Knee replacement options: partial, full, robotic or 3D-printed?
There are lots of ways to replace a knee - but which is best? Should you have a partial or full knee replacement? Are robotic techniques and 3-D printed replacements worth the extra cost? We asked expert orthopaedic surgeon Professor Ali Ghoz:
What are the main types of knee replacement surgery?
When we talk about the types of knee replacement surgery, we’re mainly talking about how much of the knee is being replaced. Knee replacement can be classed as partial or total, and partial knee replacement can be further divided into one component or two component replacements.
Many people ask about “3-D printed” knee replacements, and “robot-assisted” knee replacements. These are best thought of as techniques to help us perform a successful well-aligned knee replacement. But the first decision has to be either to have a partial or full knee replacement.
Which type of surgery is better?
The most preferable from a functional point of view is a partial knee replacement involving just one component (often known as a unicompartmental knee replacement). It’s less invasive and the functional outcome is better – it will feel like almost like a more normal knee. This is because we only replace the damaged side of the knee and preserve the rest of the knee’s biomechanics and ligaments. In contrast, bicompartmental and full knee replacements tend to result in a knee that doesn’t feel quite natural.
However, not everyone can have a partial knee replacement. Your ligaments have to be intact, the damage must only be in one part of the knee, and the bone quality needs to be good. Finally, associated deformities likely require a total knee replacement rather than a partial knee replacement.
Should I have a 3D-printed knee replacement?
The aim of a 3D printed knee is to create a knee that fits the patient – after all, some people will have small knees, and other people bigger knees.
The printing is carried out as part of the preoperative planning process. A 3D scan of the knee is made and the customised knee replacement is then printed.
The idea of making the knee to fit the patient exactly is intuitively attractive, and many people believe it is likely to last longer and result in fewer complications. However, so far nobody has been able to show there is a long-term difference in outcomes compared to the use of a standard knee replacement.
Should I choose a clinic which offers robot-assisted surgery?
With robotic assistance, we can achieve better alignment with our implants, and this is clear on the X-rays we look at. All procedures are carried out by a surgeon who is trained in performing knee replacements using the robot.
Generally, robot-assisted surgery results in less postoperative pain and an earlier return home. However, as with the use of 3-D printed knee replacements, there is still no clear evidence that the outcomes of this change in the long term.
What should I expect after surgery?
It’s normal for your knee replacement to have a minor “click” or “clunk” – especially after full replacement. This tends to get better in time – but there may always be some clicking between the metal and plastic in your knee. 1 in 5 people who has a knee replacement will always have some pain in the knee. There might be some stiffness in the knee and the scar can have some associated numbness. A patient with a knee replacement may have difficult kneeling after the operation. The knee replacement side always feels warmer than the native side. There is usually some permanent swelling around the knee replacement. The scar can be a bit sensitive and tender. It takes a full year to get used to a knee replacement.
You should also seek medical advice if you experience:
• unexplained severe pain
• episodes of the knee giving way
• any signs of infection, such as leakage
• any signs of loosening
• How long does a knee replacement last?
• The average knee replacement lasts around 10-15 years.
95% of total knee replacements survive for about 10-13 years, whereas partial knee replacement have a shorter life span (8-10 years). This is usually because of the deterioration of arthritis, and replacement with a full knee replacement is necessary the second time around.
The lifespan of knee replacements has improved in recent years. This is because materials have improved and the way we sterilise implants have changed. In modern knee replacements, we tend to use high-strength plastic inserts, ceramicised oxinium, and customised implants.
Finally, the way we cement the join to the bone has changed. Cemented knee replacements survive longer and have fewer complications than uncemented knee replacements
The drive is ultimately to make the implanting of the knee perfect. The materials we now use certainly make a difference, but it remains to be seen whether techniques such as robotic assistance or 3D printing will improve outcomes and satisfaction rates in knee replacement patients.
To book a consultation with Professor Ali Ghoz concerning your knee replacement options, click here.