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 techniques have improved markedly making it a very successful procedure for unicompartmental arthritis. Recent advances allow us to perform this through smaller incisions and therefore the procedure is not as traumatic to the knee making recovery quicker.
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
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 and a tourniquet applied to your upper thigh to reduce blood loss. Surgery will take approximately two hours.
The Patient is positioned on the operating table and the leg prepped and draped.
A tourniquet is applied to the upper thigh and the leg is prepared for the surgery with a sterilizing solution.
An incision around 7 cm is made to expose the knee joint. Smaller incisions are made if the surgery is done using arthroscopy.
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.
Once stable, you will be taken to the ward. The post-operative protocol is surgeon dependant, but in general your drain will come out at 24 hours and you will sit out of bed and start moving you knee and walking on it within a day or two of surgery. The dressing will be reduced usually on the 2nd post-op day to make movement easier. 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 orthopedic surgeon will use one or more measures to minimize blood clots in your legs, such as inflatable leg coverings, stockings and injections into your abdomen to thin the blood clots or DVT’s, which will be discussed in detail in the complications section.
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 remain in the hospital for 3-5 days. Depending on your needs, you will then return home or proceed to a rehabilitation facility. 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 six weeks.
Your sutures are sometimes dissolvable but if not, are removed at approx. 10 days.
Bending your knee is variable, but by 6 weeks it should bend to 90 degrees. The goal is to obtain 110-115 degrees of movement.
Once the wound is healed, you may shower. You can drive at about 6 weeks, once you have regained control of your leg. You should be walking reasonably comfortably by 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 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 blood stream and find their way to your knee.
If you have any unexplained pain, swelling, or redness or if you feel generally poor, you should see your doctor as soon as possible.
Complications can be medical (general) or local complications specific to the Knee
Medical complications include those of the anesthetic and your general wellbeing. Almost any medical condition can occur so this list is not complete. Complications include:
Discuss your concerns thoroughly with your Orthopedic Surgeon prior to surgery.