Partial Joint Replacement Surgery

Overview

Patients with extensive end-stage joint disease (often of the knee or hip) who have attempted non-surgical treatment but are still experiencing functional deterioration and incapacitating pain are typically advised to have joint replacement surgery. When performed as needed and indicated, joint replacement surgery is quite effective.

The damaged cartilage on both sides of the joint is removed during modern joint replacement surgery, and the joint is then resurfaced with an implant made of metal and plastic that resembles and works much like your natural joint. Although almost every joint in the body can be replaced, hip and knee replacements account for the majority of procedures.

Partial joint replacement has become one of the most dependable and long-lasting medical procedures in recent years because of enhanced surgical methods and novel implant materials.

What Determines the Appropriateness of Joint Surgery?

Numerous disorders, such as osteoarthritis, rheumatoid arthritis, and other inflammatory joint issues, prior joint fractures and injuries, joint infections, and other uncommon conditions including osteonecrosis (also called avascular necrosis) can all contribute to severe or end-stage arthritis. All of these issues cause harm to the various joint structures, which finally results in serious irreversible damage and a dysfunctional joint.

A rheumatologist, who specializes in treating these conditions, may be best able to treat some types of arthritis, such as rheumatoid arthritis and other inflammatory types of arthritis. A primary care physician, rheumatologist, or orthopedic surgeon often treats more widespread joint conditions like osteoarthritis. Joint replacement surgery may be a possibility for you if the pharmacological medication your doctor has prescribed for your arthritis starts to lose its effectiveness. These experts are more qualified to decide whether joint replacement therapy is the best course of treatment for you.

The criteria for when partial joint replacement surgery is acceptable are constantly evolving. In general, candidates for joint replacement have no predetermined maximum age. Instead, it may be advisable to base your choice on your general health, surgical readiness, and how much your arthritis impacts your quality of life.

While few patients are in perfect condition, the majority of those having joint replacement surgery must be in good enough health or otherwise tuned up medically to let their procedure be carried out safely. Consult your primary care physician before undergoing joint replacement surgery to make sure your health is suitable for the anesthesia and afterward care required.

Partial Knee Replacement Surgery

Compared to a total knee replacement, which replaces the bone surfaces of multiple compartments of the knee joint, a partial knee replacement involves only one compartment of the knee joint. Unicompartmental arthritis is commonly treated with it.

Patients with unicompartmental knee arthritis only have one compartment or segment of cartilage degenerate. The ligaments that support the knee joint can be preserved while deteriorated cartilage and bone in the affected area are removed by surgeons in situations where non-surgical methods do not relieve symptoms.

The injured portion of the knee is replaced with an implant, commonly known as a prosthesis, leaving the other compartments untouched. A growing number of patients are choosing partial knee replacement as a realistic alternative thanks to advancements in surgical methods and equipment. In fact, according to recent research, between 10% and 25% of all patients with osteoarthritis of the knee who require replacement surgery may be candidates for the operation. 

Partial Knee Replacement Candidates

Patients who have arthritis that is isolated to one compartment of the knee and who are not excessively obese (BMI greater than 40) are typical candidates for partial knee replacement. Patients with a severe angular deformity or those with marked knee stiffness should not have the operation. A patient must typically have healthy knee ligaments to qualify. For instance, partial knee replacement is frequently not an option for individuals who have an untreated ACL tear. Since inflammatory arthritis often affects the entire joint, people with rheumatoid arthritis of the knee might also not be eligible.

On a case-by-case basis, additional factors are assessed, and the patient and surgeon jointly decide whether partial knee replacement is the best course of action. One of the most crucial elements to guaranteeing a successful functional outcome and long-term durability of a partial knee replacement is choosing the proper patient. This procedure is occasionally preferred for individuals over the age of 80, even when they do not match all eligibility requirements, because it involves less trauma than a total knee replacement.

Partial Knee Replacement Procedure

The orthopedic surgeon creates a small incision to reach the knee compartment that is damaged during a partial knee replacement. He or she gently pulls the knee's supporting components out of the way and scrapes the arthritic tibia and femur's surfaces of worn-out cartilage and bone tissue. The components of the prosthesis, which are custom-sized for each patient's joint, are subsequently inserted after the surgeon has cleaned and prepared these areas.

