Valencia meeting agrees partial knee replacement now the gold standard
The open meeting of the Valencia European Knee Society earlier this month saw an important consensus reached that shifted the balance from total to partial knee replacement. Prof. Nick London explains.
The European Knee Society (EKS) holds two types of meetings. Annual closed meetings (such as the one that took place in France earlier this year) provide a ‘safe space’ for knee surgeons to debate, challenge and suggest alternatives to current thinking. You can read more about the EKS closed meetings here.
Then there are the biennial open meetings, which this year included a mix of around 550 experienced surgeons, new consultants and trainees. Here, the debate of hot topics is combined with instructional and educational sessions, and this year’s event was perhaps the best yet in terms of striking the right balance between questioning, information and discussion.
Partial Knee Replacement – the Technique of the Past the Present or the Future?
On the first day of the Valencia conference I gave an instructional lecture on partial knee replacement with the above title. I presented evidence to support the fact that the balance of medical opinion has shifted in favour of partial knee replacement (PKR) – with the advantages of PKRs outweighing the advantages of total knee replacements (TKRs) in suitable patients.
If you’re not part of the medical profession, it might seem odd that a procedure we carry out on a daily basis might still be ‘fighting’ for legitimacy, but this is how medical science progresses. You gather data on a new procedure and compare it to the existing procedure. Over time, the positive data on the new procedure may be enough to usurp the old one.
That’s what we’re seeing now with partial knee replacements, as years of data now support the consensus view that PKRs…
- Substantially reduce surgical risk
- Deliver better outcomes on average than TKRs
- Enable more rapid recovery than TKRs; and
- Result in a knee that feels more natural – allowing many patients to return to everyday activities and a greater proportion of patients to return to advanced sporting activities
Partial knee replacements are not the answer for every instance of knee wear and tear. They are not appropriate when two or more compartments of the knee are worn – that would still require a TKR. But where just one compartment is affected, the balance has now shifted to the PKR.
That shift of balance was not a forgone conclusion, and whilst one significant stumbling block has now been overcome, another remains.
The fact that PKR has not been available more widely is in part down to the views of some key opinion holders who looked at 10 year implant survival rates and saw that total replacements had the edge on partial replacements. Increasingly, that view has looked a little outdated. The difference simply isn’t that great (96% 10 year implant survival for TKRs; 94% for the best performing ‘fixed-bearing’ PKRs). And doggedly supporting the TKR purely because of its survival rate is a little bit like doggedly supporting Nokia in the face of the launch of iPhone because the battery lasts longer. It may be true but it ignores the many other advantages that more than compensate for the marginally poorer longevity.
One issue that remains, however, is training. We need to work harder to ensure that all surgeons in training are exposed to partial knee replacement techniques so that more patients in the future can benefit from the advantages.
Because as the summarising moderator noted, agreeing with the concluding statement of my lecture, in suitable patients, partial knee replacement should now be considered the gold standard.
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