Total vs Partial Knee Replacement: Which Surgery Is Right for You?

The difference between total and partial knee replacement is a crucial decision for the patient with advanced knee arthritis. A total knee replacement basically means redoing the entire damaged joint. In contrast, partial knee replacement is only done for the compartment where the patient has arthritis. They also save the good parts like bone, cartilage and ligaments.

Therefore, what kind of knee replacement surgery should you go in for:

The main factor for this choice besides your personal situation, is whether ligaments and other structures of the knees have to be preserved and whether the arthritis is in only one compartment or in several places in the joint of the knee.

A careful, expert examination that includes X-rays or other imaging will be carried out by the orthopedic knee specialist who will recommend the most suitable procedure for you. It is of primary importance that the assessment is thorough in order to make the right decision.

Short Answer: Which Knee Replacement Total or Partial?

Partial knee replacement might work if it so happens that the arthritis has been limited to just one compartment of a joint and that all the rest have healthy condition with good ligaments.

On the other hand, total knee replacement is usually the best recommendation if the arthritis is affecting most of the knee joint and the patient has been quite a lot in pain, also experiencing stiffness, deformity, and trouble with carrying out everyday activities.

This choice should not be made on the basis of the age only. The orthopedic surgeon will take into account your symptoms, findings at the physical examination and the results of imaging before suggesting the procedure to you.

What Is Total Knee Replacement?

Total knee replacement (TKR) or total knee arthroplasty is a procedure to replace the damaged joint surfaces of a knee with replacement parts.

The components of a knee are three major ones:

• Medial compartment which is the inner corner of the knee
• Lateral compartment the outer side of knee
• Patellofemoral compartment this is the knee cap to thighbone connection space

Therefore, replacing the entire knee after removing the worn out surfaces is the objective. Then the surfaces are replaced so that movement can be much smoother and the pain reduced.

When Is Total Knee Replacement a Recommendation?

A doctor might suggest a total knee replacement if a patient is experiencing: Severe and long lasting knee pain Pain associated with movement like walking or going upstairs DisComfort at night while lying down or simply resting A considerable amount of knee stiffness Chronic swelling or inflammation Knee Deformity Being able to carry out only a very limited number of daily activities Not enough relief with non-surgical therapies One major indication for total knee replacement is when a person has severe arthritis affecting several areas of the knee.

What Is a Partial Knee Replacement?

Partial knee replacement, also known as unicompartmental knee arthroplasty, involves the replacement of only the portion of the knee that has been damaged. Resurfacing is not done on the whole joint, instead the surgeon gets rid of the bad cartilage and bone where the damage has been and keeps the sound portions of the knee.

For instance, someone having severe arthritis confined mainly in the inner compartment of the knee will be able to be a candidate for a partial medial knee replacement.

Keep in mind that partial knee replacement is definitely not a miniaturized version of total knee replacement. It is done only after careful evaluation, so only certain patients are recommended.

Who Is Considered a Good candidate for partial Knee Replacement?

Partial knee arthroplasty might be an option for: 1. Artherosclerosis Limited to One Area In knee The first requirement is that arthritis is found only one compartment and the other areas are almost normal, a partial replacement can be the solution.

2. Knee ligaments Are Still Working Well

Partially knee replacement is based a lot on the function of the ligaments. So if ligaments are in pretty good condition and the joint is stable then a partial replacement can be done easily. But, on the other hand, if there has been a lot of damage to the major ligaments then a partial replacement is a very bad choice.

3. Full Knee Movement

Inability to extend and flex the joint to a certain degree because of arthritis and other diseases is a limitation for a candidate to receive a partial knee replacement.

4. Symptoms Align with the Affected Area

If the source of a person’s knee pain is clearly identifiable as the inner or outer part of the knee where the cartilage is worn out due to osteoarthritis, then a partial arthroplasty could be the way to go.

Who May Require Total Knee Replacement?

There are cases when total knee replacement becomes the most suitable option if arthritis has affected multiple areas of the joint or in the event where there is a lot of joint destruction.

A candidate for surgery might be when a person has:

• Severe osteoarthritis
• Major kneeing deformity
• Extreme stiffness
• Prolonged wearing of only a very little of cartilage
• Knee pains which occur everywhere
• Adequate mobility is seriously impaired
• Physiotherapy and the use of medicine have become unsuccessful
• The symptoms are still there after injections or other forms of treatment

According to AAOS, in most cases, total knee replacement remains an option when severe knee pain or stiffness interferes with daily activities and non-surgical treatment methods do not anymore bring enough pain relief.

