Partial Knees (UNI) Go the Whole Nine Yards
According to Top sports orthopaedist Dr. Kevin Plancher: in recent years, doctors have been turning to a procedure known as a partial knee replacement, also known as unicompartmental knee arthroplasty (UKA) or "Uniknee" and "Uni" for short, and details the benefits of the latest joint replacement hardware.
New York, NY; Greenwich, CT (PRWEB) September 24, 2009
Millions of Americans experience the aches of arthritis, says Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area. The most common type of arthritis is osteoarthritis, which is the "wear and tear" kind caused by years of use (or trauma to the joint), and one of the most common sites of osteoarthritis is the knee. Many other patients have knee pain that's caused by injury or a congenital joint malformation. And while Dr. Plancher and other experts recommend conservative pain management for most cases of knee pain--typically a combination of exercise, physical therapy and medication, surgery is sometimes the only option. The American Academy of Orthopaedic Surgeons estimates that one in four people with osteoarthritis of the knee will eventually need surgery.
"Healthy knees have articular cartilage, which is a smooth, slippery, fibrous tissue that acts as a protective cushion between bones," Dr. Plancher explains. "As the cartilage begins to deteriorate--because of injury or plain old age--the space between the bones of the joint narrows, the cartilage thins and becomes grooved and fragmented, and the surrounding bones start to grow outward and form 'spurs.'
"In many cases, the arthritis will progress to the point that the cartilage in the knee joint is all but gone and the bones are grinding against each other," he says. Until fairly recently, the only option in those cases was a total knee replacement, in which a surgeon cuts away all of the bone and tissue that makes up the knee joint and replaces the entire mechanism with a prosthetic made of plastic and metal.
But in recent years, doctors have been turning more and more to a procedure known as a partial knee replacement, also known as unicompartmental knee arthroplasty (UKA)--or "Uniknee" and "Uni" for short. In this operation, the surgeon removes only a small piece of bone from the bottom of your femur (thighbone) and the top of your tibia (shinbone), plus any damaged cartilage. Both bones are reshaped to accommodate the uniknee implant: a plastic component that's cemented to your tibia and a metal part that's cemented to the femur. It is no different than comparing a dentist who place dentures (Total Knee Replacement) verses capping a tooth (Uni) in a person's mouth.
A TARGETED APPROACH
"Your knee joint has three compartments," Dr. Plancher explains: the medial (inner) compartment, the lateral (outer) compartment, and the patellofemoral (kneecap) compartment. "If the damage is contained in either the medial or lateral compartment, we can replace that section with the uniknee implant." If it's in more than one place (or if it affects the kneecap), total knee replacement is the better option.
According to the Arthritis Foundation, about 30 percent of people with knee osteoarthritis have disease that is largely restricted to one compartment. UKA surgery allows the surgeon to preserve the healthy parts of the joint while replacing the damaged pieces, in many cases providing the same benefits as total knee replacement --less pain, better joint functioning--with less trauma, a quicker recovery and a smaller scar. UKA surgery can also offer better range of motion post-op than a total knee replacement, meaning your new knee will function more like your old (pre-arthritis or pre-injury) knee. That's because the device does not interfere with the remaining parts of the joint, meaning you retain the natural stability of your own tendons, ligaments and kneecap (and the remaining half of the joint).
If the arthritis continues to progress, as it unfortunately does in some people, having a uniknee installed can let you put off a total knee replacement for as much as ten years. "That's a big improvement over what we were doing several years ago," says Dr. Plancher. "Before the uniknee, we had to tell patients to live with the pain as long as they could, then have total knee replacement. Now, you can improve your pain and quality of life immediately and either avoid a total knee replacement or have it later, if you need it."
Of course, UKA isn't for everyone, Dr. Plancher stresses. According to the latest estimates, uniknee surgery is growing at triple the rate of total knee arthroplasty, but represents less than 8 percent of the knee replacement operations in the United States, in large part because only between 6 and 8 out of 100 patients with arthritic knees are good candidates for the procedure.
WHO'S A CANDIDATE?
According to Dr. Plancher, anyone with severe arthritis or other knee pain should talk with a doctor about the options--before the pain becomes unbearable or their life changes and they become sedentary. "Most people see surgery as a 'last resort,'" he says, "and in many ways it is. But many patients can have a less invasive procedure, like uniknee surgery, and return to their primary care provider after being told they have to be sedentary."
The ideal uniknee patient is someone who is:
Mature adults who wish to remain active. Active people who wish to return to full sports activity. People with minimal arthritis on one side of the knee People who want minimally invasive surgery.
About Dr. Plancher:
Kevin D. Plancher, M. D., M. S., F. A.C. S., F. A.A. O.S., is one of the nation's leading orthopaedic surgeons and sports medicine experts, specializing in the treatment of knee, shoulder, elbow and hand injuries. He is Associate Clinical Professor in Orthopaedics at Albert Einstein College of Medicine in New York City and the Head Team physician for the professional lacrosse team, the Long Island Lizards. Dr. Plancher is on the editorial review board of the Journal of the American Academy of Orthopaedic Surgeons. In 2007, 2008 and 2009, Castle Connolly Medical Ltd., a New York City research company, named Dr. Plancher America's Top Doctor in Sports Medicine. Every year from 2001 to 2009 he has been included in Castle Connolly's list of Top Doctors in the New York Metro area, as published in New York Magazine's yearly "Best Doctors" issue.
Dr. Plancher received his M. D. degree (cum laude) and an M. S. degree in physiology from Georgetown University in Washington, DC. He completed his residency at Harvard University's orthopaedic program and a fellowship at the Steadman-Hawkins Clinic in Vail, Colo., where he studied shoulder and knee reconstruction and served as consultant to the clinic for six years. He has been team physician for more than 15 high school, college and national championship teams.
An attending physician at Beth Israel Hospital in New York City and Stamford Hospital in Stamford, CT, he maintains offices in Manhattan and Greenwich, CT. Visit www. plancherortho. com for more information. Dr. Plancher lectures extensively in the U. S. and abroad on issues related to orthopaedic procedures and injury management. He also has been named to the sports medicine arthroscopy program subcommittee for the American Academy of Orthopaedic Surgeons. Dr. Plancher has been awarded the Order of Merit (magna cum laude) for distinguished philanthropy in the advancement of orthopaedic surgery by the Orthopaedic Research and Education Foundation. In 2001, he founded The Orthopaedic Foundation for Active Lifestyles, a not-for-profit foundation focused on maintaining and enhancing the physical well-being of active individuals through the development and promotion of research and supporting technologies. See www. ofals. org for more information.
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