HEALTH: Ask Dr. Olsen

Bison Blinds

Thank you for your health questions! This one comes from PK about knee replacement.

Dear Dr. Olsen:

Fig 1: X-rays of right and left knees. The right knee (labeled R) demonstrates advanced osteoarthritis of the knee. The articular cartilage on the end of the bone is lost, resulting in “bone on bone” with every step taken. Compare to the left knee that demonstrates preservation of the joint space and separation of the femur (bone on the top) form the tibia (bone on the bottom).

I am being told it is time for a total knee replacement. For years, I have worn a brace and taken injections in my knee but it doesn’t work anymore. I have heard about a “partial knee-replacement.” What is the difference? Which is better?


Dear PK,

Health Question: Osteoarthritis of the knee is not a dangerous entity in itself, but as you know, when the pain and functional limitation affects your productivity and quality of life it is time to take action.  If the non-operative strategies are not helpful, surgery is the most appropriate next step to consider.

To understand the difference between partial knee replacement and total knee replacement, we must first look at and understand total knee replacement (TKR).  TKR involves resurfacing the worn out arthritic surface of the knee. (figure 1) This is classically done by applying a metal surface on the end of the femur, a metal surface on the end of the tibia, and fixing a high-density plastic polyethylene in between.  (figure 2).

Fig 2: The right knee has been successfully replaced with a total knee replacement. This includes a metal resurfacing of the femur (bone on top), metal resurfacing of the tibia (bone on bottom) and a plastic polyethylene fixed in between (located between the femur and tibia, cannot be seen on era).
The procedure only takes about an hour or and hour and a half, and people are typically up and walking on the new knee the same day of surgery.  It does take time to recover from knee replacement surgery, however.  Knees like to become stiff after injury and surgery, and specific therapy exercises are necessary to restore full range of motion.  Also, the muscular strength to control the function of the knee takes time and exercise to restore as well.  As a result, most people are in need of the use of a walker or cane for three to six weeks on average.  When muscular control is restored to allow safe walking without the use of a walker or cane, then driving is permitted, typically 3-6 weeks.

At our next installment, we will compare total knee replacement to partial knee replacement.

To be continued…

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