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Oxford Study Indicates Partial, Rather Than Total Knee Replacement, Safer in Severe OA

An Oxford University study suggests partial knee replacement surgery for severe osteoarthritis (OA) may be safer than total knee replacement. According to an Oxford University news release, researchers found that individuals undergoing partial knee replacement surgery, in which only parts of the knee impacted by OA are removed, exhibit fewer complications and are less likely to be re-admitted to the hospital and less likely to suffer fatality.

However, the researchers acknowledge these individuals are also more likely to have revision surgery.

The release notes that David Murray, MA, MD, FRCS, led the research at the Nuffield Departmental of  Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford.

Murray states in the release that for each patient, the decision to have either a partial of total knee replacement stems from an assessment of the relative risks and benefits.

“To put the risks in perspective, if 100 patients had a partial knee rather than a total knee replacement, there would be 1 fewer death and 3 more re-operations in the first four years after surgery,” Murray says.

Researchers also stress that revision, re-operation, and death were uncommon outcomes of either procedure. Murray notes that overall, joint replacement tends to save lives by making patients more mobile and fit.

During the study, researchers, funded by Arthritis Research UK and the Royal College of Surgeons, used data from the National Joint Registry for England and Wales, centered on the adverse outcomes of more than 100,000 patients who had undergone knee surgery. The results suggest that while researchers found the risk of life-threatening complications from knee replacement surgery very small, individuals who undergo total knee replacement are four times more likely to die in the first month after surgery compared to those who have partial knee replacement and 15% more likely to die in the first 8 years.

Additionally, compared to individuals having partial replacement, patients undergoing total replacement were twice as likely to have a blood clot, heart attack, or deep infection and three times as likely to sustain a stroke. The results also indicate that patients who underwent partial knee replacement are 40% more likely to have a re-operation during the first 8 years after replacement.

In the release, Alex Liddle, an Arthritis Research UK clinical research fellow, Oxford University, who ran the study, states “Partial and total knee replacements are both successful treatments and a large proportion of patients with end-stage knee osteoarthritis are suitable for either. Both have advantages and disadvantages, and the choice of which procedure to offer will depend on the requirements and expectations of individual patient.”

Alan Silman, professor and medical director of Arthritis Research UK, echoes Liddle’s sentiments, noting that the study provides patients and surgeons key information about the risk and benefits of two effective types of knee replacement operations.

“…Even in the elderly with other health problems, knee replacement is a very safe and effective procedure. 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 take away these risks whilst retaining a successful outcome for patients,” Silman adds.

Source(s): Oxford University, Arthritis Research UK