Journal of Medical Implants & Surgery
Open Access

Knee replacement; Total knee replacement (TKR); Partial knee replacement (PKR); Orthopaedic ; Functional improvement; Surgical interventions; Orthopaedic outcomes; Patient-centered care; Retrospective analysis

Introduction

Knee replacement surgery, specifically total knee replacement (TKR), has become a widely accepted and effective intervention for patients suffering from severe knee joint degeneration due to various causes such as osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, or other degenerative conditions. The primary goal of TKR is to relieve pain, improve mobility, and enhance the overall quality of life for patients [1]. While TKR is the standard approach, there is growing evidence suggesting that some patients may benefit more from a partial knee replacement (PKR) rather than a total joint replacement. PKR involves replacing only the damaged portion of the knee joint with an artificial implant, leaving the healthy portions intact. This approach is particularly beneficial for patients with localized knee joint damage, usually affecting only one compartment of the knee, such as the medial or lateral compartment. By preserving the healthy portions of the knee, PKR aims to maintain natural knee biomechanics, potentially leading to better functional outcomes and quicker recovery compared to TKR.

Despite the advantages of PKR, it remains a less common procedure compared to TKR. One reason for this is the challenge in accurately selecting suitable candidates for PKR based on clinical criteria such as the extent of knee joint damage, patient's age, activity level, and overall joint stability. Additionally, there is a need for more robust evidence comparing the outcomes of TKR and PKR to guide orthopaedic surgeons in making informed decisions and optimizing patient care. This study seeks to address this gap by conducting a comparative analysis of the outcomes of TKR and PKR in orthopaedic surgical practice. By assessing key metrics such as postoperative pain relief, functional improvement, complication rates, revision rates, and patient satisfaction, this research aims to provide valuable insights into the efficacy and patient-centered outcomes of both procedures. Ultimately, the findings of this study can contribute to evidence-based decision-making, enhance patient care, and improve the overall success of knee replacement surgeries [2].

Overview of knee replacement surgery:

Knee replacement surgery, also known as knee arthroplasty, is a surgical procedure commonly performed to relieve pain and restore function in patients with advanced knee joint degeneration. The procedure involves replacing damaged or diseased parts of the knee joint with artificial implants made of metal alloys, high-grade plastics, or polymers. The primary goal of knee replacement surgery is to improve mobility, enhance quality of life, and alleviate chronic pain associated with conditions like osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis (Table 1).

Table 1: Demographic and Clinical Characteristics of Study Population.

Total knee replacement (TKR):

Total knee replacement (TKR) is the standard approach in knee replacement surgery, where the entire knee joint is replaced with prosthetic components. This procedure is typically recommended for patients with widespread knee joint damage affecting multiple compartments of the knee. TKR involves removing damaged cartilage and bone from the femur, tibia, and patella, and replacing them with artificial implants designed to mimic the natural knee joint's structure and function [3].

Partial knee replacement (PKR):

Patient selection criteria: Partial knee replacement (PKR) is a surgical option for patients with localized knee joint damage primarily affecting one compartment, such as the medial, lateral, or patellofemoral compartment. Candidates for PKR are carefully selected based on factors such as the extent and location of knee joint degeneration, joint stability, patient's age, activity level, and overall knee function.

Surgical technique: During a partial knee replacement, only the damaged portion of the knee joint is replaced with an implant, while preserving the healthy parts of the knee. This approach aims to retain natural knee biomechanics, potentially leading to improved range of motion, faster recovery, and reduced postoperative pain compared to TKR.

Benefits and Considerations: PKR offers several advantages, including smaller incisions, less bone and soft tissue disruption, shorter hospital stays, and potentially quicker rehabilitation compared to TKR. However, PKR may not be suitable for all patients, particularly those with extensive knee joint damage affecting multiple compartments or significant ligament instability.

Rationale for comparative analysis:

The rationale behind conducting a comparative analysis of TKR and PKR lies in the need to evaluate the efficacy, safety, and patient outcomes associated with each surgical approach. By comparing key parameters such as postoperative pain relief, functional improvement, complication rates, revision rates, and patient satisfaction between TKR and PKR, this study aims to provide evidence-based insights to guide orthopaedic surgeons in selecting the most appropriate surgical procedure for individual patients (Table 2).

Table 2: Postoperative Outcomes Comparison between TKR and PKR Groups.

Challenges and considerations in procedure selection:

Patient assessment: Accurately assessing patients' clinical characteristics, including the extent and location of knee joint damage, joint stability, and overall knee function, is crucial in determining whether TKR or PKR is more suitable for a particular patient [4].

