Minimally Invasive Knee Surgery - An alternative to Total Knee Replacement

Patients who have arthritis on the inside or outside part (compartment) of the knee may not need a total knee replacement to relieve pain and restore function. An alternative option, Partial Knee Resurfacing (PKR), restores only the side of the knee that is damaged by arthritis. A PKR implant is much smaller than a total knee implant and does not disturb the knee’s healthy tissues.

History of Partial Knee Resurfacing

The first PKRs date back to the early 1970s and, like early total knee replacements, showed mixed success. But, over the last 25 years implant design, instrumentation, and surgical technique have improved, making PKR a successful treatment when osteoarthritis is advanced in one compartment of the knee.

Partial Knee Resurfacing restores the knee’s damaged compartment.	Total Knee Replacement resurfaces all three compartments of the knee.

How Long Might a PKR Implant Last?
All knee replacements have a limited life expectancy. A current review of orthopedic literature shows that a modern PKR lasts in the 10- to 12-year range, depending on the patient’s age, weight, and activity level. Many orthopedic surgeons around the world report a success rate of about 92% at 10 years, indicating that many patients have long-term enjoyment of their PKR.

Why have a PKR?
Smaller Incisions/Hidden Sutures
  First, the entire knee is examined using a video camera and an arthroscope. If the kneecap and one weight-bearing surface appears healthy, then a PKR is indicated.
 
For a PKR, a 3" incision is made, rather than the 12" incision required for total knee replacement. For a more pleasing appearance after surgery, small, self-dissolving sutures, like those used by cosmetic surgeons, are hidden underneath the skin. No external sutures or skin clips are used.
 
No Blood Needed
Patients are often required to donate blood before total knee replacement, providing blood to replace the quantity lost during surgery. A PKR does not require a blood transfusion.
 
Overnight Hospital Stay 
Benefits of a less invasive procedure include less discomfort, a shorter hospital stay, no physical therapy, and more rapid healing.
 
Most patients walk on their resurfaced knee the same day as surgery and are generally released from the hospital the next day. Within two weeks, most patients are driving a car and resuming daily activities. With total knee replacement, recovery time can be four or five times longer. Also, with total knee replacement, extensive physical therapy may be required.
 
Less Bone Removed 
Only about 1⁄4" of bone on one compartment of the knee is removed to properly fit the implant. In total knee replacement, all knee surfaces lose up to 1⁄2" of bone on each of the three compartments. PKR implants save more bone so that future total knee replacement procedures can be more easily performed, if necessary.
 
No Physical Therapy 
After PKR, a few gentle exercises and progressive walking to help strengthen muscles is the only rehab necessary.

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Who Can Benefit From PKR? 
The treatment is designed for patients whose x-rays show arthritis in one knee compartment and who have not had satisfactory pain relief with non-surgical treatment.
 
When shots and pills fail and lifestyle is impaired, a PKR can be a step in the right direction.
 
Knee x-rays, taken while standing, can indicate if a PKR procedure may be right for you. The x-ray must show loss of cartilage in one of the knee’s two weight-bearing compartments.

X-rays showing a healthy knee (left) and loss of cartilage and formation of osteoarthritis (right).

Progress Chart

These are general guidelines and represent average experiences for people who are patients of The Florida Knee and Orthopedic Centers. Keep in mind that healing and recovery times will vary with each person. After joint replacement singles tennis, jogging and heavy weight lifting are not generally recommended activities.