Today, when most people suspect or find out they have knee arthritis, many think their only option is a total knee replacement (TKR). Over 15 years ago, a new option known as a partial knee replacement became available for the younger, more active patients as well as those with early joint disease. Until recently, many surgeons prescribed their patients certain replacements based solely on implant survivorship. In other words, how long will the implant last?
A recently published study by The Lancet medicine journal reports that implant survival is an “imperfect measure.” The article goes on to report that,“with this measure, patients who have died, those who undergo reoperations that are not regarded as revisions (such as debridement for infection or manipulation under anesthetic for stiffness) and those who have poorly functioning, but unrevised, knee replacements, are all classed as successes.”
The study included over 100,000 patients, 75,996 of which had received total knees (TKR) while the remaining 25,334 patients received a unicompartmental knee replacement (UKR), also known as a partial knee replacement because it only replaces half of the joint. The study found that “patients undergoing TKR are at increased risk of medical complications; they are twice as likely to have a venous thromboembolism, myocardial infarction, or deep infection, three times as likely to have a stroke, and four times as likely to need blood transfusions when compared to the UKR population. As a result, these patients are four times more likely to die during the first 8 years. Inpatient stays are longer, and re-admissions are more likely after TKR than after UKR.”
Partial replacements and joint restoration implants like the HemiCAP® are showing great results and offer the younger, more active patient an innovative, joint preserving option. Even if an implant need to be revised sometime down the road, it will most likely be revised to a primary joint replacement which is more bone sparing and less complicated than a true revision surgery.
As patients are living longer with more active lifestyles, many need to determine which options can help bridge the gap between early biological treatments and total joint replacements. This is an important reason why success needs to be measured by criteria other than just implant survivorship. Today, the main concern is not only how long the implant lasts, but how much activity, function and risk is associated with each surgery. New joint preserving options, like the HemiCAP, offer hope to those who thought a TKR was the only choice they had.