KNEE ARTHRITIS - Unicompartmental knee replacement :

lateral partial knee replacement - - Posted by Arli (Arli), 2 March 2003

Why is a lateral partial knee replacement controversial? My doctor won't do it, but I have read about others who have.  I am a young 37 and my arthritis is on the lateral side of my knee.  I lack full extension following ACL reconstruct in 1989, followed by 4 scopes to remove scar tissue.  My athletic activities are increasingly problematic, and although my doctor says I am a candidate for this procedure, it is not yet widely accepted.  WHY NOT?
Posted by JG (JG), 3 March 2003

Have you thought about some type of osteochondral grafting procedure?  Essentially, I am having a good portion of my knee "biologically" replaced (my OS's phrase).  I am having my entire trochlear region plus a small spot on my medical condyle and a larger portion of my lateral condyle.  When I was first informed of the damage in my knee (after surgery in August), I was told that my next step was knee replacement.  I said no to a knee replacement or partial knee replacement.  My OS gave me the option of a mosaicplasty.  Granted this is stretching the boundries of this procedure.  Worse case scenario, I am converted to a knee replacement.  Like you, I am young, 34.  It is an option, but very few OS will attempt to stretch it this far.  I have talked to two of the better known surgeons who specialize in joint resurfacing.  Both said that if they fixed my knee it would be the largest restoration procedure they have done on a single knee.  But I have many pluses in my favor.  I am young, very active, manage my condition effectively, heal extremely quickly, and am very motivated.  If you have questions, let me know...J
Posted by jathib (jathib), 3 March 2003

I'm not sure why it's controversial but from all I've read it has the same drawbacks as a total knee replacement. In young, active people it will simply wear out and require revisions. You can only do so many replacements before the bones in your leg just wear out. I also have arthritis on my lateral side. I have no meniscus at all. My OS is recommending an osteotomy which he says will buy me 10 years before I need a total knee replacement. But he wants me to wait as long as possible. I'm 45 now and he would still like me to wait unti I'm at least 50 if I can do it.
Posted by debby17 (debby17), 21 July 2003

Hi Arli,
I just had a lateral partial knee replacement, and I "think" it was successful.  My reason for having it wasn't arthritis...but,

Last Dec. I had a skiing accident, and fractured my lateral tibial plateau and tore my meniscus (sp?..anyhow, the OS put in a plate and 5-6 screws and sent me home.  I was non-weight bearing for 8 weeks, then started partial etc.  I was a "good girl", going PT 3x's a week, got to 125 ROM...but...always the but...I became severly knock-kneed, my surgery had failed...and my leg was deformed.  But, the worst thing was the CONSTANT pain I was in.

My OS decided to do the uni-knee replacement, and to build up my bone where the break had failed, and then put the uni-knee in.  I'm 4 weeks post-op, still not weight bearing (he wants to wait 8-12 weeks so my bone graft can heal...he's being more conservative this time)..I'm 120 degrees ROM and -2or3or4 when straightening....all in all...my pain is a 0-2 compared to a 10 post surgery...and my knee and leg look STRAIGHT again.

I'm all for this surgery, mine was due to different circumstances, but I believe it worked!  I live in AZ...I went to 5 OS's and only ONE wanted to do the partial (everyone else was pushing for TK).

Debby
Posted by karenk (karenk), 6 August 2003

I'm trading in my Unispacer for a PKR (Zimmer model). I can't stand the discomfort and pain any longer. If I had know last year that a Unispacer had a 30-40% failure rate, I would have had a PKR in the 1st place. If anyone has anything good or bad about a partial, any information is greatly appreciated. Thanks, Karen
Posted by debby17 (debby17), 7 August 2003

Hi Karen-
I had a PKR 2 months ago, and I'm VERY pleased with it.  I got the Zimmer model, my OS was very familiar with doing the uni-knees...mostly for osteoarthritis patients.  I'm 52 and had a skiing accident and fractured my tibial plateau, had an operation with a plate and screws...I was NEVER out of pain, and my knee healed (well actually in 6 months it never healed)& I was very knock kneed.  My OS had the idea to perform the PKR on the lateral side, take the plate out and do some bone grafting where the bone hadn't healed.  Post surgery there was some discomfort, but really...now it doesn't hurt, & I'm at 130 degrees ROM.  Since my bone graft is still healing, I'm still on crutches (to be conservative with the outcome...fine by me).  If you have any other questions, you can email me at debby17@comcast.net.
Posted by karenk (karenk), 7 August 2003

Thanks Debby. Just hearing someone with a Zimmer partial that's happy is good news to me.  karenk@ispwest.com

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