Is A Partial Knee Replacement Better Than A Total Knee Replacement?

In this video I’m going to answer the question is a partial knee replacement better than a total knee replacement. Specifically, I’ll be sharing the differences between the two, as well as when you might choose one over the other.

I’m Dr. David Middaugh. And I’m a specialist physical therapist at El Paso Manual Physical Therapy. And this channel dedicated to helping people stay healthy, active and mobile, while avoiding unnecessary surgery, injections, and pain medications. Please consider subscribing to this channel so that you don’t miss out on any of the helpful tips that we post up here every week.

So first, let’s answer the question what is a partial knee replacements? And then we’ll answer what is a total knee replacement. I’ve got a drawing here that I’m going to use to help me out in my explanation. And just to show you here, what I’m talking about. So here’s partial versus total knee replacement. On this side, right here, we’ve got the partial knee replacements, and this is the thigh bone, the end of the thigh bone.

So this would be the knee right here. I did not draw the kneecap because the kneecap is not affected during a partial knee replacement is what I mean by that is they don’t do anything to the kneecap. I mean, it might hurt behind your kneecap after you have surgery. But they’re not doing any surgery on the kneecap where they’re doing the surgeries where the red marks are.

So they’re typically the surgeon is typically going to operate on the medial compartment you’re going to hear the word compartment don’t run. I’ll explain more about it here in a second. But that’s the inside part of the knee. And they’ll shave off the end of the bone here on the inside part of the knee, the end of the thigh bone, and then they’ll shave off the end of the shin bone on the inside part of the knee as well.

And that’s where they put in the prosthetics or the metal part in a plastic part that and that’s what replaces the ends of the bone where you theoretically have knee arthritis. That’s why they would be doing a partial knee replacements. And you can have this procedure done on the outside of your knee.

It’s not nearly as commonly done as on the inside of the knee. And personally replacements altogether just aren’t as commonly done as total knee replacements for a variety of reasons that we’ll talk about here in a moment. Now the way that this surgery is talked about or marketed by surgeons is they say that it’s less invasive, and that the recovery times faster and that it’s less painful that to explain the compartments of the knee.

There are three compartments that are that surgeons are looking at, you have your inside compartment and your outside compartment and your kneecap compartment to show you what that looks like on the skeleton here. So here’s the end of the thigh bone. So they would if they’re doing a partial knee replacement, you get this part cut off, and then they put the metal prosthetic right there.

And then the top of the shin bone right here would be what’s cut off, and they would put the prosthetic right there. Here’s your kneecap. This is the inside compartment or medial compartment. And then out here is the lateral compartment. And then the compartment. The patellar compartment is right in here. Now looking at a total knee replacement, just to show you the picture here again, and we’ll come back to the skeleton.

This is the end of the thigh bone. Here’s the kneecap and there’s the top of the shin bone, the entire end of the thigh bone is modified, it’s surgically cut, and they put on a big metal piece that covers both ends of the thigh bone. And then on the end of the shin bone, they cut off a layer from the top of the shin bone, and they insert a male prosthetic that sits on top. And then on the back of your kneecap only the back of the kneecap is typically what’s operated on, they put what’s called a plastic button.

Now I’m giving you the very common way that this is done the knee replacements but there are variations. So in case you go to your orthopedic surgeon or you’ve talked to a knee surgeon before and they’ve given you something different, just be aware that there’s varieties of knee replacements. But this is what’s typically done, they’ll do that button on the on the back of the kneecap. And it’s a piece of plastic, very hard durable plastic that interfaces with the end of the thigh bone.

So to show you on the knee, here’s what it looks like. So they use some tools and you can find the surgeries on YouTube of this. You can find videos of surgeries on this both on live patients and on practice devices as well. But they’ll cut off the entire end of both compartments right here and the top of the shin bone, and they’ll replace it with the metal components on both sides. And then on the back of the knee cap right here.

They will shave off some of that as well and put in the button that interfaces with the metal prosthetic, the new part of your knee right there, right here on the end of the thigh bone. Now when compared in the doctor’s office, they usually say well this is more invasive because we’re cutting more bones we have to open you up more versus the partial knee replacement. The incision is a little bit smaller, they work through a smaller window to just affect the inside of the knee versus when they have to do a full or a total knee replacement.

They have to open the knee up pretty well. Why and dislocate the kneecap and versus the partial knee replacement, they typically don’t dislocate the kneecap. So it’s just less trauma to the body, which theoretically means you should recover faster, and it should be less painful. But this is the question that I often get is, which is more painful.

And what you have to understand is, unless you’ve already gone through one of these procedures, then you as an individual aren’t going to be able to compare it to the other procedure. And typically, when people get knee replacement surgery, they’re just getting one or the other. It’s rare that somebody gets a partial knee replacement, and then goes on to have a full knee replacement, it just doesn’t happen too often.

But those are the people that you probably have to ask to get true verification about which one’s more painful and which one takes longer to recover from. But theoretically, based on the amount of surgery that’s done, the total knee replacement does take a little bit longer, and is probably a little bit more painful.

But I can tell you, after having seen that many patients undergo partial knee replacements and total knee replacements, everybody’s a little bit different, and they give you tons of pain medication, which you should be taking. And that generally will not allow you to feel as much pain, there’s of course, a rehabilitation period afterwards, I have seen that it’s a little shorter, in my experience, treating somebody who’s had a partial knee replacement.

As far as getting there, the more time on their feet again, being able to walk being able to be more active, it does come a little bit quicker than a total knee replacements. But totally replacements are far more done, done more frequently than a partial knee replacement, because it does take a little more surgical skill to do the partial knee replacement, whereas a total knee replacement is much more widely taught. It’s a little less skill involved in with a partial knee replacement.

