“I cannot understand why more surgeons are not adopting partial knee replacement into their practice and why surgeons are not performing partial knee replacement on a much higher proportion of patients than they currently are.” Nick London considers who’s to blame for the failure.
All knee replacements can reduce the pain of osteoarthritis and help patients recover the freedom their arthritis has denied them. For many patients, a partial knee replacement (where one compartment of the knee is severely affected by arthritis) confers even greater advantages than a total knee replacement (where more than one compartment of the knee is affected).
Partial knee replacement surgery carries approximately one third of the risk of infection or blood clots compared to total knee replacements. Hospital stays are shorter. Recovery time is swifter. Patient dissatisfaction is less than 5% with partial replacements, compared with 10%+ for total. Crucially, patients recover greater function with a partial knee than they do a total knee.
Partial knee replacement rates a fraction of what they could be
Currently in England and Wales, according to the latest National Joint Registry report, only 14% of patients are receiving partial knee replacements. In Denmark (where, admittedly, revisions rates are higher) the figure is above 25%. In my opinion, that figure could and should be closer to 50-70%.
I cannot understand why more surgeons are not adopting partial knee replacement into their practice and why surgeons are not performing partial knee replacement on a much higher proportion of patients than they currently are.
Or rather, I can understand why, but I fear it must represent a failure of surgeon education, training, and awareness. We as training surgeons, together with the orthopaedic associations, medical device companies and others worldwide must share some of the responsibility for failing to educate and train tomorrow’s surgeons.
It has been encouraging that the National Institute for Health and Care Excellence (NICE) mandated in 2022 (*pdf) that all patients who are deemed suitable for partial replacement must be offered it, but that is clearly not yet being applied across the country.
As a response, we have requested that companies do more in terms of education regarding fixed bearing partial knees, but post-Covid we have seen very few such educational events, and I’m unable to understand why given the overwhelming success of this surgery.
For our part, we’ll be running a two-day meeting focusing on fixed-bearing partial knee replacement in Harrogate in spring 2024, but we need collective action to raise the volume of partial knees and enjoy the many benefits – for patients and for stretched health services – that they can offer.
What Is A Partial Knee Replacement?
As we explore here, your knee has three major compartments
What Is Osteoarthritis?
What does osteoarthritis look like? What are the symptoms? And short of surgery, how do you treat it?