Benefits of Partial Knee Replacement

Appropriate partial knee replacement has the potential for a lot of advantages, especially compared with the total operation.

Shorter Recovery Time

Surgery affecting only a part of the joint leads to shorter time and less intensive rehabilitation compared with total knee replacement in similar patient populations.

Healthiness of the Remaining Bones

Ligaments, bone, cartilage, and ligaments of the rest of the knee can be kept without damage.

Greater Natural Movement

One of the reasons some patients have given for not wanting this operation is the concern that the prosthesis feels very artificial. However, it is also possible that those who get the partial operation experience the feeling of a natural joint since more of their real knee tissues remain intact.

Smaller Incision

Who May Need Total Knee Replacement?

When arthritis is affecting different compartments of the knee or joint damage is significant, total knee replacement could be the more suitable choice.

This procedure might be suitable if a person presents these conditions:

• Severe osteoarthritis
• Severe knee deformity
• Marked stiffness
• Extensive cartilage loss
• Discomfort affecting the entire knee
• Loss of flexibility to a large extent
• Inability of physical therapy or drugs to cure the pain
• Continuation of symptoms in spite of injections or other therapies

According to the AAOS, total knee replacement generally comes into the picture once the pain or stiffness in the knee is so bad that the person can hardly do his or her normal daily tasks and non-surgical treatments do not work to relieve the symptoms any more.

Advantages of Partial Knee Replacement

Under the right patient conditions, partial knee replacement can offer some advantages besides the obvious limitation of the surgery on only one part or a few parts of the joint.

Faster Recovery

Patients who have a suitable diagnosis of partial knee replacement and are in good health might expect an earlier recovery, as only the affected area of the joint is being resurfaced.

Preservation of Healthy Knee Structures

Intact bone, cartilage, ligaments are all left undisturbed and hence preserved.

More Natural Knee Movement

A patient may experience that movement of a knee replaced only partially is closer to the original as a large portion of the knee still remains intact.

Smaller Surgical Approach

A lesser incision and fewer damages to the neighboring tissues are characteristic of partial knee replacement.

Still, the above advantages are only applicable to proper candidates who were selected to undergo this procedure in the first place.

Advantages of Total Knee Replacement

In case of widespread arthritis, a total replacement might be the most convenient one.

This treatment modality can have advantages such as:

• Treatment of damage that involves various compartments of the knee
• Rapid reduction in pain
• Mobilization of the patient
• Removal or correction of deformities
• Easier accomplishment of daily life activities
• Long proven solution for severe knee arthritis

Its aim is to relieve pain and restore function after the joint damage has progressed so badly that no other treatment is really working or even feasible any more.

Which Procedure Will Let Your Knee Come Back Faster: Total or Partial Replacement?

For appropriately suited candidates, a partial knee replacement can result in a quicker return to normal activities compared to a full knee replacement.

Partial knee replacement surgery preserves the majority of the natural knee and only touches the affected surfaces, which could minimize the chances of you needing an operation again sooner than with total knee replacement. It could mean, at most, that you are operated on again within two years. On the other hand, most total knee replacements last five or more years.

In spite of this the results vary greatly from one patient to the other

There are quite a few factors that can play into a patient’s recovery: your age, muscle strength, health status generally, your surgeon, the rehabilitation program you follow and to what extent you carry out your physiotherapy.

Can You Change From Partial Knee Replace To Full Replacement Later On?

Partial knee replacement can later result in the need for a full replacement.

Owing to the fact that partial knee replacement is technically limited to the area where arthritis has occurred in a way that the healthy parts of your knee are left undisturbed it means that there is a possibility that your disease process could later get more advanced to the other compartments of your knee that were left healthy. This might lead to having the total knee replacement if there is still significant pain and the other compartment of the knee is damaged.

This fact does not mean that it was the wrong decision to go for partial replacement.

It implies that the procedure has to be done only when the patient’s selection criteria suit the procedure and the patient is a suitable prospect to benefit from the operation the most.

Which One is Better, Total or Partial KneeReplacement?

Not necessarily. Neither is the correct choice for everyone.

The right choice is the one that is best for the patient’s pattern of osteoarthritis and their health as a whole.

Partial knee replacement may lead to very good outcomes provided that arthritis is confined to one compartment and the ligaments, the rest of the joint as well as the adjacent compartment are healthy.

