Arthritis is a condition that causes pain, stiffness and swelling in the joints. Osteoarthritis is the most common form of arthritis and it commonly affects the knees. Arthritis of the knee may develop as the cartilage protecting the bones of the knee joint wears down over time. Over the years, as stress is put on the joints, cartilage wears thin and sometimes even erodes completely, resulting in stiffness and pain. Arthritis of the knee occurs more frequently in older individuals; however, it sometimes develops in athletes from overuse of the knee joint or after an injury.
Symptoms of arthritis of the knee may include pain, swelling and stiffness within the joint. Some individuals also experience a feeling of weakness in the knee that results in the knee locking or buckling.
Physical therapy may be a successful form of treatment for some patients. Severe cases of osteoarthritis of the knee may require surgery to reposition the bones or replace the joint. Most procedures can be performed through arthroscopy, which significantly reduces bleeding, scarring and recovery times.
In a total knee replacement, the damaged ends of the bones are removed and replaced with a prosthesis made of metal and plastic. A partial knee replacement for patients with damage on only one side of the joint can delay or prevent a total knee replacement. These artificial parts allow the joint to move smoothly so the patient experiences pain relief and a better quality of life. Knee replacement can also help restore motion to the joint, straighten the leg and improve stability.
Recent advances in surgical technology make it possible to perform minimally invasive joint replacements. Traditional knee replacement surgery involves an 8-12 inch incision. Various minimally-invasive techniques allow the joint to be replaced with less cutting and manipulation of muscles, tendons and ligaments around the joint. There are other potential advantages to minimally invasive surgery that help make the surgery safer and allow patients to enjoy a faster and less painful recovery. Dr. Koman will discuss with you whether you are a candidate for minimally invasive knee replacement surgery.
Partial Knee Replacement
Partial knee replacement may be possible for patients with damage to one part of the joint. Doctors refer to this limited damage as a Unicompartmental knee or "Uni" knee. In a partial knee replacement, only the diseased parts of the knee are removed and replaced; the healthy portions are left untouched. Successful partial knee replacements can delay or eliminate the need for a total knee replacement. They also allow a greater range of movement than standard (non-high-flex) total knee replacements.
Benefits of partial knee replacement surgery include a smaller incision (2-3 inches), shorter hospital stay (often 24 hours or less), and faster recovery and rehabilitation.
The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the knee. Running diagonally through the middle of the joint, the ACL works together with three other ligaments to connect the femur (upper leg bone) to the tibia (lower leg bone). An injury to this ligament causes the knee to become unstable and the joint to slide forward too much. ACL injuries occur most often in athletes as a result of direct contact, landing awkwardly after a fall or playing recklessly. About half of all ACL injuries are also accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee.
Signs that you may have injured your ACL include pain, swelling and instability immediately after the injury, followed hours later by greater swelling and pain, limited motion, tenderness and an inability to walk comfortably. While not all ACL injuries will require surgery, leaving the ligament torn or damaged puts the patient at risk for recurring episodes of knee instability. It may also increase the likelihood of developing tissue damage or arthritis over time. In many cases, patients will not be able to resume high-level athletic activity without surgery.
ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually from the knee or hamstring, is used to create a graft for the new ACL. Choosing the proper type of graft depends on each patient's individual condition.
ACL surgery requires a few months for full recovery and physical rehabilitation will be needed as well.
A torn meniscus is a common injury often caused by forcefully twisting or rotating the knee. It can also be a result of degenerative changes in older adults. A meniscus tear can be repaired through arthroscopic surgery. A torn meniscus causes pain and swelling, and may also be accompanied by a frequently locking joint and the inability to completely straighten the knee. Some people experience a popping or clicking sensation within the knee as well.
The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, between the thigh bone and shin bone. They help to distribute body weight across the knee so it can be properly supported by the bones in the leg, and also provide stability to the knee joint. A meniscus tear is common after a traumatic injury, and most frequently occurs when the knee joint is bent and the knee is then twisted. Torn menisci are common in athletes and older adults whose cartilage may have worn away.
Treatment for a meniscus tear often begins with conservative methods such as rest, ice or over-the-counter medication. If these treatments are not effective and symptoms continue, you may benefit from meniscus repair or debridement. Meniscus repair is an arthroscopic procedure in which the torn segment of the meniscus is removed and the torn edges are sutured together, which allows them to heal properly.
Cartilage defects in the knee involve damage to the articular cartilage, which is the smooth substance that covers the ends of the bones and keeps them from rubbing together during movement. Cartilage damage is known as a lesion and can range from a soft spot on the cartilage or a small tear in the top layer to an extensive tear that extends all the way to the bone.
Cartilage defects range widely in their size and the degree of damage they may cause. They need to be thoroughly assessed based on a number of factors including their location and the age and activity level of the patient before a treatment plan can be determined. For some patients, conservative treatment methods such as resting the knee, wearing a brace, taking non-steroidal anti-inflammatory medications and injections of corticosteroids may be used if the defects produce only mild symptoms. However, in most cases, a surgical treatment will be necessary to provide relief from pain and other symptoms.
Debridement- Older patients who have smaller cartilage defects with mild symptoms may be suitable candidates for debridement. This arthroscopic procedure involves several small incisions in the knee into which a tiny camera and instruments are inserted. Loose or damaged tissue will be removed, but the defects are typically not repaired.
Microfracture- is an arthroscopic procedure performed to repair damaged knee cartilage, often used on athletes who may have suffered cartilage injuries while playing sports. During the microfracture procedure, a small surgical tool called an awl is inserted into the knee to create small holes, known as microfractures, in the bone near the defects to help release the cells that produce cartilage and restore the damaged area. The number of holes created varies depending on the size and location of the area being treated, with most patients requiring five to 15 small holes.
Osteochondral Autograft Transplantation (OATS)-This procedure takes healthy cartilage from another area of the bone that does not bear weight and transplants it to the damaged, weight-bearing area. This is used for smaller defects and involves filling holes with small quantities of transplant materials. One of these methods is mosaicplasty, which is a transferring of cartilage from a healthy part of a joint to the area that has experienced damage.
Autologous Chondrocyte Implantation-This procedure takes a sample of healthy cartilage and multiplies it in large quantities outside the body before being implanted back onto the bone. This newly grown cartilage coats the bone and provides regained support.