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  • Q&A with Australian Health Practitioners

    Should I consider a partial knee replacement?

    Related Topics
    Orthopaedics Pain
    I have a long history of knee problems, arthritis, knee swelling, dried out cartilage, bone bruising, Meniscus partial removed etc. I rather don't have any injections in the knee joint as I believe this is more a bandage than a solution. I'm in chronic pain and I was reading into partial knee replacements, however in Australia surgeons don't want to perform this surgery before you're 50 plus. In Belgium they are much easier about this, why? I can't see myself getting to 50 with a knee like this. Are there any surgeons who wouldn't mind to look at my case? My lower back doesn't help either as I have severe narrowing at the lower 2 vertebrae's what makes my left leg bend backwards. I'm only 32 years old.
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  • 7

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    Dr Chien-Wen Liew

    Orthopaedic Surgeon

    Adelaide Orthopaedic HIP, KNEE and SHOULDER Surgeon specialising in Sports Injury and Joint Replacement. View Profile

    You are in a difficult predicament. The reason why there is a reluctance to perform joint replacement surgery on you is mainly due to your age. Our research shows us that younger patients do not do well with arthritis. The first step is to determine how bad your knee is. I am guessing from what you have written that you have had key hole (arthroscopic) surgery in your knee. This will show how bad the arthritis is, and for a younger patient, is usually all that is required - especially if it is just meniscal. Arthroscopy of the knee does not help with established arthritis. 

    A partial knee replacement is also called a Unicompartmental knee replacement. Your knee has 3 compartments. In 9 out of 10 cases, the compartment that is diseased is the medial compartment. If the other 2 compartments are preserved, then a unicompartment replacement is suitable. 

    The reason why it is not preferred is that it has a much higher rate of revision than total knee replacement. Total knee replacement has a revision rate of around 7.2% at 14 years, whilst it is 20.5% at 14 years for a Uni. This is even worse if you are under 55. You revision rate jumps to 31.8% at 14 years. This is all Australian data. You are a long way from 55. 

    In some cases, knee replacement surgery can be considered in young patients in severe situations. Each cases needs to be fully assessed to ensure that your surgeon is doing the correct thing by operating on you. Your back does not help you symptoms, and the one danger here is if your back is contributing a lot to your knee symptoms. It may take some time to work out which element causes you the most issue, but at the end, the right decision needs to be made. 

    I hope this helps to answer your question. 

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  • 6

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    Dr David Agolley

    Orthopaedic Surgeon

    Dr David Agolley is an Australian trained Orthopaedic Surgeon, with specialist expertise in hip and knee surgery. Special interests are robotic and computer assisted hip … View Profile

    Dr Liew has made excellent points above and I agree. Unfortunately, there is no reliable way today to restore your knee back to its health when you were a teenager.  All treatment now be it no surgery, or surgery are band-aid solutions. There is no recovering your God given cartilage.

    Speak to your orthopaedic surgeon and re-consider non operative treatment like injections, and an off-loading knee brace fitted by a trained orthotost. Don't just buy a brace online to save money, as they are special devices that need to be fitted properly.

    If you are considering surgery, depending on your condition, there may be a few options for you. Read in to a procedure called high tibial osteotomy. Under the correct circumstances, it may be the better option for you when you exhaust conservative measures. 

    Good luck.

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  • 3

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    Dr Siva Chandrasekaran

    Orthopaedic Surgeon

    Unfortunately management of arthritis in the young adult is a difficult problem with no easy solutions.  The first line of treatment would usually consist of activity or occupation modification and mantaining the strength and flexibility of the joint with physiotherapy.Pain medications such as anti-inflammatories and injections such as cortisone or hyluronic acid may help relieve symptoms of acute exacerbations.  

    Surgical options would centre around joint preservation procedures such as osteotomies or realignment of the knee to help unloaded the affected portion of the knee.

    Unfortunately joint replacement in the young adult does not have favourable long term results.  Moreover, the sucess of subsequent revision surgeries becomes less and less.  The conversion of the uni-compartmental knee replacement to a total knee replacement does not perform as well as a primary total knee replacement.  However, I have found that robotic assisted partial knee replacement as increased the precision of component positioning but the long term survivorship studies are still pending.  

    I generally would not advocate a joint replacement procedure for someone in their thirties and would suggest a joint preservation procedure such as an osteotomy if surgery is required.

    All the best!!

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