Partial Unicondylar Knee Replacement in India - Treatment For Partial Unicompartmental Knee Arthriti

Many middle aged Indian patients develop partial knee osteoarthritis. In Indians, osteoarthritis of the knee affects the inner half or medial compartment to start with and then proceeds to affect the outer half or lateral compartment.

Localized attrition occurs in the beginning as a so called "lesion". Later it gradually affects the front and inner portion of the inner half of the lower end of the thigh and leg bones (anter- medial wear) leading to partial knee arthritis. This is obvious on standing x rays as meidal or inner space joint space narrowing. Clinically these individuals may be bow legged since childhood.

In India the standard surgical treatment for OA knee is a total knee replacement. However the ideal candidate for a TKR is a person older than 65 years. Clearly someone in their fifties is not suited for a TKR as his/her life span would exceed that of the joint and he would need a revision knee replacement later on.

Indian surgeons offer osteotomy or a Uni condylar knee replacement for partial knee affliction. In an osteotomy, the thigh or leg bone is divided and re aligned so that the abnormal weight bearing axis is normalized. Pain relief is provided for a period of up to 10 years but is not total. An osteotomy is the logical operation for patients with bow legs and knock knees in the working class whose work demands would wear out an artificial joint. It is not the right procedure when there is no deformity.

A unicondylar or partial knee replacement substitutes the worn half of the joint with prosthesis. The bony resection is restricted to the affected half alone sparing the outer half and the patella unlike a total knee replacement. The operation can be done by a minimally invasive technique sparing the quadriceps muscle. The pre requisites are that the one half alone must be worn as seen on x- rays and the anterior cruciate ligament should be intact. The technique of insertion is demanding but the rewards to the patient are numerous. Shorter hospital stay, quicker recovery, small incisions, no blood transfusion, less pain, less cost (vs. TKR) and better function (squatting, kneeling, climbing stairs) are the much acclaimed benefits. The knee feels more natural as sensations carried by the ligaments are intact.

The Oxford unicompartmental knee is a representative type and is a mobile bearing uni knee. It replicates the function of the meniscus. The wear rates are low. Survivorship analysis is 98% at 15 years.

Advantages of partial knee replacements
1) minimally invasive surgery- Since the surgery involves a small exposure to see the affected half alone, surgeons can make the incision smaller, producing less post operative pain and smaller scars
2) less blood loss- Since the surgery is minimally invasive, less blood loss occurs.
3) Faster rehabilitation- Patients can stand up and walk on the same day, squat by week one and return to work earlier.

These innovative knee replacement procedures are available in India. Baby boomers and young patients with partial knee arthritis lacking Mediclaim or Medicare can now fly to India and have their surgery performed in hospitals with international standards.