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Surgeon Optimistic About New Type of Knee Replacement

(Mar 1, 2009)

The knee is a hard-working joint. It endures the tumbles and bruises of childhood, the twists, turns, and shocks of competitive sports, yoga, and jogging as we strive to stay fit, in some cases the added weight of pregnancy and obesity, and over many, many years the everyday stress as we sit, stand, walk, kneel, lift, dance. Beginning in their 40s and 50s many people develop arthritis in their knees, a deterioration of the cartilage that cushions the joint, causing the bones in the knee to grind against each other.

When arthritis becomes extremely painful and debilitating orthopedic surgeons have offered patients one of two knee replacement options: A total knee replacement in which all of the cartilage, the back of the knee cap, the ends of the femur (thigh bone), and tibia (shin bone), and one or two ligaments are replaced with a metal and plastic implant, or a partial (unicompartmental) replacement in which just the ends of the tibia and femur are replaced. A new, third option is giving patients and doctors another minimally invasive approach.

Bicompartmental Knee Replacement

The new procedure, called a bicompartmental knee replacement, is designed for people with arthritis under the knee cap and under the inner (medial) portion of the femur – a common manifestation of arthritis. Until last year these patients would have been candidates only for a more invasive total knee replacement.

Since then the bicompartmental knee replacement has become integral in some surgeons' treatment tool kit, said Jeffrey Geller, MD, an orthopedic surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center.

Bicompartmental Knee Replacement and Total Knee

Replacement

"Bicompartmental knee replacement is less invasive than a total knee replacement, there's less damage to the tissues around it, and it retains more of the body's natural tissue," Dr. Geller said, "including the anterior and the posterior cruciate ligaments. Many people who have a total knee replacement report that their new knee feels a bit like a mechanical knee. The bicompartmental implant has more of a 'natural' feel, patients say."

In the long run the bicompartmental implant may reduce the number of total knee replacement procedures, as well as surgeries to revise those replacements when they wear out after several years. "We know that one of the main reasons to convert to a total knee replacement after a unicompartmental knee replacement is development of arthritis under the patella," Dr. Geller said. "This obviates that need."

Good Candidates for Bicompartmental Knee Replacement

The new procedure is generally most suitable for patients who are in relatively good shape, according to Dr. Geller. "The ideal candidate has arthritis in the medial portion of the joint and enough arthritic damage under the patella that you would not do a unicompartmental implant," he said. "It's best for people who do not have a tremendous amount of deformity in the knee, who have been able to maintain reasonably good range of motion and have not developed too much stiffness, and who have an intact anterior cruciate ligament."

Dr. Geller, who has no financial ties to any implant company, said he offers patients with medial and patellofemoral arthritis the option of either a bicompartmental or a total knee replacement. "Some people still prefer the security of a full replacement. They would rather bet on a sure thing."

Outlook for Bicompartmental Knee Replacement

It may be several years before clinical studies can demonstrate the safety and effectiveness of the bicompartmental procedure, but Dr. Geller believes there will be few long-term complications with the procedure. In the meantime he is conducting studies in his own practice closely comparing patient's outcomes. "The unicompartmental approach has already been shown to be a legitimate option for younger patients with disabling knee pain isolated to a single, specific area of the knee, 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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