Partial knee replacements safer than total procedures

Medical procedures balance the risk surgeries pose to patients' health with the effectiveness of each treatment. While every physician strives to use the most accurate and safest technology to deliver meaningful medicine, some methods may put patients at a higher risk of complications, injuries or even death.

According to a recent study conducted by researchers at the University of Oxford and published in The Lancet, patients who receive partial knee replacements are at lower risks of post-surgical complications, heart attacks and death when compared to patients with total knee replacements. Physicians may want to use the findings to revise their selection criteria for which patients receive each surgery.

Examining the data
The U.S. Center for Disease Control and Prevention explained that 719,000 people undergo total knee replacement surgeries each year. These procedures make up the majority of knee replacements, as only 10 percent of all operations remove a section of the joint as opposed to the whole. Age is also a strong factor when it comes to knee surgeries, as 53.5 percent of all patients are between 65 and 84 years old.

Because so many people undergo knee replacements and the aging population of baby boomers means this number may rise even higher, the University of Oxford researchers looked into the effect that different surgical strategies can have on overall patient outcomes. The study used data from the National Joint Registry, an initiative in the United Kingdom that recorded patient data from April 2003 to August 2012. The researchers found 25,334 cases of partial knee replacements and 75,996 cases of total replacement surgeries.

After reviewing the data, the study found that while patients with partial knee replacements were 40 percent more likely to require follow-up procedures known as revisions, patients who underwent total knee replacements were significantly more likely to develop serious complications post-surgery. These patients were twice as likely to develop a thrombosis, three times as likely to require blood transfusions and had a 15 percent higher chance of dying within eight years after the surgery.

David Murray, M.A., M.D., consultant orthopaedic surgeon at the University of Oxford and contributing author of the study, believed that more partial knee replacements could help patients.

"To put the risks in perspective, if 100 patients had a partial knee rather than a total knee replacement, there would be one fewer death and three more re-operations in the first four years after surgery," Murray said in a statement. "For an individual patient, the decision whether to have a partial or total is based on an assessment of the relative risks and benefits."

Alex Liddle, clinical research fellow at Arthritis Research U.K. and lead author of the study, added that the overall mortality rates for knee replacement surgeries remains low. 

"Even in the elderly, with other health problems, knee replacement is a very safe and effective procedure," Liddle said in a statement "These data remind us that there are still patients, who fortunately very rarely, can develop life threatening complications following surgery and we still need to find surgical approaches that takes away these risks whilst retaining a successful outcome for patients."

It is unlikely that patients will stop choosing total knee replacements entirely, but orthopaedic surgeons may want to consider saving the procedure for only those in the most need. This may help others avoid the unnecessary risks that total joint surgery poses. Otherwise, patients who need a minimally invasive surgery are putting themselves in harm's way with total knee replacements, which puts their lives and the hospital's reputation at risk.