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