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Knee Replacement & Osteotomy

Opinion and Philosophy on Knee Replacement

Mr Taylor believes that the gold standard is a cemented replacement and decides whether to retain the posterior cruciate ligament or replace the patella (knee cap) on an individual basis. Half or Unicompartmental knee replacement is a frequent part of his practice at any age but more frequent in younger patients due to the low but definite risk of the need for early revision.

Mr Taylor believes some of the marketing around implants eg. the gender specific knee and high flex knee needs to be interpreted with caution as the literature shows no advantage to gender knees and reports of early loosening of high flex replacements.

Ladies are particularly susceptible to arthritis of the knee cap (patellofemoral joint) and Mr Taylor has a special interest in replacing the patellofemoral joint as an isolated procedure.

Primary Knee Replacement ; Custom Knee Replacement (Visionaire Custom System).
Unicompartmental Replacement ; Bicompartmental Replacement ; Patellofemoral Joint Replacement.

What is an Osteotomy?

In the knee it is common for one side to wear more than other ( cf. if a car tyre wears and is unbalanced it will continue to wear more on the one side). If this occurs and Osteotomy may be a good intermediate treatment if the wear is not too advanced.

The operation can be performed on either the tibia (in a bowed leg) or the femur (in a knock knee), where the weight is transferred to the unworn side by dividing the bone and removing or inserting a wedge of bone (in effect straightening the knee).

Cemented v Uncemented Knee Replacement - A fully cemented Knee Replacement is the gold standard (National Joint Registry) but results of uncemented knees are improving and gaining popularity especially in younger patients.

Unicompartmental Knee Replacement - not all knees are suited to this operation. If it is the advantages are that the knee feels more like a normal knee (probably because the cruciate ligaments are retained), in most instances has a better range of movement than a total knee replacement and an easier short term recovery. If one compartment is replaced it has to be remembered that the other parts of the knee can in turn wear out. Mr Taylor's experience is similar to the National Joint Registry in that this does not occur very often.

Periods of Hospitalisation:

Hip replacement - 2 - 4 days. Bilateral - 5-6 days.
Knee Replacement - 2 - 4 days. Revision - 5-6 days
Anterior Cruciate Ligament Reconstruction - 24 hours.
Osteotomy - 1 - 2 days.
Arthroscopy - daycase.