Unicondylar Knee Replacement simply means that only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement.
Unicondylar Knee Replacements have been performed since the early 1970′s with mixed success. Over the last 25 years implant design, instrumentation and surgical technique have improved markedly making it a very successful procedure for unicompartmental arthritis. Recent advances allow us to perform this through a smaller incision and therefore is not as traumatic to the knee making recovery quicker.
Total Knee Replacement surgery replaces the ends of the femur (thigh bone) and tibia (shin bone) with plastic inserted between them and usually the patella (knee cap).
Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.
When the articular cartilage wears out, the bone ends rub on one another and cause pain. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always it affects people as they get older (Osteoarthritis).
Other Causes Include
In an Arthritic Knee
The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.
The decision to proceed with Knee Replacement surgery is a cooperative one between you, your surgeon, family and your local doctor.
The benefits following surgery are relief of symptoms of arthritis. These include
Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes or physical therapy.
The big advantage is that if for some reason it is not successful or fails many years down the track it can be revised to a total knee replacement without difficulty.
Not quite as reliable as a total knee replacement in taking away all pain Long term results not quite as good as total knee
Who is not suitable?
Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.
Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back. Surgery will take approximately two hours.
The Patient is positioned on the operating table and the leg prepped, with a sterilizing solution and draped.
An incision around 7cm is made to expose the knee joint.
The bone ends of the femur and tibia are prepared using a saw or a burr.
Trial components are then inserted to make sure they fit properly.
The real components (Femoral & Tibial) are then put into place with or without cement.
The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.
When you wake, you will be in the recovery room with intravenous drips in your arm, and a number of other monitors to check your vital observations.
Once stable, you will begin Physical Therapy and prepare for discharge home. The post-op protocol is surgeon dependant, but in general, your drain will come out shortly before discharge. You will sit out of bed and start moving you knee and walking on it within hours surgery. Your rehabilitation and mobilization will be supervised by a physical therapist.
To avoid lung congestion, it is important to breathe deeply and cough up any phlegm you may have.
Your Orthopaedic Surgeon will use the following measures to minimize DVTs (blood clots in you legs), such as inflatable leg coverings, stockings and a blood thiner.
A lot of the long term results of knee replacements depend on how much work you put into it following your operation.
Usually, you will go home the day of surgery. You will need physical therapy on your knee following surgery.
You will be discharged on a walker or crutches and usually progress to a cane at 4 weeks.
Your sutures are dissolvable and the glue will come off within 2 weeks of surgery.
Bending your knee is variable, but by 6 weeks it should bend to 90 degrees. The goal is to get 115-120 degrees of movement.
You may shower 2 days after your surgery. You can drive at about 3-4 weeks, once you have regained control of your leg.
You should be walking reasonably comfortably for 6 weeks.
More physical activities, such as sports previously discussed may take 3 months to be able to do comfortably.
When you go home you need to take special precautions around the house to make sure it is safe. You may need rails in your bathroom or to modify your
sleeping arrangements especially if they are up a lot of stairs.
You will usually have a 2 week and 6-week check-up with your surgeon who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on X-ray.
You are always at risk of infections especially with any dental work or other surgical procedures where germs (Bacteria) can get into the bloodstream and find their way to your knee.
If you ever have any unexplained pain, swelling, redness or if you feel unwell you should see your doctor as soon as possible.
On the Patient Info tab under Surgery Day Info page can we correct the After Your Surgery paragraph as follows?
Complications can be medical (general) or local complications specific to the Knee
Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
Blood Clots (Deep Venous Thrombosis)
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Fractures or Breaks in the Bone
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
Stiffness in the Knee
Ideally, your knee should bend beyond 100 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually 10 to 15 years and may need to be changed.
Wound Irritation or Breakdown
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this.
Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Leg length Inequality
This is also due to the fact that a corrected knee is more straight and is unavoidable.
An extremely rare condition where the ends of the knee joint lose contact with each other or the plastic insert can lose contact with the tibia (shinbone) or the femur (thigh bone).
The Patella (knee cap) can dislocate. This means it moves out of place and it can break or loosen.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem.
Damage to Nerves and Blood Vessels
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain.
Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.
Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.