Principal Director & Unit Head, Orthopaedics, Fortis Memorial Research Institute, Gurgaon
Part 3 of 9 in Recent Advances in Joint Replacement
Partial or Total Knee Replacement: Matching the Procedure to the Patient
April 13, 2025
Two patients with damaged knees can need two completely different operations, and Dr. Jangid's masterclass set out the logic doctors actually use to decide between them: how much of the joint is worn, how old the patient really is physiologically, and what that patient needs their knee to do.
Age is physiological, not just a number on a chart
Dr. Jangid draws a sharp line between chronological age and what he calls physiological age: a fit, active person in their seventies can be a better surgical candidate than a sedentary person decades younger. His point is practical, not philosophical. Since a well-placed implant can now last 25 to 30 years or more, a genuinely active older patient who may live into their nineties deserves the same durable implant as someone half their age, rather than a lesser one on the assumption that they will not need it for long.
What the patient needs to do with the joint matters
Two patients of similar age can also need different treatment based on their daily physical demands. Dr. Jangid contrasted a patient with a desk job, a good candidate for hip replacement since the joint mainly needs to support walking and daily movement, against a patient doing physically demanding manual labour, where a replaced joint may not tolerate the repeated heavy load the person's livelihood requires. The decision has to account for what the patient will actually go back to doing, not only the X-ray.
Partial replacement for younger patients with partial damage
A growing group of patients, typically between 45 and 55, have only half of the knee joint worn out while the other half remains healthy. For these patients, Dr. Jangid's practice favours a partial (half) knee replacement rather than a full one, reserving total knee replacement for later, generally past age 70, where possible. Partial replacements now also last more than 25 years with robotic placement. Where bone damage is more extensive, customised implants are available in India at a reasonable cost, with a comparatively quick recovery.
This article is based on a Jivo Masterclass session conducted by Dr. Subhash Jangid, Senior Director, Orthopaedics & Joint Reconstruction, Fortis Memorial Research Institute, Gurgaon. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Subhash Jangid taught doctors across Africa on April 13, 2025.
FROM THE LIVE Q&A
Moderator
One attendee thanked Dr. Jangid for the presentation and asked about opportunities to train under him.
Dr. Subhash Jangid
Doctors from Africa can apply for a one-year fellowship programme in India to learn joint replacement surgery. Interested doctors need to email the team and register with India's National Medical Council before joining for the year-long training.
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Frequently Asked Questions
Is there an age limit for hip or knee replacement surgery?▼
There is no fixed age limit at either end. Hip replacement is generally offered from skeletal maturity onward if the joint is badly damaged, and partial knee replacement is usually done from around age 40, occasionally as early as 30, though most patients present between 45 and 50. Modern implants can last more than 30 years, so age by itself is not the deciding factor.
Could an 80-year-old patient with a knee fracture still be considered a candidate for joint replacement surgery?▼
Yes. Age alone should never be the reason to deny treatment. What matters is whether the patient is physiologically fit and medically able to tolerate surgery, not their chronological age. Every patient deserves the chance to keep leading an active life, fracture or not.
Most post-operative painkillers are known to affect the liver. What pain medication is recommended after joint replacement that avoids this?▼
Opioids are used at a very low dose, delivered through a transdermal skin patch or a nasal spray rather than as tablets or injections, giving good pain control without sedation, headache or nausea. Alongside this, the only oral tablet used is paracetamol, which does not affect the stomach or the kidneys.
Sharing an update: how valuable has attending these weekly sessions been?▼
The attendee said he joins every Sunday and is never disappointed, describing the sessions as consistently insightful and helpful for improving his own practice. He mentioned he had further questions and would send them on separately to be passed along to Dr. Jangid.
Could the presentation be shared as a PDF in French as well as English, and was a translator available for the French-speaking doctors on the call?▼
Yes to both. The English PDF was shared with the group, the French version had already been sent separately, and a dedicated French translator was present throughout the session to help the doctors from Congo follow along.
What does Dr. Jangid mean by physiological age versus chronological age?▼
He means that surgical fitness should be judged by how active and medically fit a patient actually is, not by their age in years. A fit patient in their seventies can be a stronger candidate for a durable implant than a sedentary, younger patient.
Who is typically a candidate for partial rather than total knee replacement?▼
Younger patients, typically between 45 and 55, whose knee damage is limited to one half of the joint while the other half remains healthy, are generally good candidates for a partial knee replacement rather than a full one.
In This Series: Recent Advances in Joint Replacement
- 1.Recent Advances in Joint Replacement
- 2.Who Needs a Knee or Hip Replacement: Symptoms and Warning Signs
- 3.Partial or Total Knee Replacement: Matching the Procedure to the Patient
- 4.How Robotic Surgery Is Changing Joint Replacement
- 5.Hip Replacement Surgery: Implant Design, Materials and Durability
- 6.When Joint Replacement Surgery Should Be Delayed or Avoided
- 7.Correcting Severe and Bilateral Knee Deformities
- 8.Recovery, Pain Management and Rehabilitation After Joint Replacement
- 9.Joint Replacement Surgery in India: What International Patients Should Know