On the other hand, when arthritis is present in multiple compartments or there are major bone deformities as well as stiffness or there is a problem in the joint’s internal ligaments one would prefer total knee replacement to a partial one.

The American Academy of Orthopaedic Surgeons clinical guidance suggests that unicompartmental knee replacements may give patient-reported and functional results comparable to or even better than total knee replacements in the short to mid-term for properly selected patients with only one compartment osteoarthritis. However, the long-term replacement rate for unicompartmental knees could be slightly higher than that for the total knee replacements.

How Does a Surgeon Decide Between Total and Partial Knee Replacement?

Orthopedic surgeons make a few differentiations before deciding on the best replacement procedure for the patient. These differences are, for instance:

1. The site of osteoarthritis: Is the damage confined to one joint compartment only or has it affected almost the whole knee?

2. From your X-rays: They show cartilage wear, joint-space loss and bony deformity.

3. Knee motion: Restricted motion is often taken into account.

4. Ligament state: Ligamentous stability is one prerequisite for undertaking a partial replacement.

5. Pain location/level: The location and extent of your knee pain guide the decision making.

6. Systemic diseases: Your general condition and fitness level may be determining elements for your surgical intervention.

7. Level of knee function: To what extent does your knee condition affect your walking, stair climbing, work and daily living are relevant issues.

Surely, making the surgery decision solely on the patient’s age or basing it on the experience of someone else who underwent the surgery would be wrong. That is why the whole process of orthopedic assessment becomes crucial.

Total vs Partial Knee Replacement: Which One Should You Choose?

A candidate for partial knee replacement is a patient with arthritic involvement only in one compartment and good knee function and joint stability.

If you are a patient suffering with multiple compartments involvement of arthritis or significant deformity, severe stiffness or extensive joint destruction, a surgeon may recommend a total knee replacement.

But unless someone has a proper physical exam and imaging studies done by an orthopedic surgeon, it is impossible to tell whether partial or total replacement is the best option for the person concerned.

Frequently Asked Questions

Is partial knee replacement better than total knee replacement?

For some patients, a partial joint replacement might even be an alternative for full replacement if they have arthritis limited to one region of the knee. If the damage of arthritis has involved all regions of the knee, one may have no other choice but to decide to get the whole joint replaced.

Is partial knee replacement less painful?

People who get a partial knee replacement generally report less pain than patients who are operated on for total knee replacing. Nevertheless, a person’s pain experience post-operatively may not be compared directly with that of another.

Does partial knee replacement have the same durability of total knee replacement?

Knees can be replaced by either methods and still have a durable result, it is however that a patient with partial knee replacement, in the long run, may require additional surgeries. The outcome expectation is dependent on patient selection, implant factors, and other factors.

Is it possible for a 60-year-old to have partial knee replacement?

Relying solely on age is a rather naive approach when deciding whether one is a candidate for surgery or not. Other factors as like where and how much arthritis is present is, what are your ligaments’ situation, how much can you move your knee and what is your general health are to be taken into account.

Will knee replacement allow walking normally again?

After proper knee replacement and thorough rehabilitation one can significantly regain walking ability. Recovery is, however, very personal and varies from patient to patient.

What is the better choice of surgery for bad arthritis?

In case a patient has arthritis in every part of the knee, it is probably better to go for a total knee replacement. If the severe arthritis is limited to one compartment of the knee, partial knee replacement may be a viable option.

Final Word

The difference between total and partial knee replacement surgery is certainly not going to be a case of just bigger versus smaller surgeries. The type of procedure which is best for a given patient is basically a consequence of how severe, spread out and located the damage is to the joint in consideration.

A partial knee replacement operation will conserve the greater amount of the patient’s original knee joint with the result that the person will be able to get back to normal walking quicker if they are well-matched patients with very confined compartmental arthritis issues. On the other hand, in those patients who have arthritis affecting more than one part of their knee or arthritis which is causing quite severe pain, stiffness and disability, total knee replacement is likely to be a better choice.

As soon as you notice that your knee is very badly painful, you can’t really be walking at all because of that, or you become very stiff and can’t make it up or down the stairs with ease then the only way to know if something is seriously wrong is to have a knee specialist assess your situation.

Shekhar Srivastav, M.D. after carrying out an examination, discussing clinical findings and interpreting the diagnostic image study will provide advice whether surgery including joint replacement is not the necessary recourse or that there are other, non-invasive treatment options.

Medical disclaimer: This article serves only as an educational material and is not meant to substitute a personal diagnosis and treatment planning of an orthopedic expert who is qualified.