Another question I get is, How soon can you begin to walk after you’ve had either a partial knee replacement or a total knee replacement. And the answer to that is within 24 hours, as long as nothing crazy is happening. No infection, no, nothing went wrong during the surgery, everything was normal as planned by the surgeon, then you’re supposed to be up on your feet and beginning to walk within 24 hours after having the procedure.

And I can tell you being a therapist who’s seen a patient in the hospital, right after having a knee replacement, that first time when you stand up and have to bend your knee and straighten it as you get in and out of bed. It is brutal. But that’s how everyone starts. And it just gets typically easier after that. And it’s necessary to begin to wait bear to put weight through your leg that your knee and use the muscles and begin to walk right after having knee replacement done whether it’s a partial or total, because it helps with the healing and helps get the muscles to work properly.

It helps to put forces through the joints so that it can begin the healing processes and move them along as needed so that you can regain your normal function as close as possible after you have this surgery done. And another common question I get is what if you decide to get a partial knee replacement? Can you have a total knee replacement after and before I answer that you can’t go the other way.

If you have a total knee replacement, then the ends of your thigh bone and your shin bone are completely gone and replaced by metal prosthetics and plastic parts too. And there’s no way you can have a partial knee replacement after that if you mess up your total knee replacements for whatever reason, whether it’s been wear and tear over, you know, years and years and years, and you just wore out the new replacements, or something went wrong and you injured yourself somehow, then what needs to be done is what’s called a knee replacement revision.

So you have to have a revision done to your knee replacements. And they essentially will take out all the old components and put all the new components back in to redo your knee. But if you’re looking at the possibility of having a total knee replacement after a partial knee replacement, it is possible to do that you’re probably going to have to dig and dig for a doctor that will do it. You might have to travel to a bigger city to find a more experienced doctor that’s willing to do it.

Because by and large, those are specialty surgeries. Most surgeons are trained to do you know several types of surgeries but they stick to what they know really well so that they don’t hurt anybody. And the surgeons that are more experienced more trained are the ones that are going to take the risk on doing a surgery on an old surgery. Now something important that I haven’t mentioned to this point is that you need to be a candidate for a partial knee replacement surgery.

You can’t just decide to have one or the other. If only the medial compartment or the inner compartment of the knee is affected by knee arthritis. Only then are you given the option to have a partial knee replacements and that’s also if the skill level of the doctor, the surgeon that you’re working with, if they can do it, because it may be that all they’re able to do and all they’re making available to you as a person with the arthritis is that they can only offer you a total knee replacement for whatever reason.

As in, they don’t have the skill set, they don’t have the parts, it’s not commonly done in your region. So if you know that your knee arthritis is only in the inner compartment of your knee, and you’ve been told that you should get a total knee replacement and you’re considering the less invasive option, then you might need a get a second or third opinion or travel to a specialty surgeon who can do that kind of a surgery for you.

Now, if you’ve got knee arthritis in multiple compartments, you know, the inner compartment, the outer compartment as well as problems with the kneecap and the end of the thigh bone where the kneecap touches it, then you’re looking at probably getting a total knee replacements and getting a partial knee replacement isn’t going to even be on the table for you.

Of course, a guy on the internet, you know a specialist physical therapist on the internet, I’m not a surgeon, you’re going to have to talk to your surgeon to make that incision to make that decision. But they’re going to be the ones that are going to give you the best information possible considering your specific knee that it gives you some more information from the physical therapists perspective on getting a knee replacement.

I would always ask the question of how bad is your knee right now because you might have knee arthritis because it is common again, but it might not be bad enough to need a knee replacement and Your surgeon may not understand that it’s possible to rehabilitate your knee, it may not be beyond saving naturally. And the only option left on your on the table for you is having some version of knee replacements.

If you can fully bend and straighten out your knee and you only get periods in other words, it comes and goes periods of time when your knee hurts. And you generally are able to feel pretty good at some points even though it may hurt. But you can tolerate walking and being on your feet for say 30 minutes or more at a time, then you might have a chance at flaring down your knee arthritis enough to keep it flared down.

And what needs to happen is you need to change your muscles in your hip and knee so that you can offload the pressure inside your knee joint to keep it from repetitively flaring up and making the arthritis progress faster than it should. I can’t tell you how often I see patients here in the clinic that had been told they need knee replacements.

They have X rays showing that they’ve have they have some pretty bad knee arthritis, yet they have full range of motion and they’re not constantly in pain. Maybe they’ve been flared up for the past several weeks or month. But before that they actually were okay, they had some knee pain off and on but they were able to walk and be on their feet just fine.

And then all of a sudden it flared up for whatever reason, they overdid it somehow or they started with exercise. In that case, we can often help people reduce their knee inflammation and get back to the way they were before their flare up and avoid having a knee replacements, which helps him to avoid an unnecessary surgery, then learning how to maintain the muscle strength.

The balance of muscle strength within your hips and knees is what keeps you healthy for the long term. So that you can at the very least delay having a knee surgery or maybe even prevented altogether for the rest of your life. If you’re suffering from knee arthritis and you’re looking for what to do next to avoid having surgery. I’ve got a playlist of all our knee arthritis videos in the description below. And if you’ve got a knee replacement and you’re looking for help with pain after having a knee replacement because it happens all the time, we’ve also got another playlist down in the description below.

That’s helped for people that have had a knee replacement. And I also want to make you aware that we’ve got an online program a full online and on demand program that you can purchase to help you get your knees healthier. It’s called the 28-Day Knee Health And Wellness Boost Program. You’ll find more details about it down the description below. Hey, thanks so much for watching. Please share this with somebody that you think needs to see this information. And I’ll see you in the next video. Bye