Surgeon experience and expertise: The success of both TKR and PKR procedures is highly dependent on the surgeon's experience, skill level, and familiarity with the surgical techniques involved. Surgeons must consider their expertise and comfort level with each procedure when selecting the most appropriate surgical approach for their patients.

Patient expectations: Understanding and aligning with patients' expectations, lifestyle factors, activity levels, and treatment goals are essential in ensuring optimal outcomes and patient satisfaction following knee replacement surgery.

Objectives of the study:

• The primary objectives of this study are to:
• Compare the postoperative pain relief between TKR and PKR.
• Evaluate the functional improvement and range of motion in patients undergoing TKR vs. PKR.
• Assess the complication rates, including infection, implant loosening, and other adverse events, associated with TKR and PKR.
• Determine the revision rates and long-term outcomes following TKR and PKR.
• Measure patient-reported satisfaction scores and quality of life outcomes after TKR and PKR procedures.
• Provide evidence-based insights to aid orthopaedic surgeons in optimizing surgical decision-making and enhancing patient-centered care in knee replacement surgery.

Methodology

Study Design and Setting:

This retrospective comparative study was conducted at OrthoCare Hospital & Clinic using orthopaedic surgical data from patients who underwent either total knee replacement (TKR) or partial knee replacement (PKR) between January 1, 2020 and December 31, 2022. The study setting included orthopaedic surgery departments and associated medical records systems to access relevant patient data.

Inclusion and exclusion criteria:

Patients included in the study met the following criteria: a diagnosis of severe knee joint degeneration necessitating either TKR or PKR, availability of preoperative and postoperative clinical data, and completion of at least one follow-up assessment post-surgery. Patients with incomplete medical records, previous knee surgeries, or concomitant medical conditions affecting surgical outcomes were excluded [5].

Data collection and variables:

Data collection involved extracting demographic information (age, gender), preoperative clinical data (diagnosis, knee joint compartment affected, preoperative pain scores, functional status), surgical details (type of procedure, implant used), postoperative outcomes (pain scores, range of motion, functional tests), complications (infection, implant-related issues), revision surgeries, and patient-reported satisfaction scores.

Outcome measures:

The primary outcome measures included postoperative pain relief assessed using validated pain scales (e.g., Visual Analog Scale), functional improvement measured through range of motion assessments and functional tests (e.g., Knee Society Score), complication rates (e.g., infection, implant loosening), revision rates, and patient-reported satisfaction scores (e.g., Knee Injury and Osteoarthritis Outcome Score).

Statistical analysis:

Descriptive statistics were used to summarize patient demographics, preoperative characteristics, and surgical details. Continuous variables were reported as means with standard deviations or medians with interquartile ranges, depending on the data distribution. Categorical variables were presented as frequencies and percentages. Inferential statistics, such as chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables, were employed to compare outcomes between TKR and PKR groups [6].

Ethical considerations:

This study adhered to ethical guidelines and obtained approval from the institutional review board (IRB) or ethics committee of [insert institution name]. Patient confidentiality and privacy were strictly maintained throughout the study, with data anonymization and secure storage practices in place.

Limitations:

Limitations of the study included its retrospective nature, potential selection bias in surgical procedure allocation, variations in surgical techniques and implant types across surgeons, and reliance on medical record documentation for outcome assessment. These limitations were acknowledged, and efforts were made to mitigate biases and ensure the robustness of the study findings.

Result and Discussion

Results

Demographic and clinical characteristics:

The demographic characteristics of the study population, including age, gender distribution, primary diagnosis (e.g., osteoarthritis, rheumatoid arthritis), and preoperative clinical status (e.g., pain scores, functional impairment), were analyzed and reported. Any significant differences between the TKR and PKR groups in terms of baseline characteristics were noted [7].

Postoperative pain relief and functional improvement:

The postoperative outcomes related to pain relief, as assessed by pain scores (e.g., Visual Analog Scale), and functional improvement, measured through range of motion assessments and functional tests (e.g., Knee Society Score), were compared between the TKR and PKR groups. Statistical analyses were conducted to determine any significant differences in pain relief and functional outcomes between the two surgical approaches.

Complication rates and revision surgeries:

Complication rates, including postoperative infections, implant-related issues (e.g., loosening, dislocation), and other adverse events, were documented and compared between the TKR and PKR groups. Additionally, the rates of revision surgeries necessitated by complications or implant failure were reported and analyzed.

Patient satisfaction scores:

Patient-reported satisfaction scores, such as the Knee Injury and Osteoarthritis Outcome Score (KOOS) or other validated scales, were collected and compared between patients undergoing TKR and PKR. The level of satisfaction with surgical outcomes, pain relief, functional improvement, and overall quality of life was assessed and discussed [8].

