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PostPosted: 06 May 2018 00:31 
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Many more people facing surgery for knee problems would be better off with a partial rather than total knee replacement, which should allow them to recover faster, say experts.

Partial replacements are also cheaper, say researchers from Oxford University. The NHS, however, needs to get the support of surgeons, many of whom rarely carry out the less invasive procedure.

Partial replacements, also known as unicompartmental replacements, are suitable for people who have arthritis in just one side of the knee, usually the inner. They can be carried out with a smaller incision using minimally invasive surgery, but they are only suitable for people whose ligaments inside the knee are strong.

Researchers from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) publishing in the journal found that the less invasive procedure was being used less than it could be.

The main reason for the surgery is osteoarthritis. About half of all patients should be suitable for a partial replacement, but an analysis of data routinely collected by the National Joint Registry showed that of 98,147 knee replacements undertaken in 2016, only 9% were partial.

“The main strength of this study is that we were able to use real data, from very large numbers of people, about their actual operations, their GP visit, and their own reported quality of life outcomes in a way that is not always possible,” said Dr Rafael Pinedo-Villanueva, the co-lead researcher and NDORMS senior health economist, who is funded by the National Institute of Health Research Oxford Biomedical Research Centre and the Medical Research Council. This has allowed us to provide strong proof that partial knee replacements are both better for patients and cheaper for the NHS.”

The researchers found that whether a patient had partial or total knee replacement depended on the surgeon, as did the success of the operation. Those surgeons who carried out more partial replacements had better outcomes from them than surgeons who did fewer.

“This is an important finding,” said co-lead researcher Prof David Murray. “If surgeons aim to use partial knees in a quarter or more of their knee replacements this will substantially improve the results of knee replacement and will save money. In addition, more partial knee replacements will be done and more patients will benefit from this procedure.”

Ed Burn, first author of the paper, said they needed to get surgeons on board. “For patients and the NHS to see the benefits of partial replacements, we need the buy-in of surgeons, who would need to feel comfortable performing a greater proportion of their knee replacements as partials,” he said.

“If we see surgeons carrying out this procedure more often, the proportion of knee replacements that are partials would increase from the current figure of 9% and we would see an increase in future economic and populat"

This report was published in the Guardian.


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PostPosted: 06 May 2018 13:46 
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John Goodfellow and John O’Connor designed the Oxford unicompartmental knee in the early 80s. This joint was used mainly in Oxford for a long time. After the publication of many papers other hospitals also started using the joint. However widespread use of this joint never happened. This present paper which advocates Unicompartmental Knee Replacement comes from Oxford!

It is true that it is a simpler procedure compared to total replacement. However instrumentation for precise placement of the joint was never as good as for a TKR. This paper does say that more a surgeon uses this joint the better the result. This is true for any surgical procedure. However when a less experienced surgeon does a TKR, his results are much better than when a less experienced surgeon does a partial replacement. This is the reason why more surgeons opted for TKR than a Uni knee.

I would opt for a Total Knee Replacement than a Uni knee because even when arthritic changes are confined to one compartment, often minimal arthritic changes are usually present in the other compartment too. If that progresses the patient will need a second replacement for that compartment too. Hence very careful assessment of the joint prior to surgery will be required to decide if Uni Knee is suitable for that patient. May even need arthroscopic assessment before a Uni Knee.

There are many other reasons why surgeons prefer to replace the whole joint. The present day TKR is a highly precise procedure and the long term results are brilliant. Why then would a surgeon consider a Uni Knee!


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