Knee Resurfacing: An Alternative to Total Knee Replacement

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Knees wear out for a variety of reasons, including inflammation from arthritis, injury, or simple wear and tear. For patients with severe defects or degenerative disease of the knee joint, surgery is often required.

Total knee replacement is the surgical removal of worn-out knee surfaces and replacing lost cartilage and diseased bone with metal and plastic. This surgical procedure has been performed for decades. In fact, 300,000 undergo this procedure each year.

However, the procedure does have its limitations. For patients under 60, an alternative to total knee replacement is available. Called knee resurfacing arthroplasty, this innovative procedure is designed to protect the remaining, normal cartilage in an attempt to prevent further damage — and prolong the lifespan of the original knee.

Limitations of Total Knee Replacement for Persons Under 60

Total knee replacement patients often describe their restored lifestyle/activity as profound. Yet, there are down sides:

• Rehabilitation usually takes several months, or longer.
• Total knee replacement requires removal of substantial amounts of bone.
• When the original prosthesis wears out, successive procedures (commonly called "revisions") are often less successful.

While the useful life of a total knee replacement is generally claimed to be up to 20 years, clinical evidence indicates that complications can begin to arise at approximately 8 to 10 years.

Each successive total knee replacement revision is likely to have a shorter useful life than the previous implant. Here's the reason why: The amount of remaining good quality bone stock into which the implants are anchored can be an issue. Bone loss as a result of tissue reaction, implant loosening, implant preparation and other factors can lead to great challenges in restoring a solid anchoring site for the implant.

For these reasons, surgeons are reluctant to perform total knee replacement for patients younger than 60. This also explains why younger patients have been told, historically speaking, to tough it out.

The Benefits of Knee Resurfacing

Yet, now there is an alternative for younger adults with bad knees and active lifestyles. It's called knee resurfacing, or "resurfacing arthroplasty," and it is designed to protect the remaining, normal cartilage in an attempt to prevent further damage.

This treatment option affords faster pain relief, shorter recovery times and significant improvement in range of motion. What’s more, it can be performed on an outpatient basis, in as quickly as one hour.

Knee resurfacing replaces only the damaged portion of the surface of the knee joint. Compared with total knee replacement, a much smaller amount of diseased tissue is removed. Knee resurfacing also uses a smaller prosthesis.

One knee resurfacing system is called HemiCAP. The system has two parts, which are connected:

• An articular component: A rounded, cap-like implant made from a cobalt chrome alloy, a material that has been used in joint reconstruction devices for over two decades. Likewise, this material has proven to be a safe, effective and strong weight-bearing surface in joints.
• A fixation component: This part, which is made of central titanium and resembles a screw, is implanted into the thigh bone.

In this knee resurfacing technique, the surgeon determines the exact diameter of the defective knee tissue. Next, a guide wire is introduced into the middle of the defect. The fixation component is implanted here; it will establish the mechanism for anchoring the cap-like articular component.

Specially designed instruments then map the contours of the cartilage surrounding the defect. Once the tissue is prepared for the resurfacing implant, the implant is brought into position and seated.