Types of knee surgery for the treatment of arthritis

Patients with moderate to severe knee arthritis who have exhausted non-surgical treatment options may consider replacing the entire knee joint. The surgery consists of cutting the extremities with arthritis of the tibia (bone of the shin) and the femur (thigh bone) and covering them with prostheses (like closing the teeth).

Knee replacement

Video of knee replacement surgery

The two prosthetic parts are made of metal or a tough plastic called polyethylene. These new surfaces move smoothly against each other, creating a functional knee joint. Partial recovery usually takes 4 to 6 weeks1 and full recovery can take a few months to a full year.

Total knee replacement surgery provides most patients with pain relief and improves joint function of the knee. However, a replacement knee is not as strong and durable as a healthy knee, and patients who do not engage in high-impact activities (such as jogging) that can accelerate wear on the new joint are highly recommended.

Partial knee replacement surgery (unicompartmental knee arthroplasty)

Partial knee replacement, often called a unicompartmental knee replacement, involves replacing only one of the three "compartments" of the knee:

The medial compartment refers to the inner knee (where a person's knees touch when the legs are together).

The lateral compartment refers to the outer knee.

The patellofemoral compartment is in the front of the knee, where the patella (kneecap) meets the femur (thigh bone).

Partial knee replacement surgery treats the arthritically damaged compartment of the knee joint (usually the lateral or medial compartment) while preserving healthy areas. This surgery is appropriate only for a small number of people, and patients may not be eligible if their knees are not properly aligned (eg, surrounded by legs or knees), have severe knee stiffness, ligament damage or if they suffer from inflammatory arthritis. like rheumatoid arthritis.

Compared to total knee replacement, partial knee replacement is less invasive, so it is usually less painful and requires less recovery time. However, partial knee replacement is not as reliable as total knee replacement to relieve pain.

This surgery is suitable for a limited number of physically active younger people (under 60) whose poor knee alignment has caused great wear on only one side of the knee joint, a condition called unilateral knee. Arthritis or asymmetric knee arthritis.

During the knee osteotomy, the surgeon cuts the femur (thigh bone) or tibia (shin bone) and:

Remove a small wedge of bone, or

Add a small wedge of natural bone graft or artificial bone material.

Osteoarthritis of the knee

Video of knee osteoarthritis

The osteotomy of the knee realigns the joint to move more pressure towards the "good" side of the knee joint and reduce wear on the bad side. The goal is to reduce pain and, perhaps, decrease the progression of knee osteoarthritis. A successful knee osteotomy surgery may postpone the need for total knee replacement surgery for up to 10 years.

Unlike total knee replacement, patients with recovered knee osteotomy can participate in high-impact sports.3 This is major surgery with potential risks and complications, and patients must commit to extensive post-surgical physical therapy. A full recovery can take months or even a whole year.

Arthroscopic surgery requires only small incisions through which the surgeon inserts a very small video camera and surgical tools. During knee arthroscopy, a surgeon can evaluate joint degeneration due to arthritis.

The surgeon can also perform debridement and knee washing, which includes the following process:

Remove loose pieces of cartilage or bone (loose osteophytes) that are suspected of causing irritation

Trim or smooth the cartilage that has become irregular and bumpy

Remove inflamed synovial tissue

Wash the joint with a saline solution, a process called washing, to clean materials known to cause irritation and swelling

Once damaged, the cartilage does not heal well. Even if the joint is able to grow new cartilage, it tends to be rough and uneven and, therefore, less able to facilitate a smooth movement in the joint.

There are a handful of surgeries that try to repair or encourage the growth of healthy cartilage:

Stimulation of the bone marrow, which stimulates cartilage growth by making precise microfractures in the surrounding bone

Techniques of osteochondral transplant (OATS), also known as "mosaicplasty", which involves the transplantation of cartilage from one place to another

Implantation of autologous chondrocytes (ACI), which requires two surgeries. In the first, the cartilage cells are collected and then grown in a laboratory for several weeks. During the second surgery, the cartilage cells are reimplanted.

These procedures may be appropriate for patients who have a relatively small area and very isolated articular cartilage damage. Usually, these patients are younger and have damaged their cartilage through trauma (for example, a sports injury) instead of years of gradual wear and tear. Therefore, these surgeries are usually more appropriate for people trying to slow or prevent severe arthritis instead of relieving it.

This article focuses on the most common types of knee surgery for arthritis. New types of surgery, less invasive surgical techniques and new implant designs and materials are ongoing research topics

At Expert Joint Care Clinic Dr.Nandan Rao treats for shoulder joints problem and joint replacement surgery. He is best orthopaedic doctor in Mumbai.