESERVED
  • FEELING OF A NATURAL KNEE, KINESTHETIC SENSE PRESERVED
  • SITTING CROSS LEGGED AND SQUATTING NOT A POSSIBILITY IN TKA.
  • VERY SMALL INCISION, DONE MIS.

  • EXCELLENT RECOVERY- DAY CARE PROCEDURES IN THE U.S.
  • NO SERIOUS COMPLICATIONS REPORTED LIKE DVT, PULM. EMB. EVEN IF INFECTION OCCURS REVISION VERY EASY.

 

IS IT THE PANACEA FOR OA KNEE?

Patellofemorel replacement

  • STUDIES SHOW THAT FIRST GENERATION PATELLOFEMORAL CONSTRAINT DESIGNS HAD A SHORT AVERAGE LIFE ~ 5YEARS.
  • NEWER LESS CONSTRAINT DESIGNS LIKE ‘AVON’ HAVE A GOOD RECORD OF TEN YEARS
  • LATEST ASYMMETRIC DESIGNS ARE EXPECTED TO DO BETTER.

 

Unicompartmental replacements

  • UNICOMPARTMENTAL DESIGNS ( HAVE BEEN SINCE MARMOR) SIMILARLY, AFTER AN INITIAL SLUMP TILL 1995 HAVE STARTED GIVING CONSISTANTLY GOOD RESULTS
  • UPTO 95% LIFE TILL 15 YEARS
  • FOR PARTIALS, SINCE IT IS A RECENT DEVELOPMENT DATA BEYOND 15 YRS IS NOT AVAILABLE BUT ONE CAN EXPECT A LONGER SURVIVAL

 

INCOMPETENT LIGAMENTS

HOW DO WE DO IT? (UNI AND PATFEM)

  • 30 TO 45 MIN SURGERY
  • UNDER TOURNIQUET AND NO DRAIN REQUIRED SO MINIMAL BLOOD LOSS (
  • POSTOP EPIDURAL ANALGESIA
  • NEXT DAY MOVEMENT TO START
  • THIRD DAY DISCHARGE
  • TOTAL RECOVERY IN TWO TO THREE MONTHS TIME

 

PATELLOFEMORAL

  • PATELLA REPLACED WITH POLYTHYLENE INSERT
  • TROCHLEA WITH UNCONSTRAINED METAL
  • INLAY AND ONLAY TECHNIQUE: INLAY MY PREFERRED- LAZY
  • PATELLAR TRACKING TO BE CLOSELY EXAMINED BEFORE SURGERY, MOST REQUIRE LATERAL RELEASE.

 






UNICOMPARTMENTAL

  • MEDIAL MOST COMMON
  • OPTION OF ALL POLY OR METAL BACKED
  • ACL SHOULD BE INTACT
  • FUNCTIONAL ACL SEEN BY AN ANTERO MEDIAL WEAR PATTERN, IF THE WEAR IS ON POSTERIOR ASPECT- POOR CANDIDATE
  • 1-2MM THICKNESS BONE TO BE CUT FROM TIBIA AND 7MM FROM FEMUR

PATELLOFEMORAL ARTHRITIS IN- 40 YEAR OLD FEMALE

PATELLOFEMORAL REPLACEMENT-POSTOP

BILATERAL PATELLOFEMORAL REPLACEMENT

BILATERAL PATELLOFEMORAL REPLACEMENT

LATERAL VIEW

BICOMPARTMENTAL

  • INCISION A LITTLE LONGER AND IN MIDLINE
  • TAKES LONGER TIME
  • COMPLICATIONS MUCH LESSER THAN TKA.

 

BICOMPARTMENTAL INVOLVEMENT

BICOMPARTMENTAL REPLACEMENT

Bicomp in 55 yr

Bicomp 47yr


BICOMP-POST OP

Medial compartment involvement

Right medial and left bicomp

Right UKA, Left bicomp


left medial and lateral few years apart