Patient Centered Approach to Total and Partial Knee Replacements

Patients who need surgery for degenerative knee conditions have two effective options – partial or total joint replacement – to ease their pain. Choosing the best procedure requires careful consideration of each individual’s imaging tests, clinical examination, overall health, activity goals and age. “You don’t ever want to use a cookie-cutter approach,” says Adrian T. Baddar, MD, F.A.A.O.S.  “We know that people come to us when they’re ready to regain their quality of life, and the right surgery can do that.”

Knee replacements in general have become less grueling due to improved equipment, pain control techniques and rehabilitation practices. While virtually anyone can undergo a total joint replacement, more patients also are now candidates for a partial replacement. That less invasive surgery targets only specific areas of damaged cartilage, sparing healthy bone and tissue.

Ideal candidates have pain confined to a certain section of the joint – commonly the medial or inner compartment – near-normal range of motion and alignment, and intact ligaments around the knee. Body weight also may play a role if there are concerns a smaller prosthesis could wear out prematurely.

Partial replacement patients often can go home the day of surgery, walk without assistance in as little as a week and regain function and range of motion after a week or two of physical therapy. That compares to about six weeks of physical therapy after a total replacement.

Since today’s prosthetic joints last 15 to 20 years on average, partial replacements can be a good option for active adults in their 40s or 50s in addition to older patients who qualify. Most will remain candidates for a full replacement in the future, if needed.

In Dr. Baddar’s practice, the ratio of partial to total knee replacements has climbed to nearly 50/50. “Patients are coming in earlier, before they have extensive damage or pain, and the implants are holding up well,” he says. “Outcomes have been very positive.” At the same time, total joint replacement is still a highly effective surgery for people who need it. Intense post-surgical pain also is now rare thanks to powerful regional nerve blocks and medications injected into the knee in the operating room, including a 72-hour numbing agent. “People are really surprised at how comfortable they are,” Dr. Baddar notes.

Most patients also are on their feet within two or three hours of surgery, avoiding the stiffness that comes from immobilization, he adds: “That begins the physical recovery and is a big psychological boost going into rehabilitation. People realize right away that their knee is going to hold up.”

Dr. Baddar, who has been in practice for 13 years, became the first fellowship-trained hip and knee replacement specialist on the Peninsula after completing a program at the prestigious Cleveland Clinic. Along with minimally invasive joint replacement, his specialties include complex joint revisions, sports medicine, arthroscopy and general orthopaedics. “We pride ourselves on taking care of our patients from beginning to end,” he says. “We’re there as long as they need us.”