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Knee Replacement Prosthesis Shows Promising Results

(Mar 1, 2009)

About Bicompartmental Knee Replacement

Bicompartmental knee replacement, a procedure for patients with medial and patellofemoral joint compartment arthritis, is a new, less-invasive option for those who might otherwise require total knee arthroplasty (TKA). The principles of bicompartmental knee replacement are similar to those of unicompartmental knee replacement, but in the new procedure both the compartment under the patella and the medial compartment of the knee are replaced.

"The bicompartmental procedure will not replace the unicompartmental technique altogether," said Jeffrey Geller, MD, an orthopedic surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center, "but it provides a useful alternative for patients with patellofemoral arthritis or those at high risk for it. In the long run it may also reduce the number of TKA procedures as well as TKA revisions years later."

Recounting the history of knee implants, Dr. Geller said, "TKAs and unicompartmental procedures have both been around for about 30 years, but in the beginning the partial procedures were not very good and many failed within a couple of years. So the trend in the 1980s was away from partials to TKAs for everyone, even if their arthritis was confined to the medial compartment. In the past 10 years the partial implants have improved and these better results made people push the envelope and develop this bicompartmental version," he said.

Bicompartmental Knee Replacement, Unicompartmental Knee Replacement, and TKA

Dr. Geller still performs a fair number of unicompartmental knee replacements because they are even less invasive than the bicompartmental implant, and for the right person, they work quite well. "But bicompartmental knee replacement is less invasive than TKA, and patients retain more of their natural tissue including the anterior and the posterior cruciate ligaments. Many people who have a total knee replacement report that it feels a bit more like a mechanical knee. With the bicompartmental system the knee maintains more of its natural kinematics and more of a 'natural' feel, patients report," he said.

Although it has become available relatively recently, Dr. Geller has already made bicompartmental knee replacements an integral tool in his treatment of arthritis of the knee (J Knee Surg. 2008;21[1]:7-14), and he has performed close to 30 in the past year and a half. Dr. Geller has no ties to any orthopedic implant company, he said.

Good Candidates for Bicompartmental Knee Replacement

In general, according to Dr. Geller, the procedure is most suitable for patients who are in relatively good shape. He finds that the ideal patient is someone who has mostly medial compartment arthritis and enough patellofemoral changes that you would not do a unicompartmental procedure. "It's best for people who do not have a tremendous amount of deformity in the knee, who have been able to maintain a reasonably good range of motion and have not developed too much stiffness, whose deformity is correctable, and who have an intact ACL [anterior cruciate ligament]," says Dr. Geller.

Outlook for Bicompartmental Knee Replacement

While there are no long-term data regarding the safety and efficacy of this relatively new prosthesis, Dr. Geller believes there will be few long-term complications with the procedure. He is also conducting long-term research which will be valuable, though he is hopeful he can combine his data with other institutions already using the device and pool their data to isolate any trends. "Multicenter trials will amass a larger database and earlier answers on the impact of this innovation to reconstructive knee surgery," he noted.

"We know there is a slightly higher rate of complications with the unicompartmental replacement, but that may be acceptable if the opportunity to salvage more bone stock prevents the catastrophic complications of revision total knee arthroplasty," Dr. Geller said. "We believe that the unicompartmental approach has already been shown to be a legitimate option for younger patients with disabling knee pain, and as we gain experience this may also be the case for the bicompartmental replacement."

Contributing faculty for this article:

Jeffrey Geller, MD is the Director of Minimally Invasive Joint Replacement Surgery in the Center for Hip and Knee Replacement at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Assistant Professor of Orthopedic Surgery at Columbia University College of Physicians and Surgeons

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