Knee Treatment

Partial Knee Replacement

You appear to have exhausted every option to manage your knee discomfort, and it is becoming clear that surgery will be necessary to resolve the issue. Surgery varies depending on the stage of arthritis. The procedures listed below are often used to treat knee arthri

Arthroscopic surgery, or keyhole surgery

Correction of alignment (high tibial osteotomy, or HTO)

partial knee replacement (either capping or unicondylar replacement)

Complete knee replacement (TKR or knee arthroplasty)

Your doctor has determined that "capping," also known as "partial knee replacement," is the best course of action for you after doing the required tests. It is a relatively young enterprise in India, despite having over 30 years of experience outside. We want to inform you about this procedure in this leaflet.

Understand your knee joint.
The thigh bone (femur), the leg bone (tibia), and the kneecap (patella) comprise the knee. Cartilage is the soft, buttery covering that covers all of these bones (Fig. 1). The cartilage caps are what prevent friction while a joint moves. These caps deteriorate with age or damage, exposing the raw ends of the bones. Although it is recognized that changes in arthritis may not impact the entire joint, this condition is classified as arthritis. From an understanding perspective, the knee may be thought of as consisting of three components (compartments): the medial (inside), lateral (outside), and anterior (knee cap joint) (Fig-2). One, two, or all three of the joints' compartments may be impacted by arthritis. Unicompartmental osteoarthritis is the term used when just one compartment is impacted. When osteoarthritis affects only one compartment, treatment is different than when it affects all three.

What is a partial knee replacement, exactly?
Nowadays, it is sufficient to replace just the damaged knee compartment when only one is impacted. This is referred to as partial knee replacement or capping (Fig-3). This is a novel idea in contrast to the past, when total knee replacement was the sole option for treating an injured knee, whether it was completely or partially damaged. Applying a cap to the injured knee is comparable to what a dentist does when he applies a cap on a fractured tooth instead of repairing it. It performs almost as well as a knee replacement in those who are carefully selected. The sole restriction is that only one compartment may sustain damage. Only within a "window period"—not too early, nor too late—can capping or partial replacement be done.

Why not replace the whole knee after surgery is underway?
One's thinking naturally comes up with this idea. Additionally, this argument is frequently used by doctors who do not perform partial knee replacements. But when you think about it, why not use partial instead of full? God-given knees should be kept as long as possible since they are always superior to man-made ones. Completely replacement knees are never as excellent; one must be aware of their limits. Therefore, the tendency is to use less intrusive procedures (joint preservation surgeries) to try to keep the original knee as long as possible if arthritis strikes a younger individual. Therefore, if possible, it makes sense to merely replace a portion of the system.

Isn't I too young for a knee replacement?
Surgery can be performed at any age. It is carried out regardless of age if the patient has knee discomfort that cannot be relieved non-operatively. Since nothing is taken from the knee, a partial knee replacement is a knee preservation procedure. This is intended to prolong the original knee's lifespan. It is performed on younger patients with just partial knee injury.

How can we determine whether a joint is acceptable for capping and only partially damaged?
Doctors can determine if the entire knee is injured or just a portion of it in a number of ways. A decent notion is provided by a clinical examination and a few specialized X-rays. For instance, you could be a candidate for partial knee replacement if your discomfort is restricted to the interior of your knee (Fig-4). In questionable situations, an arthroscopy—a camera-assisted view of the interior of the knee—can be performed shortly before the procedure.

What happens if I postpone the procedure?
Partial replacement can be helpful during a certain window of time—not too early, not too late. Many individuals with early-stage arthritis may not feel incapacitated and may be reluctant to have complete replacement. These patients typically choose to endure the discomfort. When arthritis only affects one compartment in these early cases, capping (partial replacement) restores knee balance and stops the progression of the condition. If left untreated, the arthritis spreads to other areas and ultimately results in knee replacement.

To what extent is the operation successful?
One of the better knee surgeries is this one. The pain is almost gone. Both the gait and the form of the legs improve. Up to 15 years, about 90% of patients are in good health. The secret to a successful procedure is using the right surgical technique and choosing the right patient.

Since all of the ligaments are unaltered, a partial knee replacement feels like a natural knee. There are no limitations on sitting on the floor, sitting cross-legged, or any other position, and one can fully bend their knee.

Does the procedure hurt?
Pain is the first thing that comes to mind while considering surgery. Partial replacement is a lesser procedure, thus it is comparatively less unpleasant, even if all surgeries include some level of pain and suffering. This procedure may now be performed almost painlessly because of the application of contemporary pain management approaches (Fig. 5). Our staff goes above and beyond to make sure your procedure is pain-free since we are especially sensitive to this.

How long do partially replaced knees last?
In up to 95% of instances, the capping lasts for 15 years, but it can last longer. The ones that are failing can be repaired by replacing the whole knee. This makes it a better alternative than having a knee replacement done right away because switching from one full to another is a rather substantial procedure if the knee replacement fails for any reason.

How much time does recovery take?
You'll spend three days in the hospital. To fine-tune your medical state, you will be admitted one day before surgery, and the following morning, you will undergo surgery. On average, the procedure takes one hour for a single knee. Before being moved to your room, you will remain in the post-operative recovery area until the evening of the procedure. The day following surgery, gentle physical rehabilitation is initiated. Below is a common recovery plan for those who have one knee capped.

Can surgery be performed on both knees simultaneously?
Yes, that is quite feasible, and for the past ten years, it has been our standard procedure. There is sufficient data to suggest that the success rate of performing both knees simultaneously is equivalent to that of doing them individually in certain situations.

