Archive for the ‘Revision knee replacement’ Category

How long do robotic partial knee replacements (MAKOplasties) last?

Tuesday, November 2nd, 2010
I really can’t comment on the longevity of our newest-generation partial knee (aka uni-knee arthroplasty, or UKA) implants.
 
Historically, total knee replacements (aka total knee arthroplasty, or TKA) have nearly a 90% survivorship at 10-15 yrs.  Newer-generation TKAs we expect to surpass that, but none of them have been around long enough to say.
 
Historically, UKAs have had only an 80% survivorship at 8-10 yrs, most of the failures likely due to flaws in implantation.  Newer-generation UKAs are still seeing similiar results, but may have a slight improvement to this.
 
Newest-generation UKAs (ie- robotic) are seeing an astounding success in the short-term (3 yrs), with the added new possibility of continued resurfacing of other parts of the knee if they wear out in the future.  Historically, if the partial knee was doing OK, but your arthritis progressed to the other side of your knee, your only option was a conversion to a TKA.  Now, we can reliably implant a new UKA or patellofemoral joint (PFJ) knee arthroplasty to the other portions of your knee to match your original one.
 
So, many robotic, minimally-invasive & UKA surgeons believe that robotic UKAs have solved 2 major issues for failure of traditional UKAs: 1) less-than-perfect implantation and 2) progression of arthritis.  Unfortunately, this technology is too new to tell.  The first one ever placed in a human being was done in 2006.
 
Regardless of the longevity of the implant, you will find that the surgical impact to your knee, and the speed of recovery, is an order of magnitude easier than that of a TKA.  For this reason, many of my patients request a robotic UKA, even accepting the potential for future surgeries (which also exists for TKA).

How long is the recovery from your joint replacement surgeries?

Sunday, August 29th, 2010

A very general guide for all joint replacement is:
- You will continue to improve for an entire year, even if you feel 100% within weeks after surgery.

The following is highly variable, and represents a reasonable baseline.  The recovery can be longer depending on the severity of the disease.  Most of my patients stop their pain medication on the following schedules:
- Total hips in 1-3 weeks
- Partial knees in 1-4 weeks
- Total knees in 2-10 weeks
- Revision hip or knee replacement, too variable to comment

I usually recommend that my patients take 2 months off of work for any joint replacement.  That way, you can always go back to work sooner if you feel like it.  Most of my patients return to work within a few weeks.

How long does a total -vs- partial -vs- revision joint replacement last?

Sunday, August 29th, 2010

Regarding implant longevity, the short answer is: we don’t know.

The point that I need to emphasize is that longevity of an implant is HIGHLY VARIABLE.  It really depends on multiple factors.  No patient is the same, activity levels vary, accidents can happen, and the modes of failure are numerous and unpredictable. 

For total joint replacement, 10-15 years is an often quoted average.  Individually, joint replacements can last as long as only a few weeks to 40+ years.

Revision joint replacements may also last as long, but depending on how extensive the revision is, this can also vary widely, and is less predictable than the original (known as a “primary”) joint replacement.  Additionally, your joint’s function can decrease with every surgery that is done to it, mostly because of scar tissue formation.  This also varies widely.

Partial knee replacements can have the same longevity, but they have a higher rate of revision than total knee replacements at 10 years by most studies. 

Advantages of partial knee replacements are that they are easier & quicker to recover from, they feel more natural, and if/when they need to be revised, chances are high that the revision will recover and act more like a primary knee replacement rather than a revision knee replacement at that time.  Even though a partial knee replacement may be the only surgery you need during your entire lifeitme, one way to view a partial knee replacement is that it may be a way to postpone getting a total knee replacement.  To use dental terms: a partial knee is a “filling”, a total knee is a “crown”.

What is a “revision” total joint?

Sunday, August 29th, 2010
Q:  If realistically a total joint replacement can fail over time, what about “do-overs”?  Are they possible, and can they be effectively performed?
A:  “Do-overs” (commonly referred to as “revisions”) are becoming more routine.  Technology, techniques & knowledge are advancing quickly in this realm.  For all of my patients receiving a joint replacement earlier than 75 years of age, I try to prepare them for the possibility of 1 or more revisions during their lifetime.  More information can be found on my website at http://chowhipandknee.com/revision-surgery.html