October 3, 2002
Knees in need of surgery?
You’ve tried over-the-counter painkillers, maybe glucosamine or chondroitin, modified exercise and even injections to calm the pain in your arthritic knees. Despite your best efforts, nothing seems to stop the discomfort of osteoarthritis for more than a few hours, and sometimes it wakes you up at night. You may be at the point where you’ve started thinking about knee surgery, and wondering about your options.
For about 20 years, total knee replacement, known as total knee arthroplasty or TKA, has been the surgery of choice. Dr. Seth Leopold, associate professor in the Department of Orthopaedics and Sports Medicine, calls the TKA one of the most successful surgical innovations of the 20th century.
“Traditional TKA represents between 80 and 90 percent of most knee replacements,” Leopold says. “Over 90 percent of TKAs are still functioning 10 years after surgery, a very good batting average.”
There are some drawbacks to TKA. The recovery period immediately after surgery can be arduous, although that has been improved by use of epidural, or regional, anesthetics rather than general anesthesia.
“Recovery from TKA still requires a commitment from the patient,” Leopold says. “You have to be willing to push through a certain amount of discomfort and you have to be emotionally and physically prepared to spend some time with a physical therapist. Recovery from this surgery doesn’t happen automatically.”
A small number of patients, about 10 to 15 percent of the people who are candidates for knee replacement surgery, have a second option, minimally invasive partial knee replacement. Since this operation replaces only one of the three compartments in the knee, it is sometimes called unicompartmental knee arthroplasty, or UKA.
“This surgery addresses the problems of patients who have arthritis in only part of the knee, but the pain is severe enough that they want to have a joint replacement to relieve it,” Leopold says. “Doing a total knee replacement for a patient like that seems like more surgery than they need, because the surgeon has to cut out a fair amount of normal tissue in order to implant a TKA. We don’t like to take out normal tissue.”
For the right patient, UKA has some advantages. The success rates for partial knee replacements in general are very close to those for TKA 10 years after surgery. The incision is smaller, about three inches long compared to six to eight inches, and discomfort right after the surgery is noticeably less.
“With this new approach, the hospital stay is shorter, the post-operative pain is reduced, the blood loss is minimized so the likelihood of transfusion is low, and rehabilitation is about three times quicker,” Leopold says.
Another big advantage is that patients who have had UKAs feel like the knees are almost normal, in contrast to TKA recipients who often report that the replacement — while a big improvement over the old arthritic joint — feels different or unusual in some way.
The decision to have a knee replacement, and what kind to have, is one that you and your family must make with information provided by your doctor. Either type of surgery requires time in the hospital, as well as some physical therapy.
“You have to weigh the potential risks of surgery against the potential benefits to your quality of life,” Leopold says. “The decision of whether to have knee replacement surgery and when is profoundly personal, and the patient shouldn’t feel any pressure from the surgeon to make that decision. When they feel ready, that’s when we do the surgery.”
Leopold joined the UW faculty this summer and will be practicing primarily at the Eastside Specialty Center and UW Medical Center.
