Hip and Knee Questions and Answers.

Figure 1 - Model of a partial knee replacement.

Figure 2 - Model of a traditional total knee replacement. The patella (knee cap) is not shown in this model.

Options for severe arthritis of the knee

What options are available for a patient who has severe arthritis (sometimes called "bone-on-bone") throughout the knee?

When the weight-bearing surface of a joint, called cartilage, is lost or severely damaged, that condition is called arthritis, or degenerative joint disease. Normal cartilage is very smooth and slippery. Arthritic cartilage is rough and cracked. When the cartilage is gone completely, bones beneath the cartilage on opposite sides of the joint rub against one another, and this can be quite painful.

Usually before considering surgery, most knee specialists would recommend a course of non-operative management, to see whether relief can be obtained without needing to go through the inconvenience and risk of surgery. Non-operative treatments for arthritis include pills (like Tylenol or an anti-inflammatory such as ibuprofen, or one of the newer ones like Vioxx or Celebrex) or shots (either cortisone-type shots, or a joint-lubricating fluid like Synvisc or Hyalgan). Some kinds of non-operative management don't involve medications at all: weight loss if appropriate, activity modifications, and sometimes use of a cane or a brace can help. But for some people with severe arthritis, these aren't enough, and the pain continues despite these efforts. In those instances, surgery may be reasonable.

For young people with arthritis (usually under age 40-50) it is desirable to avoid a joint replacement if possible, since patients in that age group are very likely to outlive the joint replacement. In those individuals, who represent a very unusual circumstance, there are other surgical options available. It is reasonable to talk to your physician to find out which is best for you.

For people in "middle age" or older, a knee replacement is usually the best choice to relieve the pain of knee arthritis, and restore a reasonable level of function. There are two kinds of knee replacements: partial and total.

When the arthritis in the knee is confined to just one side, and as long as the pain is only on one side of the knee as well, sometimes a minimally-invasive partial knee replacement can be performed (see figure 1). For more detail about this procedure, click here.

For people with arthritis throughout the knee (sometimes called bi- or tri-compartmental arthritis), a total knee replacement is still the most reliable operation we have. More than 90 percent of patients who undergo this operation will be very satisfied with it, and they now last more than 10 years in more than 90 percent of patients. This procedure involves replacing the weight-bearing surfaces of the knee with metal and a high-performance plastic (see figure 2). Most patients are able to walk without pain once they recover from this procedure, and many also resume their preferred (non-impact) recreational activities, such as golf, cross-country skiing, dancing, or riding a bicycle.

The best way to learn more about these procedures (or to find out whether it is a good option for you) is to speak with a joint replacement specialist, or a good orthopedic surgeon who is comfortable with complex knee surgery.

Knee Arthritis

Surgery for Hip and Knee at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

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