Knee replacement surgery is one of the most successful surgical options available, with more than 90% of knee replacements still in place after 20 years. It’s an option for treating pain and stiffness in the knee joint after all other non-surgical treatments have failed to relieve symptoms. There are a few different types of knee arthroplasty, based on what needs to be repaired.

Total knee replacement surgery

The knee is the largest joint in the body. It connects the thigh and shin bones with muscle, tendons and ligaments. Each bone is covered in protective layers of shock-absorbing cartilage. When any of these layers wear out due to arthritis or disease, a knee replacement surgery can help alleviate pain and improve movement.

“Total knee replacement surgery is a knee-resurfacing operation. The old, arthritic cartilage is removed and replaced with an implant to create a smooth sliding surface for the knee,” said Dr. Leonard Buller, orthopedic surgeon specializing in adult reconstruction of the hip and knee and medical director of orthopedics and sports medicine at IU Health Saxony Hospital. “We replace both the inside and outside portions of the knee on the thighbone, shin bone or patella, the kneecap bone.”

Candidates for total knee replacement surgery have significant arthritic knee pain and have exhausted all non-surgical options for relief, like physical therapy, anti-inflammatory medications and injections.

The benefit of a total knee replacement is that it eliminates arthritis completely and the patient can get up and walk the same day of surgery. While there’s less of a possibility of needing additional knee surgery in the future when compared to a partial knee replacement, the total replacement surgery requires a longer recovery period of about six weeks.

Partial knee replacement surgery

The knee is made up of three compartments: the inside (medial), outside (lateral) and patellofemoral (front kneecap) compartments. A candidate for partial knee replacement surgery has arthritis symptoms in one of those compartments. Like total knee replacement surgery, partial replacement resurfaces the damaged area of the knee for smooth movement.

The benefit of a partial knee replacement surgery is a quicker recovery in four to six weeks. However, the risk of a partial surgery is that it may not entirely resolve your knee problems.

“If you develop pain later in another part of your knee, you’ll need a total knee replacement surgery,” Dr. Buller said. “Also, the partial knee replacement implant doesn’t last as long. The best data we have suggests that 90% of these last 14 years, which is a shorter lifespan than a total knee replacement. Still, a partial is a great option for some patients.”

Revision knee replacement surgery

When a knee replacement implant fails, a revision knee replacement surgery repairs the joint. The American Joint Replacement Registry (AJRR), the world’s largest registry of joint replacements, identified the top three causes of knee revisions: infection, instability and mechanical loosening.

IU Health Saxony is a Center of Excellence for revision hip and knee replacement, and Dr. Buller’s team treats the highest volume of these surgeries in the state. Since a revision surgery is a more complex procedure compared to the other types of knee surgeries, Dr. Buller—a surgeon investigator for AJRR—recommends patients find an experienced provider who can consider any other medical issues contributing to knee problems and optimize treatments for a successful outcome.

“Pain is oftentimes a presenting symptom of knees needing surgery, but it’s not a diagnosis. Doing surgery for pain alone will likely result in poor outcomes. Patients should seek a provider who can identify the source of the pain to solve the problem,” said Dr. Buller, who has published research on revision surgery. “Our team takes a holistic approach to make sure we’re treating the whole patient and not just the knee.”

One way to achieve excellent longevity in a knee implant and avoid future revision surgery is through enhanced technology like computer navigation. IU Health Saxony applies computer navigation in all knee replacement surgeries.

“This allows the surgeon to place the implant with the highest accuracy and precision possible,” Dr. Buller said. “Studies suggest this results in a longer lifespan of the implant.”

Minimally invasive surgery

A surgeon trained in minimally invasive surgery will work with you to determine if you are a candidate for this approach. A minimally invasive procedure can reduce scarring and avoid cutting additional muscle tissue or stressing tendons during the procedure, which helps improve recovery time.

“I take a minimally invasive approach to surgery for all my patients. But you need to trust that your surgeon is going to do the right surgery for you without sacrificing quality,” Dr. Buller said. “Our goal is to put in a lasting knee replacement with the best results, so if you can achieve this with minimal invasion and accommodate those goals, that’s the win.”

The decision to have knee replacement surgery depends upon several factors, including symptoms, physical limitations, whether you’re healthy enough for surgery and an understanding of the lifespan of the implant. Discuss with your doctor your goals and expectations for surgery to ensure you have the correct surgery for your needs.