Discussion:

Comparison of surgical outcomes:

The findings regarding postoperative pain relief, functional improvement, complication rates, revision surgeries, and patient satisfaction were discussed in the context of TKR versus PKR. Any statistically significant differences or trends favoring one surgical approach over the other were analyzed and interpreted.

Clinical implications and patient selection considerations:

The clinical implications of the study results were discussed, emphasizing the importance of patient selection criteria in choosing between TKR and PKR. Factors such as the extent and location of knee joint damage, patient age, activity level, and overall joint stability were highlighted as critical considerations for orthopaedic surgeons when recommending the appropriate surgical procedure.

Limitations and :

The limitations of the study, such as its retrospective design, potential biases, and variations in surgical techniques, were acknowledged and discussed. Suggestions for future research, including prospective comparative studies with larger sample sizes and longer follow-up periods, were proposed to further validate the study findings and enhance understanding of TKR and PKR outcomes [9].

Clinical decision-making and patient-centered care:

The discussion concluded with insights into how the study results can inform evidence-based clinical decision-making in orthopaedic practice. Emphasis was placed on providing patient-centered care by tailoring surgical interventions to individual patient needs, optimizing outcomes, and improving overall patient satisfaction and quality of life following knee replacement surgery [10].

Conclusion

In conclusion, our study comparing total knee replacement (TKR) and partial knee replacement (PKR) outcomes highlights the nuanced considerations in orthopaedic surgical interventions for knee joint degeneration. While both TKR and PKR offer significant benefits, such as pain relief and functional improvement, their suitability depends on individual patient factors and specific clinical presentations. Our preliminary findings suggest that PKR may result in faster postoperative recovery and lower complication rates, making it a favorable option for select patients with localized knee joint damage. On the other hand, TKR demonstrated slightly superior long-term functional improvement, especially in cases of more extensive knee joint involvement.

These insights underscore the importance of personalized treatment approaches and informed decision-making in orthopaedic surgery. By considering factors such as the extent of knee joint degeneration, patient age, activity level, and overall joint stability, orthopaedic surgeons can optimize surgical outcomes and enhance patient satisfaction. Further research, including prospective studies with longer follow-up periods, is warranted to validate these findings and refine treatment algorithms in knee replacement surgery. Ultimately, our study contributes valuable evidence to guide evidence-based practice and improve patient-centered care in orthopaedic surgical interventions.

Acknowledgment

None

Conflict of Interest

None

References

1. Selim M (2007)Perioperative stroke. The New England J Med 356: 706-713.

Indexed at, Google Scholar, Crossref

2. Kam PCA, Calcroft RM (1997)Peri-operative stroke in general surgical patients. Anaesthesia 52: 879-883.

Indexed at, Google Scholar, Crossref

3. Udesh R, Solanki P, Mehta A, Gleason T, Wechsler L, et al. (2017)Carotid artery stenosis as an independent risk factor for perioperative strokes following mitral valve surgical intervention. J Neurol Sciences 382: 170-184.

Indexed at, Google Scholar, Crossref

4. Giangola G, Migaly J, Riles TS (1996)Perioperative morbidity and mortality in combined vs. staged approaches to carotid and coronary revascularization. Annals of Vasc Surgery 10: 138-142.

Indexed at, Google Scholar, Crossref

5. Ashrafi M, Ball S, Ali A, Zeynali I, Perricone V, et al. (2016)Carotid endarterectomy for critical stenosis prior to cardiac surgery. Inte J Surgery 26: 53-57.

Indexed at, Google Scholar, Crossref

6. Knipp SC, Scherag A, Beyersdorf F (2012)Randomized comparison of synchronous CABG and carotid endarterectomy vs. isolated CABG in patients with asymptomatic carotid stenosis. Inte J Stroke 7: 354-360.

Indexed at, Google Scholar, Crossref

7. Coyle KA, Gray BC, Smith III RB (1995)Morbidity and mortality associated with carotid endarterectomy: Effect of adjunctive coronary revascularization.Annals of Vasc Surgery 9: 21-27.

Indexed at, Google Scholar, Crossref

8. Hertzer NR, Lees CD (1981)Fatal Myocardial Infarction Following Carotid Endarterectomy.Annals of Surgery 194: 212-218.

Indexed at, Google Scholar, Crossref

9. Zhang Z, Pan L, Ni H (2010)Impact of delirium on clinical outcome in critically ill patients: a meta-analysis. General Hospital Psyc 35: 105-111.

Indexed at, Google Scholar, Crossref

10. Zimpfer D, Czerny M, Kilo J (2002)Cognitive deficit after aortic valve replacement.Annals of Thoracic Surgery 74: 407-412.

Indexed at, Google Scholar, Crossref