What is the cost of this operation?
The method and implant utilized may have an impact on the cost. When you see your doctor to schedule the operation, you can talk about this. We provide packages for a variety of patient types. The approximate cost of each knee is 1.5 to 3 lacs*.

Which implant should we use?
We only utilize the highest-quality, long-lasting foreign implants. Ours is named 'Oxford Uni'. A 'free moving' plastic component sits between the two steel caps that are attached to the two bones, indicating that the knee is a movable bearing knee (Fig-6).Because the plastic does not deteriorate as quickly, the knee has a longer lifespan. New implants are constantly being introduced to the market. We carefully select the finest option for our patients after staying up to speed on all the latest advancements.

What is the process for having surgery?
Our staff will take control after you make the decision to have surgery. They will walk you through the entire process, which includes deciding on a surgical date and making backup plans for it. You must take the following actions:

To determine whether you have any health concerns that require care, have a general health checkup. In order to verify your suitability for surgery, you will need to see the anesthetist.

Physiotherapy

Nutritional guidance

problems with payments or health insurance.

Before surgery, a complete examination is performed to ensure that there are no known risks. Typically, spinal anesthesia—an injection in the back that numbs the legs—is used for the procedure rather than general anesthesia. Throughout the procedure, you will remain conscious, but your legs will be devoid of sensation. You won't learn anything since the medications will put you to sleep. The majority of patients report that the procedure went well and that they "did not come to know when the operation started and finished."

What is required following surgery?
Under the direction of our head physiotherapist, our home care team will take over when you are released from the hospital, which should happen three days following the surgery. This is done in light of the challenges patients have while returning to the hospital on a regular basis. They will arrange for at-home stitch removal and physical therapy. You can always choose to have the sutures taken out at the hospital.

What difficulties could arise?
Although there aren't many complications with capping, like with any procedure, complications can happen sometimes. We take every effort and adhere to international standards to minimize our issues. In the rare event that a problem does arise, we take prompt corrective action. This rigorous approach has allowed us to maintain a low rate of complications. To keep you informed, not to worry, here is a list of some of the more frequent issues. Although you should be aware of the more prevalent ones, this is by no means an exhaustive account.

Anaesthesia-related side effects: Headache, nausea, vomiting, and giddiness are frequent postoperative side effects that can be quickly managed with medicine. Medication allergy reactions are quite infrequent.

Knee swelling and blood accumulation: This operation is done under tourniquet control, which means that a pressure band on the thigh (tourniquet) is used to fully halt the blood flow to the leg throughout the procedure. There may be some blood leaking and collecting inside the knee after the same is released at the conclusion of the procedure. If necessary, such collected blood is extracted under local anesthesia using a syringe and needle.

Problems with wound healing: It's normal to have some fluid discharge and redness surrounding the wound. heals with patience and attention.

Infection: One out of every 300 surgeries may result in infection, a heinous side effect. We take every care and make sure you don't have any infections that might spread to the region that will be operated on.

Knee deformity and stiffness: Some knees are prone to become stiff on their own or as a result of inadequate post-operative rehabilitation. They often heal with a combined effort from the patient and the physiotherapist.

Loosening: The prosthetic caps, which are cemented to the native bone, might occasionally become loose. The cause might be an injury, poor bone quality, or an implant that doesn't fit perfectly. Thankfully, this only occurs in 1 in 100 cases, and it could require additional surgery to fix.

Our partial knee replacement method (capping)
Compared to knee replacement, partial knee replacement is a less common procedure. In North India, we are the first to do this procedure. We are knee experts rather than just knee replacement doctors, which explains why. We carry out the whole range of knee procedures, including alignment correction (HTO), capping (partial replacement), key-hole surgery (arthroscopy), and knee replacement (TKR). We make the best decision for our patient.

We have mastered the art of partial knee replacement, a really life-altering procedure, thanks to our experience. Some of our technique's highlights are listed here.

1.By doing the following, we have been able to increase our success rate:
(a) Selecting the appropriate patient: We follow a rigorous procedure for selecting patients. It entails a number of specialized knee x-rays, some of which are difficult to get elsewhere. This is crucial for the outcome of this procedure because it allows us to determine whether the knee is injured in one or more areas. Just before the procedure, if there is still any question, we do an arthroscopy, which involves using a tiny camera to check into the knee. We have every facility we need in our OT, and we accept calls based on what works best for our patients. All of this is feasible because we are skilled in both open and keyhole knee surgery procedures.

(b) The implant: The artificial cap that we utilize is known as a "mobile bearing."Like any other partial knee, it is composed of three components, but the middle plastic portion is freely movable and may be adjusted to suit internal stresses. A group of surgeons in Oxford, UK, created what is commonly referred to as the "Oxford knee." The most common partial knee implant worldwide, this joint has the best track record.

(c) The dressing method: We employ a precise implant fitting method, including computer navigation where necessary. Even with obese patients, we have been able to get flawless alignment and fixation thanks to this.

(d) Optimize the remaining knee: We don't leave the knee alone when performing partial knee replacement. In whichever manner we can, we also work on the rest of the knee. This aids in extending the knee's lifespan.

2.Pain management:
Our pain management program is strictly monitored, and we want patients to have a comfortable and painless surgical experience.

3.No physiotherapy:
Following this procedure, the majority of our patients do not require supervised physiotherapy. They handle things on their own.

4.Accessibility:
To handle any patient issues, our staff, including the senior surgeon, is reachable by cell phone. If necessary, our home care staff can attend to the patient's needs.

5.If necessary, we perform both knees together.