Knee Replacement Alternative – Orthopedic Surgery

Introduction – Knee Replacement Alternative

Total knee replacement is elective surgery. It is a life-enhancing surgery, not life-saving surgery. The decision to undergo total knee replacement surgery is totally yours. It is important to be aware of the treatment options other than total knee replacement surgery. The patient can sometimes simply decide not to have surgery and continue with the arthritic knee. Although in this case, strenuous and painful activities need to be avoided; the patient should adopt some gentle exercise such as walking. The patient also may benefit from some moist heat, massage or other forms of physical therapy. Weight loss is another measure which can be very helpful in reducing pain from arthritic knees by reducing the stress on them. There are a number of medications including anti-inflammatory medications and pain medications, which can help to live with arthritis. There are also medicines available to be injected directly into the knee, such as cortisone and newer products that improve the joint lubrication. Unfortunately, the arthritis is progressive disease in most cases. A cane or a crutch may be required in order to walk.

There are various alternatives to total knee replacement surgery which may be considered by a patient who wishes to avoid the knee replacement. These are as follows:

  1. Arthroscopy
  2. Osteotomy
  3. Uni-compartmental arthroplasty
  4. Specialized Braces
  5. Cartilage Transplantation

Arthroscopy

It is now possible to transplant articular cartilage from one location of joint to another.
There are less invasive surgical procedures available which can be helpful in some cases. One of such techniques is arthroscopy. Arthroscopy requires only small incisions or ports around the knee which allow the insertion of small instruments, which are about the size of a pen. During arthroscopy, the degenerated and worn cartilages are usually trimmed and smoothed, which reduces the inflammation. Additionally, the lining of the knee joint (the synovium) can be trimmed, and this also reduces inflammation. Any loose fragments in the knee which irritate the synovium are removed. Patients having knee arthroscopy almost always go home on the same day. Recovery from surgery requires a couple of weeks. However, the benefit of arthroscopy decreases with advancing arthritis. In advanced arthritis, arthroscopy is of little value.

Osteotomy

Some cases, where the leg is imperfectly aligned, can be treated by an osteotomy. An osteotomy means an operation to cut the bone. The osteotomy is performed either above or below the knee, and re-aligns the knee to a better position. This is a bigger operation than an arthroscopy and the hospital stay is usually of about 1 or 2 days. It takes 6 to 8 weeks for the bone to heal. Physiotherapy is usually required to restore knee motion and strength. Complete recovery is expected after a few months. An osteotomy is a good option, especially for younger patients in whom the leg is clearly not straight. Unfortunately, the success of an osteotomy also decreases with increasing severity of arthritis.

Uni-Compartmental Arthroplasty

In some cases, only a portion of the knee joint becomes worn out and needs to the replaced. Replacing only a portion of the knee joint is called as a uni-compartmental arthroplasty. Patients usually require hospital stay of about 2 or 3 days and it takes a couple of months for the knee to recover. Physical therapy is usually required to restore the knee motion and muscle strength. Unfortunately, in most cases of arthritis, the wearing of joint surfaces is diffuse. Therefore, this surgery is less commonly performed than total knee replacement.

Specialized Braces

There are specialized braces available which can be helpful in some cases of knee arthritis. These braces are designed to transfer load from an area of the knee where the cartilage is more damaged to an area of joint where the cartilage is less worn. These braces are helpful in cases where there is still some healthy cartilage remaining in the knee.

Cartilage Transplantation

It is now possible to transplant articular cartilage from one location of joint to another. Healthy cartilage, from an area of the knee that does not bear weight, can be transplanted into another area of the knee where weight-bearing cartilage has been damaged. Cartilage transplantation is suitable for localized areas of cartilage damage in an otherwise healthy joint. Unfortunately, in most cases of arthritis, the degeneration of articular cartilage is diffuse involving most of the joint surfaces. Such joints are not amenable to cartilage transplantation.

 

- Link of interest: Orthopedic News on Facebook

This article is not medical advice nor a substitute to professional health advice. Always consult a doctor.

 

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