These components are often secured with cement, however, non-cemented knee replacement implants, also known as uncemented or cementless implants, are now also utilized. The incision is closed after repositioning the tissues and structures in their anatomical positions.

To perform partial knee replacement, some surgeons use robotic and computer-assisted techniques. This technology has allowed the surgeon to create and manipulate a 3D image of the patient's knee in advance of the surgical procedure, a process that allows for extremely accurate removal of damaged tissue and refined placement of the prosthesis during the actual procedure.

Recovery from Partial Knee Replacement Surgery

Within three to six weeks, the majority of patients can anticipate returning to their regular activities. Many patients discover that six to ten weeks after completing physiotherapy, they can resume their favorite sports, like golf. Unless they have a health condition that necessitates an overnight stay, patients can typically anticipate returning home the same day as their operation. On the same day as after surgery, the majority of patients can walk independently or with help. Within a few days of surgery, the patient typically receives a cane to encourage enhanced independence and starts outpatient therapy. Within one to two weeks following surgery, patients frequently stop taking their prescription pain medications.

Partial Knee Replacement Complications

Low blood loss and a low incidence of complications are typical with a partial knee replacement. As with any surgery for joint replacement, risks for this procedure include deep vein thrombosis, infection, implant loosening, and instability of the knee. In general, issues following partial knee replacement are less common than those following total knee replacement. Talk to your surgeon about any concerns you may have about these or other complications.

Patients who have undergone the operation after being thoroughly evaluated can anticipate a few issues and a quick recovery. However, much like with other types of knee surgery, revision procedures are occasionally required. Results from revision surgery might not be as favorable as those from the initial procedure.

Partial Hip Replacement Surgery

Similar to a total hip replacement is a partial hip replacement. If only the ball-shaped femoral head at the top of your thigh bone is injured or diseased, your surgeon might advise it. If the socket portion of your hip joint is healthy. The femoral ball of the hip joint is excised during partial hip replacement surgery and replaced with a prosthetic component linked to a long metal stem. A kind of porous substance is used to embed this implant into the thigh bone from below. This gives the bone time to build naturally around it over time.

When a total hip replacement is not deemed essential and the hip socket is still healthy and functional, partial hip replacement surgery is a reasonable alternative to treat hip fractures. Small incisions are all that are required for a minimally invasive partial hip replacement surgery.

Partial Hip Replacement Candidates

Partial hip replacements are not appropriate for all individuals. The severity of the injury and the health of the hip joint will both be important considerations in making the choice. A healthy hip socket is necessary for the operation to be completely effective due to the nature of the procedure. As arthritis is a degenerative condition that typically affects the entire hip joint, treating it with partial hip replacement is not advised. Less active patients may benefit from it because the joint is likely to be put under less strain, extending its lifespan. Due to the shorter time spent on the operating table and significantly lower risk associated with it, partial hip replacement can potentially be a good surgical choice for more high-risk patients. Despite being a faster procedure, a total hip replacement should not be considered a viable alternative because the prerequisites are substantially different.

Partial Hip Replacement Preparation

Physical examination and imaging tests can be used to determine whether a partial hip replacement is indicated. The doctor may undertake an examination of the hip to evaluate its movement, stability, strength, and overall alignment after learning about the patient's general health, the severity of their hip discomfort, and how it impacts their ability to carry out daily activities. If a partial hip replacement is required, the doctor may prescribe X-rays to evaluate the degree of deformity or damage in the hip joint or an MRI to evaluate the integrity of the hip's tissues and bones and to detect the fracture grade. Your doctor will go through the advantages of this procedure with you as well as what to anticipate afterward. There are four main grades of hip fractures:

• Grade one. Sub-trochanteric
• Grade two. Intertrochanteric
• Grade three. Fractured Femoral Neck
• Grade four. Sub-capital Fracture

Grades one, two, and three don't obstruct the joint and can therefore be repaired using pins and nailing devices. The four types of grade four fracture are as follows:

• Type one. Stable fracture with pressed-together bones.
• Type two. Total fracture with preserved bone alignment
• Type three. A complete fracture with bone fragment displacement, but some contact
• Type four. A complete fracture with complete fragment displacement and zero contact

Pins and nailing devices can be used to treat types one, two, and three, however, type four usually involves disruption of the femoral head's blood supply and is unlikely to recover as a result. Hemiarthroplasty, often known as a partial hip replacement, is, therefore, necessary in this case. Due to superior results, lower costs, and more patient satisfaction, world literature currently supports total hip replacement for younger, more active patients.

