People Waiting at Hospital

We know that for the under 50s and the elderly, total knee replacements can present challenges. But what’s the position with partial knee replacements? New research by YKC’s Nick London, Dave Duffy and others seeks to find out.


Total knee replacement in the young

A knee replacement will present very different issues depending on your age. Younger patients (in knee replacement terms, that means under-50s) will almost certainly require some type of revision surgery later in life because, while implants are lasting longer than ever before, we’re not yet at the point at which they’ll last 35 or 45 years. The sooner those revisions begin, the faster the options for (and results of) further revisions diminish. This is why knee surgeons will generally be extremely reluctant to carry out knee replacements – and especially total knee replacements – in the young. Put simply, you don’t want to exhaust your options for knee replacement too soon.

But it’s not just the law of diminishing revision returns that presents a problem. Functional outcomes for total knee replacements (TKRs) in the young are often surprisingly disappointing, possibly because this age group has much higher expectations of the outcome, and is perhaps more likely to want to push the performance of their new knee than older age groups might.

> Discover more about knee replacements


Total knee replacement in the elderly

At the other end of the age range, we see a different set of issues. Older patients are more likely to have a range of conditions beyond their osteoarthritis. They may also be at higher risk of experiencing complications related to the surgery itself, the anaesthetic or the period of mobility in hospital or at home following surgery. While knee replacements are not to be discounted purely because of age – assessment should always be made based on a range of patient factors of which the risks associated with age are just one – it is true to say that elderly TKR patients are more likely to experience a rockier, less predictable course to recovery.

> Discover more about Osteoarthritis
> Discover more about knee replacements


Partial knee replacement performance and satisfaction

We wanted to explore the situation for partial knee replacements (PKRs) and carried out a study of 229 PKR patients to understand their satisfaction levels and the functional outcomes of the knee. You can find more about the study here.

In the younger age group, patient satisfaction was extremely high and identical to the rest of the cohort. Functional outcomes showed significant improvement on the wider patient group, although this may simply be a reflection that younger patients are inevitably more likely to want to do more with their knees. In terms of function and satisfaction, we saw no sign of the issues that we often see with total replacements.

This is very encouraging news for a group of patients who, in addition to the functional advantages seen above, will also benefit from the reduced risk and increased bone preservation inherent in partial knee replacement. This increases the chances of having a successful total knee replacement in later life, should they need it.

It was a similar story with our elderly patient cohort. Partial knee replacement enables a much more rapid and predictable recovery, and it’s much rarer for a PKR to compound other medical issues because the surgery is smaller. The length of hospital stay was the same for older and younger patients.

Functional outcomes were as good in the elderly as for those in the middle age range of our patient group (although, for obvious reasons, they were not quite at the level of our youngest patients). Those elderly patients who wanted to return to a high level of activity, however, were able to do so.

> Questions about your knee surgery?


The Forgotten Joint Score

Something else notable among our elderly cohort was the high Forgotten Joint Score (FJS) achieved by their knee replacements. The FJS is a measure of patient satisfaction which looks at how aware a patient is of their implant in everyday situations such as sleeping, walking or climbing the stairs.

We know that hip replacements tend to have a very high FJS. Patients effectively ‘forget’ that they’ve had a replacement because their joint doesn’t remind them about it very often. Total knee replacements tend not to perform as well and rarely get close to the score of hip replacements… but partial knee replacements do.


Age not a factor for PKRs

Our research should help alleviate some of the traditional concerns about performing knee replacements in the very young or old. For those whose symptoms are sufficient for them to be offered some form of knee replacement surgery, and providing other factors support the procedure, age need not be a barrier to enjoying the benefits of partial knee replacement.

Read the abstract here:

If you’re exploring your knee replacement options, contact us or phone us on 03453 052 579.

> Discover more about Nick London
> Discover more about knee replacements
> Discover more about Osteoarthritis
> Questions about your knee surgery?

Prof. Nick London

Prof. Nick London

Private appointments weekly at The Duchy Hospital Harrogate & Nuffield Hospital Leeds

Private Secretary

Lou Nellies
01423 369 119

Email Nick


Knee replacement x-ray

Can I Have A Knee Replacement?

What’s the difference between a total & partial knee replacement? And is either right for you?

Osteoarthritis knee treatment

What Is Osteoarthritis?

What does osteoarthritis look like? What are the symptoms? And short of surgery, how do you treat it?

Treatment FAQs, your questions answered

Treatment FAQs

Here are some of our knee specialists’ most frequently asked questions for some of our most common procedures

Internet Explorer is no longer supported.