If a knee replacement isn’t ideal for younger or highly active patients, what’s the alternative? Alex Dodds, knee surgeon for Cheltenham, Gloucester and the Cotswolds, explains.
*photo courtesy of wk1003mike via shutterstock
A knee replacement can be a liberating, life-changing operation, but you have to get the timing right. Let’s assume you’re in your early 40s and have had the misfortune to develop osteoarthritis earlier in life than most. A partial knee replacement (used where just one compartment of the knee is worn) will see you right for perhaps 10 or 15 years, although the failure rate will be higher in younger patients. After this a total knee replacement will keep you mobile for a further 15 years, give or take. At this point, only a revision knee replacement is possible. The only option is revision of the existing implant, the results of which are never as good as the original.
By your mid-70s, therefore, your options may be running out and your quality of life could be adversely affected for years. Naturally, knee surgeons do all they can to avoid reaching this cliff edge, usually by delaying knee replacement for as long as possible.
But what happens to the 40-something who’s living with constant knee pain?
> Discover more about partial & total knee replacements
Osteotomy and the importance of alignment
Imagine that someone is stood before you with a plumb line descending from the centre of the hip to the centre of the ankle. In most people this line should pass through the centre of the knee. But for many people, this doesn’t happen. One reason for this may be because they have varus knee. You’ll probably know it better as bow legs.
Patients with varus knee tend to overload the inner (medial) part of the knee more than any other. Gradually, the overloading wears this part of the joint away, resulting in an osteoarthritic knee. It’s a common cause of osteoarthritis in younger patients.
If a patient at my Cheltenham knee clinic is in their 50s, a partial knee replacement is the obvious and successful solution to this. But for the reasons explored above, a partial knee replacement for a patient in their 40s can be a risky proposition for the long term. That’s when a realignment — shifting the weight bearing axis from the inside to the outside bit of the knee — may be beneficial.
We might achieve that with special braces that can help nudge the tibia (shinbone) into a better position. Or we could use an osteotomy, a surgical procedure to realign the knee joint.
Benefits of osteotomy
We’ve already discussed the value of an osteotomy in terms of delaying knee replacement surgery, but another significant benefit is that you can be more active with an osteotomy than you can with a knee replacement. As I explore in my ‘Is It OK To Run After A Knee Replacement?’ post, high impact activities aren’t advised for patients with knee implants because of the risk of damage to the implant.
If you’re a 40-something builder, gardener, cleaner or simply someone who enjoys running, you’ll be able to safely put more impact through your knee following an osteotomy than you would following a knee replacement.
The desire to stay very active for longer is the chief reason some older patients also choose osteotomy ahead of knee replacement (although it’s important to stress that a knee replacement enables you to be active, just not in a high impact, heavy-on-the-knees sort of way).
As with all surgical choices, it’s important to explore your options to find the treatment route that would best suit you and your lifestyle. To do that now, book your appointment at my Gloucestershire knee clinic. Or call 01242 246549.
> Discover more about knee replacements
> Discover more about knee osteoarthritis
> Discover more about partial & total knee replacements