Partial Knee Replacements Safer, But Require More Follow-Up
According to a new study published in The Lancet, a team of researchers from the University of Oxford, funded by Arthritis Research UK and the Royal College of Surgeons, found that:
- Although the risk of life-threatening complications from knee replacement surgery is very small, people who undergo total knee replacement are four times more likely to die in the first month after surgery, when compared to those who have partial knee replacement, and 15 percent more likely to die in the first eight years.
- Patients undergoing total replacement are twice as likely to have a thrombosis, heart attack or deep infection, three times as likely to have a stroke and four times as likely to need blood transfusions, compared to those having partial replacement. In addition, after total knee replacement, patients are in the hospital longer and the chance of being readmitted or requiring a re-operation during the first year is higher.
- Patients who had a partial knee replacement are 40 percent more likely to be re-operated on during the first eight years after the replacement, when compared to those that had a total knee replacement.
Because of the higher revision rate of partial knee replacement surgery, which is traditionally regarded as the most important factor to determine the choice of implant, its use in the treatment of end-stage osteoarthritis is controversial, with only about 7,000 being performed annually in the UK. Partial knee replacements are often offered to younger people who, because of their higher activity levels, have increased failure rates. Total knee replacement is one of the most common surgical procedures, with over 76,000 performed annually in the UK. Only five percent of patients require revision surgery over a 10-year period.
Professor David Murray, from the Nuffield Departmental of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford, who led the research, said: "For an individual patient, the decision whether to have a partial or total is based on an assessment of the relative risks and benefits. The main benefit of the partial knee is that it provides better function. The risks have been assessed in this study, which found that partial knees have fewer complications and deaths; however they do lead to more re-operations. To put the risks in perspective, if 100 patients had a partial knee rather than a total knee replacement there would be one fewer death and three more re-operations in the first four years after surgery."
His colleague Alex Liddle, an Arthritis Research UK clinical research fellow who ran the study, added: "Partial and total knee replacements are both successful treatments and a large proportion of patients with end-stage knee osteoarthritis are suitable for either. Both have advantages and disadvantages, and the choice of which procedure to offer will depend on the requirements and expectations of individual patient."
Arthritis Research UK is the charity dedicated to stopping the impact that arthritis has on people's lives.