What are the options for an arthritic knee
Friday 1 July 2016

In the UK nearly 5 million people seek treatment for osteoarthritis of the knee. Almost one in five people aged 45 and over have some treatment for this condition.

The risk factors for osteoarthritis are

- A familial tendency

- There is a slightly higher incidence in women

- Osteoarthritis is also related to ageing

- Stresses on the joint through occupational or recreational activity as well as obesity

- Injury to the knee

- Malalignment for example as the result of fractures

The commonest symptom is knee pain which is exacerbated by exercise and activity and initially this is relieved by rest.

As the disease progresses, symptoms can occur even at night and at rest and can affect sleep.

In younger individuals, knee pain is not always due to osteoarthritis and other causes have to be looked for and these include cartilage tears, ligament injuries, tendon inflammation or bursitis.

DIAGNOSING OSTEOARTHRITIS

Osteoarthritis is usually diagnosed by your doctor examining you and arranging for an x-ray of your knee. There are no blood tests for osteoarthritis, however these may be done to rule out other types of arthritis. Your doctor or therapist may also advise an MRI Scan if they feel your knee pain is due to damaged ligaments or cartilage in the knee or due to loose fragments of bone or cartilage in the knee.

TREATMENT OPTIONS FOR OSTEOARTHRITIS

Treatment is decided by the severity of your arthritis and your symptoms from this.

If your arthritis is not severe, the initial treatment would involve targeted knee exercises and physiotherapy to strengthen the muscles around your knee joint. Modification of activities that may aggravate your knee symptoms and increase the wear in your joint and

If your symptoms persist your doctor may advise a steroid or hyaluronic acid injection for partial and temporary relief.

KEYHOLE SURGERY FOR THE KNEE

This is done to wash out loose bits of bone and cartilage in arthritic knees as well as address any torn cartilage fragments which may be aggravating symptoms and causing mechanical problems with the knee such as sharp catching pain and locking of the knee joint.

MICRO-FRACTURE is a technique whereby a small area within the knee which has lost its cartilage is stimulated through keyhole surgery to produce cartilage and scar tissue so that this replaces the defect.

AUTOLOGOUS CHONDROCYTE TRANSPLANTATION

This is now available for circumscribed and small areas of cartilage loss. This is not an option for an arthritic knee with a wide area of degenerative disease and loss of cartilage. In this technique, your cartilage cells are harvested, grown in the laboratory and put back into the defective area in the knee joint.

JOINT REPLACEMENT SURGERY

Joint replacement surgery remains the cornerstone of treatment still to this day. However, the design and model of the artificial knee joint has been continually improved over the years. There are various joint replacements that are now available for osteoarthritis and your Orthopaedic Surgeon will be able to guide you as to what is the best choice for you.

Total knee replacements have been around for a long time and are quite successful, however about one in four total knee replacement patients remain unsatisfied with their new knees and the reasons for these are various and not usually due to technical issues with the surgery. Therefore, surgeons are now considering partial replacements in a carefully selected sub set of patients.

- Partial knee replacements include:

- Patellar joint replacement

- Replacing just the surface of the knee cap

- Medial or Lateral Partial Knee Replacements

Replacing only the worn inner or outer aspects of the knee rather than replace the joint fully, have the advantage of being a less invasive surgery ensuring a faster recovery and a more normal feeling knee, giving better function and satisfaction to the patient after knee replacement. These are known to last for less time than total knee replacements. However they remain an attractive option in the younger patient with osteoarthritis or in an older patient where a major operation such as a full knee replacement may not be required.

If you feel you have knee pain related to osteoarthritis, it is best to seek early advice from your doctor and therapist for help and information on how to minimise symptoms and prolong the life of your joint.

If you are severely affected by osteoarthritis, it may be best to seek advice early as leaving an arthritic knee for too long can increase the deformity and bone loss and lead to you needing more complex surgery rather than simple joint replacement treatment.

Mr Praveen Panose MBBS, FRCS(T&O), MS(Orthopaedics)

Consultant Orthopaedic Surgeon specialising in hip and knee surgery.


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