Arthritic Knee Surgery
When non-operative treatments for knee arthritis fail, surgery can be considered. Surgical options include: arthroscopy, partial knee replacement and total knee replacement.
- Role of arthroscopy:
Arthroscopy involves a surgeon making a small incision in the knee and irrigates and removes loose pieces of cartilage. In the arthritic knee, there is a limited role for an arthroscopy. Results of a "clean out" or a "wash out" are unpredictable and would be appropriate only in very selected cases.
- Role of unicompartmental of partial knee replacement:
Partial knee replacement (also known as a "Uni") replaces only the part of the knee that is worn out. This can be either the patello-femoral joint (knee cap-femur) or, more commonly the femoral-tibial joint. These procedures are appealing due to the fact that they are generally less invasive, have an easier recovery and due to the fact that there is more retained normal tissue left behind, are perceived by patients as less mechanical. The ideal candidate for these procedures is an evolving topic and you would need to discuss with your orthopaedic surgeon if you are an appropriate candidate for this procedure. Issues of location and amount of disease as well as the amount of deformity present are important considerations. Newer technologies such as computers, robots and custom guides have been introduced to this concept in attempts to improve outcomes. The influence of these technologies has yet to be determined. Outcomes of partial knee replacements can be comparable to total knee replacements ten years after surgery.
- Role of cartilage procedures:
This procedure involves implanting cartilage cells into the area of disease in the knee. While appealing in concept, there is a role for this procedure in an arthritic knee where the disease is very localized and has no role to play in the treatment of the advanced arthritic knee.
- Role of total knee replacement:
Total knee replacement is the gold standard for the patient who has failed non-operative treatment for arthritis of the knee. This procedure involves resecting the ends of the bones of the knee and replacing them with a combination of metal and plastic. The procedure is one of the most successful of all surgical procedures and on average provides 90-95% pain relief, has a 1-2% complication rate and approximately 90% of these knees will be satisfactory 20 years from surgery.