Surgical Options

The available Surgical interventions include:

1.     Arthroscopy2.     Osteotomy3. Knee replacement

Unicompartmental knee replacement Total knee replacement

Arthroscopy

Arthroscopy involves: • Cleaning or debridement of joint• Repair of damaged cartilage • Removal of loose bits of cartilage &

bone • Draining of infected or excess synovial fluid• Removal of diseased synovium

Surgical Interventions

• The aim of surgical treatment of OA is to decrease or eliminate pain and to improve function

• The particular choice of procedure for the individual patient is determined by a complex set of variables:

pain severity degree of functional impairment evidence for structural joint damage

 

• Arthroscopy done under regional anesthesia

• Does not involve any blood loss

• Usually offers temporary relief of symptoms for somewhere between 6 months - 2 years

Arthroscopy

Osteotomy

• Osteotomy literally means “bone cutting” • The deformity is corrected by removing or

adding triangular wedges of bone• Useful in preventing deterioration of joints

with OA due to a pre-existing deformity such as bowleggedness

• This procedure will reduce pain, eliminate deformity.

• Best results are obtained with patients younger than 55 years ,involvement of either medial or lateral compatment only.

Osteotomy

Unicompartmental knee replacement

Total knee replacement 

Knee Replacement

Myths

• Hip replacement works but knee replacement doesn’t

• Knee replacements are still experimental

• Knee replacements only last 8-10 years may be 15 years maximum

• I am too fat - my implants might break

• TKR surgery is too costly

• TKR is not successful

• After TKR, I have to be bedridden for 3 months

• A total knee replacement implies that everything about the joint is being replaced

Myths

Indications of Knee Replacement

•   Knee pain that has failed to respond to conservative therapy

• Knee OA

• Pain - at rest - at night - with activity

• Loss of function

• Knee tumors

• In short PAIN , PAIN & PAIN.

Unicompartmental Knee Replacement

• Only a small part of the knee is replaced in this procedure

• Recommended for patients with medial or lateral compartment disease moderate to severe pain and functional

impairment

• It is intended to relieve pain and preserve function for as long as possible, before a total knee replacement is become necessary

Unicompartmental Knee Replacement

Unicompartmental Knee Replacement

Advantages

• Minimally invasive• Short hospital stay • Rapid recovery• Satisfactory conversion to TKR

Disadvantages• Long - term (>15 years) result unknown• Not recommended for heavy manual work

Total Knee Replacement

• The ultimate solution for OA of knee is to replace the worn-out parts of the knee with an artificial joint

• The prosthesis that is used is made up of plastic and metal and is placed on the joint surface of each bone

• This surgery has been widely used for many years with excellent results especially for knees

Total Knee Replacement - Prostheses

  

Intraoperative - TKR

Day 1 - Post-Op TKR

AP Lateral

Common Post-Operative (TKR) Course

• Day 1 Standing, bending and sitting out in a chairMay take a few steps with help

• Day 2 Walking (with aids)

• Day 4/5 Stair climbing

• Day 5-7 Home (with 2 walking sticks)

• Week 6 Walking unaided (or 1 stick) Driving

• Week 10-12 Full recovery

Benefits of TKR

• TKR can relieve pain that doesn't respond

to other treatment options

• Pain reduction in 90 to 95% of the patients

• Reduced stiffness and improved joint

movement

• Increased walking ability

• Improved alignment of deformed joints