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Partial rather than full knee replacement better for many patients

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Many more patients with osteoarthritis of the knee could benefit from having partial knee replacement rather than total knee replacement, new research reveals.

Researchers at the University of Oxford’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) found that partial replacements, also known as unicompartmental replacements (UKR), are better for patients who have only part of their knee affected by arthritis and could, therefore, have either a partial or a total replacement.

Partial replacement is a less invasive procedure, in which only the affected part of the knee joint is replaced.

Based on data from the National Joint Registry for England and Wales, the researchers found that the procedure allows for a faster recovery, carries less post-operative risks and provides better function.

The findings have been published in the BMJ Open journal.

“The main strength of this study is that we were able to use real data, from very large numbers of people, about their actual operations, their GP visit, and their own reported quality of life outcomes in a way that is not always possible,” said co-lead researcher and NDORMS senior health economist Dr Rafael Pinedo-Villanueva.

“This has allowed us to provide strong proof that partial knee replacements are both better for patients and cheaper for the NHS,” he added.

It’s thought that about half of the patients needing knee replacement could be suitable for a partial replacement. However, data from 2016 shows that, of the 98,147 knee replacements undertaken, only 9% were partial.

Outcomes vary depending on how many partial replacements surgeons carry out: those done by surgeons using them for a small proportion of knee replacements tend to have worse outcomes than total replacements. Partial replacements done by surgeons using them for a high proportion of knee replacements provide better outcomes.

“This is an important finding,” said co-lead researcher Professor David Murray. “If surgeons aim to use partial knees in a quarter or more of their knee replacements this will substantially improve the results of knee replacement and will save money. In addition, more partial knee replacements will be done and more patients will benefit from this procedure.”