PARTIAL KNEE REPLACEMENT
Replacement
Arthritis
Causes
The leading cause of arthritis is osteoarthritis, commonly known as "wear and tear" arthritis. Other factors such as trauma and various illnesses like rheumatoid arthritis, systemic lupus, septic arthritis, and psoriasis can also contribute to joint degradation, resulting in symptoms such as pain and limited mobility.
Arthritis affects almost 6% of all adults, with a higher prevalence among women compared to men. Research suggests that between 6% and over 13% of men, and between 7% and 19% of women aged over 45 are affected, indicating a 45% lower risk of incidence in men.
Age plays a significant role in the development of osteoarthritis. As the population ages, the prevalence of osteoarthritis is expected to increase. The risk of developing osteoarthritis starts to rise from the age of 40 onwards. Approximately half of the population aged 65 and above are affected by osteoarthritis in the knee, although it can also impact younger individuals.
Symptoms
Knee arthritis manifests through pain, swelling, stiffness, and diminished strength. Pain may localize to the inner (medial), outer (lateral), or front (patellofemoral) regions of the joint, or it may present as a general discomfort surrounding the knee. Swelling and discomfort at the back of the knee could indicate a Baker's Cyst, a fluid-filled sac resulting from arthritis. Sensations like 'grinding', 'clicking', or 'locking' may also occur. Range of motion can greatly decrease, impeding tasks such as walking long distances. Those with patellofemoral joint arthritis often experience feelings of instability or buckling, making activities like stair-climbing, squatting, or rising from a seated position challenging.
Diagnosis
Your surgeon will conduct a comprehensive assessment, starting with a detailed medical history and a physical examination, often including X-rays. They will assess the knee's range of motion, ligament stability, and the strength of the surrounding muscles. X-rays can reveal signs of arthritis, such as reduced joint space and bone spurs. Additionally, an MRI may be recommended to evaluate potential damage to other areas of joint cartilage or the meniscus.
Treatment
Non-operative
Physical therapy is employed to address knee arthritis by bolstering the muscles responsible for supporting the joint. Strengthening these muscles diminishes the reliance on bone structure for joint stabilization, consequently reducing stress on the arthritic area. In addition, your surgeon might recommend anti-inflammatory medication or administer injections to alleviate inflammation. Furthermore, specific nutritional supplements may prove beneficial in reducing both pain and inflammation.
Operative
The way ACL tears are managed depends on the specific type of tear. If the ACL is torn off from either the femur (thigh If conservative treatments fail to alleviate symptoms, your surgeon may recommend surgery for knee arthritis. There are three surgical options available. One option is minimally-invasive arthroscopy, often called a "knee scope," which can help to alleviate symptoms like catching and locking by cleaning out the knee. While not a permanent solution, this procedure can provide relief for mechanical symptoms. Arthroscopy allows for a comprehensive evaluation of the entire knee joint, including the cartilage, meniscus, and ligaments.
The definitive treatment for knee arthritis is joint replacement surgery. During this procedure, the surgeon replaces the worn-away cartilage with metal and plastic implants, resurfacing the bone ends. If the arthritis is localized to one or two compartments (medial, lateral, or patellofemoral), only the affected areas will be replaced (unicompartmental or patellofemoral replacement). However, if arthritis affects all three compartments, a total knee replacement is necessary to alleviate symptoms.) or the tibia (shin bone), ACL repair might be recommended. This repair is done through a minimally-invasive arthroscopic procedure where the torn ACL is sewn back into place and secured with screws or buttons. Additionally, a strong suture may be used to reinforce the repair.
In cases where a more extensive reconstruction is necessary, a new ACL graft is used to replace the original ligament. The choice of graft placement technique and the type of graft used is a decision made collaboratively between you and your surgeon. Most often, these procedures are also conducted arthroscopically.
The graft can be sourced either from tissue around your knee or from a donor. The timeline for postoperative rehabilitation, as well as the return to daily activities and sports, varies based on the specific technique and graft chosen, and is determined by your surgeon's professional judgment.
Partial Knee Replacement
Who are the candidates for partial knee replacement?
Patients experiencing medial or lateral knee osteoarthritis may be suitable candidates for partial knee replacement. "Medial" refers to the inner compartment of the joint, closest to the opposite knee, whereas "lateral" refers to the outer compartment, farthest from the opposite knee. It's worth noting that medial knee joint degeneration is the most prevalent form of arthritis deformity.
Several factors warrant consideration:
If knee pain persists despite anti-inflammatory medication and maintaining a healthy weight, a knee replacement might be advisable.
Your doctor will assess the location of your knee pain, evaluate your range of motion, and check for knee stability. Eligibility for partial knee replacement will be determined through knee X-rays. However, definitive confirmation of candidacy may only emerge during surgery.
Candidates typically require an intact anterior cruciate ligament, sufficient knee motion, damage limited to one compartment, and knee stability. Additionally, the deformity's angulation is taken into account.
Previously, partial knee replacement was predominantly recommended for sedentary patients over 60 years old. However, there's a growing trend towards considering younger, more active patients for this procedure.