Partial Hip Replacement Procedure

In a partial hip replacement, artificial prosthetic parts are used to replace the femoral ball. The following steps make up a partial hip replacement procedure, which can take an hour to 90 minutes to complete:

• Entering the joint. An incision is made towards the front, side, or back of the hip, and the muscles, tendons, and other tissues are pushed away from the joint to uncover the femoral head (ball) and acetabulum (socket), depending on the approach and the doctor. The hip is then put in a position to reveal or widen the joint.
• Femoral head removal. The head and neck of the femoral head are removed at this stage.
• Femoral channel preparation. The femoral channel is then hollowed out to make room for the implantation of the femoral stem.
• Femoral placement. The hollow core of the femur can be pressed-fit or fixed with cement to hold the femoral stem in place. The top of the femoral stem is then fitted with a precisely placed metal or ceramic ball and fastened.
• Rejoining the hip joint. After rejoining the hip joint and repositioning the surrounding muscles and tissues, the treatment is finished.

Partial Hip Replacement Recovery

How well the patient adheres to postoperative home care instructions and safety precautions will have a significant impact on how well they recover from a partial hip replacement or total hip replacement for hip fractures. There will be some discomfort following a partial hip replacement procedure, but the medical staff will administer the right anesthetic to keep the patient as comfortable as possible. A physiotherapist will give instructions on the precise exercises to strengthen the leg and restore hip movement to enable walking and other activities following surgery. Walking and hip movement will start immediately after the procedure. A significant portion of the healing process will take place at home, where adequate attention must be paid to wound care, food, and activity as directed by the doctor and physiotherapist. Three to six weeks after surgery, patients who underwent partial hip replacement surgery typically return to their regular routines. The recovery time will vary depending on the level of exercise the patient intends to resume; this should be discussed with the doctor and physiotherapist as each patient is distinct.

Partial Joint Replacement Surgery Prevention

Comprehensive medical management of your arthritis can reduce your need for joint replacement surgery. You can extend the length of time you can live with arthritis by taking arthritis drugs, changing your exercise routine to low-impact ones (such as swimming, walking, biking, etc.), losing weight, taking nutritional supplements, and getting joint injections. Joint replacement surgery can reduce pain and restore the quality of life that has been lost due to arthritis when other therapies are no longer effective and you experience both discomfort and a decline in function.

Despite advancements in partial joint replacement surgery, young, athletic patients with arthritis are unlikely to have these procedures last a lifetime. In some of these situations, joint-preserving operations including osteotomies, joint debridement or cleanouts, and cartilage transplants may be useful in avoiding joint replacement surgery.

Partial Hip Replacement Complications

Following are some of the hip replacement surgery risks:

• Blood clots. These can be harmful if they travel to the lungs or obstruct blood flow from the leg back to the heart.
• Infection. Antibiotics are typically used to treat wound infections. Deep joint infections might require additional surgery. The hip implant may need to be changed in some circumstances.
• Nerve damage. This is unusual. It could make a muscle feel tingling or numb or make it difficult to move.
• Issues with healing wounds.
• Issues with anesthesia.
• Hip dislocation following the operation.
• Different lengths of the legs. A shoe insert can be used to address any difference, which is typically very minor.
• Hip implant loosening inside the bone.

Conclusion

One in five Americans will experience knee and hip arthritis at some point in their lives. To treat the discomfort and incapacity that might come along with this condition, a variety of non-surgical and surgical methods are fortunately available. Although partial joint replacement is a surgical treatment option for some people who have arthritis in only one region of the joint, total joint replacement is still the most common surgical operation for late-stage knee arthritis.