***This blog will be expanded for a revision of my knee replacement book to include a chapter on partial knee replacements vs total knee replacements as well as a chapter on the future of high tech in the operating room. Image guided and robotically assisted surgery, pressure sensitive initial components to assist with proper placement and gapping, etc…The following is a preview…***
One thing I love about my profession is that it’s constantly evolving and moving forward. Research tells us what best practices are, continuing education classes bring thought leaders on various techniques and theories into a classroom style teaching atmosphere. In Oklahoma I’m required to have 40 hours of continuing education every two years to maintain my PT licensure. I’m not going to say I enjoy the cost or that I enjoy giving up a weekend to attend a course, but I’ve never left one without learning a great deal. I always leave courses with more tools in my toolbox, and that is always a benefit to the people I get to work with.
Up until two years ago I would never have recommended a partial knee replacement. I don’t know the exact percentages, but almost every patient I worked with that had a partial, within 1-2 years, would undergo a revision to a total knee replacement. That means more opportunity for infection. It also means more bone loss and scar tissue as the old partial has to be removed down to good healthy bone for the new total knee prosthetic pieces. It also means more pain as clients would have to start their rehab all over again. Why recommend something that would likely result in twice the surgery, or worse?
So what happened two years ago? I went to an orthopedic symposium put on by a local hospital group. Several orthopedic surgeons spoke on varying topics from ACL reconstruction to minimally invasive spinal surgery. One of the surgeons speaking at the symposium performs partial knee replacements via something called Makoplasty. Dr. Paul Jacob performs these regularly and spoke to the group for an hour on Mako assisted partial knee and total hip replacements. Currently surgeons are performing Mako on partial knees, total knees and total hips.
Without getting too in depth, what sets Mako apart is that it is an image driven procedure. That means you have a CAT scan prior to surgery and the procedure is totally based on your anatomy. To indirectly quote him, We make the components fit the patients anatomy, not making the patient fit the components. In not so many words, the fit is much closer to your specific and normal anatomy. The end result of a Mako partial knee replacement is that it functions very much like your normal anatomy and is dialed down to the millimeter.
Briefly I’m going to list a few advantages and disadvantages to a partial knee replacement performed via Makoplasty. The list is indeed longer for both, but these are the high points.
Advantages:
- The fit is much closer to your normal anatomy. Much closer!
- All knee ligaments (ACL, PCL, MCL and LCL) remain intact.
- The meniscus on the opposite side remains intact. The vast majority of partial knees are performed on the inside section of the knee (medial side), so you would retain your lateral meniscus.
- The recovery is significantly faster. Mere weeks instead of months.
Disadvantages:
- Radiation. You are exposed to radiation due to the fact that you undergo CAT scanning.
- Possible pinsite fractures. (rare) During the procedure a metal pin is drilled into the shin bone (this is another way they make it extremely accurate), but a hole in the bone takes time to heal and can potentially weaken your shin bone, increasing the potential for fracture.
- Possible incision injuries. People are recovering so much faster that there have been instances of wound dehiscence (incision coming open) due to people being able to push further, too soon following surgery.
The bottom line is this is a decision that you and your surgeon have to make. Mako trained surgeons have a VERY specific set of criteria to be met before someone is even considered for a Mako partial. Including imaging, area of pain complaints, age of the patient, and other factors. No surgeon wants to perform a partial, only to have to go back within a year or two to convert it to a total knee. As noted above, until 2 years ago I would have never recommended a partial knee replacement, but due to advances in technique and improved tech in the OR, I wouldn’t hesitate to recommend a MAKO partial knee to anyone who meets the criteria.
If you have questions or need further information please reach out to me. I’d love to help.
Best regards and God bless,
Chris