Half’ Knee Replacement
When – if at all – should it be done?
The knee joint is the by far most often effected joint when it comes to arthritis, followed by the hip. Arthritis literally means inflamed joint, Out of almost 150 different types of arthritis the ‘osteoarthritis’ is the most often one and this term is used to describe degenerative changes inside the joint due to age related wear and tear. Many diseases can also cause wear and tear inside a joint, like gout – high level of uric acid -, Rheumatoid Arthritis (R.A.) – an auto-immune disease interfering with the nutrition of the joints, Psoriasis – similar effect like R.A., diabetes – also effecting the nutrition of the joint, to name just a few.
Under ‘normal’ circumstances, and with no other underlying disease, the knee might start to show some signs of arthritic changes from the age of 60 on wards. At the first stage, out of four, you would not notice anything, or maybe some clicking sensation when walking downhill, but the knee would not stop you from performing any daily activities. This stage is diagnosed by radiographic imaging only. The final stage, the fourth, would mean that the cartilage, that usually covers the joint surface like a cushion, has been worn away completely, and you would walk ‘bone on bone’. Often there is an obvious deformity and permanent swelling of the knee as well as misalignment causing an X- or O- shape of the leg. At this stage there would be a permanent discomfort which can reach severe pain when weight bearing through the leg. The total knee replacement (TKR) is not only the golden standard but also a treatment option for good. In the hand of an experienced surgeon like Dr. Alf Neuhaus the procedure would be done in about 75 minutes and his team would get you up and leaving the hospital full weight bearing through the joint within two to three days.
Unfortunately sometimes the arthritis may affect you at a much younger age, which could be due to an accident in the past, underlying diseases or performing impact sport on a high level. This often leads to advanced wear and tear in only one part, either the medial or lateral compartment, of the knee, meanwhile the other parts are still doing well. Initially the treatment of choice would be a specific exercise program to strengthen those muscles that work on the less effected side, avoiding – if possible – further heavy impact, and using anti- inflammatory medication either as crèmes or tablets. Also direct infiltration of the knee with Cortisone (anti- inflammatory) and Hyaluronic Acid (‘WD40’ for joints) could be used. Insoles to try to correct the alignment of the knee have shown to be ineffective. Eventually his treatment might not be effective any more, and the next step, the ‘Half’ knee replacement (uni-condylar) has to be considered. The prosthetic material used is practically only half as big as the total knee replacement and would just replace the worn out surface. The surgical procedure is as straight forward as the TKR, and hospital stay and recovery time would be similar. But the average life span, obviously also depending on activities following the surgery, would be 10 to 15 years, compared with the 20 to 25 years in a TKR.
So in the age group under 60, and when all conservative treatment approaches are failing, life quality is diminishing and muscle strength and mobility are decreasing, it would be a valuable option to get you back to a normal life without knee pain. The life span of the prosthesis can be extended by performing only none- impact sports like golf, swimming, bike riding, using a gym or gentle hikes. It would even be important to maintain a reasonable level of fitness, as the partial knee will eventually have to be replaced by a TKR. This procedure would be almost as straight forward as the primary TKR, and recovery would be the same too.
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