Posts Tagged ‘osteoarthritis’
What is the difference between partial and total knee replacement?
A replacement of the weight-bearing surfaces in patients suffering from arthritis mainly osteoarthritis is indicated when the pain is unbearable and effects the patients walking ability and quality of life.
The knee has three compartments – the inside aspect of the knee n the medial compartment , the outside of the knee – the lateral compartmentand the patellofemoral compartment is the front of the knee. The medial compartment is usually affected by osteoarthritis followed by the lateral compartment.
A total knee replacement is when all three compartments of the knee are replaced. In comparison to this a Partial knee replacement or Unicompartmental knee replacement is when one of the knee compartments only is replaced.
By removing less bone and trying to maintain most of the patient’s bone and anatomy a partial knee replacement will cause less trauma or damage than traditional Total knee replacement. This coupled to the potential use of smaller implants will also allow more of the patient’s bone to be kept and can help the patient return to normal function faster.
However a partial knee surgery is only possible if the arthritis in the knee is confined to a limited area. If the arthritis is more widespread, then the partial knee replacement will not be considered. In addition a partial knee surgery is usually recommended in patients who are older than 55 years and relatively sedentary but not obese.
Partial knee replacement has the following benefits:
* The incision size is about 1/3 of that of a total knee replacement.
* The operation is usually accompanied by less pain and tha patient may leave the hospital the day after surgery.
* The physical rehabilitation process is quicker and patients can expect to be walking with just a stick with a return to their routine activities in just 4 to 6 weeks
* The range of motion of the knee usually approaches that of a normal knee making functional activities easier.
There are risks though which include:
* A higher rate of revising the partial knee replacement than total knee replacement. This revision may be associated with a worse functional outcome than if the total knee had been replaced in the beginning.
Knee Surgery Rehabilitation* Some patients may develop arthritis in other areas of the knee resulting in revision surgery.
* Some patients may wear out the unicompartmental knee implant resulting in revision surgery.
However long-term results are very good when the minimally invasive Partial knee replacement is done on the right cohort of patient and when a partial knee replacement is done on a properly selected patient the results are quite successful.
Dr.Giles R. Scuderi, in an online publication, August 2011, reported that between May 2001 and June 2004, 388 total knee – arthroplasty cases were enrolled in a prospective, randomized and multicenter investigational device exemption trial. The patients received either a high-flexion mobile-bearing knee or a fixed-bearing control knee. The patients were assessed at 2 to 4 years . The results show 293 patients with degenerative joint disease were compared using Knee Society Assessment and Function scores, radiographic results, complications analysis, and survival estimates. Both the mobile-bearing and fixed-bearing groups demonstrated similar, significant improvement over preoperative assessments in Knee Scores including maximum flexion, and range of motion (ROM).
Post knee surgery physical therapy received a major boost with the advent of the LegTutor. This is a new device that improves motor, sensory and cognitive impairments through intensive active exercises with augmented feedback. The repetitive training is tailored to patient performance and allows the therapist to customize the most suitable rehabilitation program to the patient’s ability. The LegTutor together with its sisters the HandTutor, ArmTutor and 3DTutor are currently in use in major U.S. and foreign hospitals. Used in private clinics and even at home with tele rehabilitation the Tutors are successful for children as well as adults. The LegTutor is used to improve knee and hip movement ability in both neurological and orthopedic injury and disease.
HandTutor proven successful for self management, joint protection and exercises in hand osteoarthritis
In the July issue of BMC Musculoskeletal Disorders http://www.ncbi.nlm.nih.gov/pubmed/21745357 – Dr. Dziedzic and his group from Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom discuss their plan to assess self management, joint protection and exercises in hand osteoarthritis: a randomized controlled trial with cost effectiveness analyses.
The HandTutor is used for hand exercises and should be assessed within this trial.
The HandTutor, ArmTutor, LegTutor and 3DTutor are used in many clinics in the USA and worldwide with patients are also using these devices in private outpatient clinics and the home environment. Home bound patients can use tele rehabilitation that is supported by physical and occupational therapists.