Knee Replacement Surgical Options

Featuring Dr. Bassam Masri, MD, FRCSC, Orthopaedic Surgeon

Duration: 2 minutes, 58 seconds

So once you and your physician have decided that everything else is no longer working and surgery is required for osteoarthritis of the knee, there are a variety of options.

The most common option, by far, is a knee replacement. In very young patients, and typically patients in their 20s who have localized arthritis to one part of the joint, typically on the inside of the joint with a bowlegged deformity, occasionally you can break the leg bone – the tibia – and do what’s called an osteotomy and realign the leg. But that’s only an option for very young patients.

Another option is a partial knee replacement. And that is a reasonable option if the arthritis is localized to one of the three compartments of the knee joint. And the knee joint can be thought of as having three compartments. The inside of the knee is one compartment, the outside of the knee is a second compartment, and the third compartment is the kneecap area.

So if there’s arthritis located either to the inside or the outside, then a partial knee replacement can be considered. If the arthritis is localized to the kneecap area, and this is not just patients with pain in the kneecap, but bona fide arthritis one can see on an x-ray of the knee, then a partial replacement of the kneecap area can be an option.

And the final – and really, the most common surgical option for osteoarthritis of the knee – is a knee replacement. And that is usually offered to patients who have pain either all over the knee, or even if they have localized arthritis in one compartment but the pain is global in the knee, then we generally offer a full knee replacement.

Or, if technically a partial knee replacement is not possible, or if the patient and their surgeon decide that a full knee replacement is the best option, then that is what is offered.

Generally, the long term outcome of a full knee replacement is better than that of a partial knee replacement in that the revision rate at 10 years for a partial knee replacement is two to three times as high as that of a full knee replacement.

And this is why a lot of patients and surgeons choose to do a full knee replacement as opposed to a partial knee replacement. So the question I guess asked is why would you even consider a partial knee replacement if the failure rate at 10 years is higher?

So if the patient is younger and they wish to have another option as they get older, to be converted to a full knee replacement, then that is also another option, but that is a personal decision that the patient and the surgeon have to discuss and agree that it is the best option for a particular patient.

There really is no right or wrong answer in this regard, as long as everybody knows what the facts are and then they make an informed decision. So if you think that you need a knee replacement or have any further questions, consult with your physician.

Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

Local Practitioners: Orthopaedic Surgeon