Quality standard

Statement 2: Choice between partial and total knee replacement

Statement 2: Choice between partial and total knee replacement

Quality statement

Adults with isolated medial compartmental osteoarthritis who will have knee replacement are given the choice of partial or total replacement.

Rationale

Adults who are offered a knee replacement should be given a choice of partial or total replacement if clinical and radiological assessment shows both are suitable options. Discussing the risks and benefits of each procedure helps the person choose what is most suitable for them, based on their personal circumstances and preferences.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local processes to support a discussion that includes the risks and benefits of partial and total knee replacement with adults who have isolated medial compartmental osteoarthritis and will be having knee replacement.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from service protocols.

b) Evidence of service specifications to ensure that both total and partial knee replacements are available to adults with isolated medial compartmental osteoarthritis who will be having knee replacement.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, from service specifications.

Process

Proportion of primary knee replacements that are partial knee replacements.

Numerator – the number in the denominator that are partial knee replacements.

Denominator – the number of primary knee replacements.

Data source: The National Joint Registry (NJR) collects data on the number of primary knee replacements that are unicondylar knee replacements. Data is presented in the 12-month and 36‑month practice profiles for hospitals in the NJR's Surgeon and Hospital Profile service for hip, knee, ankle, elbow and shoulder joint replacement surgery.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that adults with isolated medial compartmental osteoarthritis who will be having knee replacement are given the choice of either partial or total knee replacement. This is if clinical and radiological assessment shows both options are suitable, and after discussing the risks and benefits of both operations and considering personal circumstances and preferences.

Healthcare professionals (members of the orthopaedic multidisciplinary team) allow time to discuss the benefits and risks of partial and total knee replacement with adults who have isolated medial compartmental osteoarthritis and will be having knee replacement, and for whom both options are suitable. The choice of operation should take account of the outcome of clinical and radiological assessment and the adult's personal circumstances and preferences. Healthcare professionals work with colleagues to ensure that adults having knee replacement have the operation they have chosen.

Commissioners ensure that they commission services that provide both partial and total knee replacements. They should ensure that services provide adults who have isolated medial compartmental osteoarthritis and will be having knee replacement with an opportunity to discuss the risks and benefits of each operation, if both options are suitable.

Adults who have isolated medial compartmental osteoarthritis who are having their knee joint replaced and could have either partial or total replacement discuss the risks and benefits of both operations, and their circumstances and preferences, with a member of the orthopaedic team. This is to help them decide whether to have only the affected part of their knee joint replaced, or the entire joint. Their choice of operation also takes account of their clinical circumstances and relevant aspects of their condition.

Definitions of terms used in this quality statement

Partial knee replacement

This operation involves only replacing the affected part of the knee, that is, the medial compartment. [Adapted from NICE's guideline on joint replacement (primary), methods – glossary]

Total knee replacement

This operation involves replacing both sides of the knee joint. Patella resurfacing may be done as part of a total knee replacement. A separate patella implant is attached to the back of the kneecap to connect and fit smoothly with the femoral implant. [Adapted from NICE's guideline on joint replacement (primary), methods – glossary]