Knee

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Non Operative

Modification of patient activity
Oral medications
Local injection
Viscosupplementation

Viscosupplementation

What is viscosupplementation?

Viscosupplementation is a procedure in which a thick fluid called hyaluronate is injected into the knee joint. There are no cures for osteoarthritis, so viscosupplementation will not cure osteoarthritis of the knee. However, it is thought that hyaluronate will improve the lubricating properties of the synovial fluid, reduce the pain from osteoarthritis of the knee, improve mobility, and provide a higher and more comfortable level of activity.

When is viscosupplementation considered a treatment option?

Viscosupplementation is usually reserved until other treatment options have been tried and have not relieved your pain. Single dose, or three to five injections, each 1 week apart, are required.

How soon after viscosupplementation injections do patients report pain relief?

Not all patients are helped by the injections. Of those who are, many report feeling some pain relief during the 3- to 5-week course of the injections, while pain relief is delayed in others. Most patients report the greatest pain relief 8 to 12 weeks after beginning treatment. The length of pain relief varies; some patients have reported benefits for more than 6 months following the injections. 

Arthroscopic Surgery

Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The term literally means “to look within the joint.”

The benefits of arthroscopy involve smaller incisions, faster healing, a more rapid recovery, and less scarring. Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day.

Why is arthroscopy necessary?

Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI, or CT scan also may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than through “open” surgery or from X-ray studies.

 What are the joints that can be viewed with an Arthroscope?

Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As engineers make advances in technology and orthopaedic surgeons develop new techniques, other joints may be treated more frequently in the future. 

What are the conditions that can be treated by arthroscopy?

It has been shown in clinical studies that knee and hip arthroscopic surgery have a limited role in the surgical treatment of arthritis. Conditions such as meniscal and ligament tears, causing mechanical symptoms can be treated successfully with this procedure.

Total Knee Replacement

Knee replacement, also called knee arthroplasty, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.

Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee.

The goal of knee replacement surgery is to relieve the pain by resurfacing the parts of the knee joint that have been damaged and to restore the alignment of the extremity returning the patient back to its normal life. 

Revision Total Knee Replacement

Knee revision surgery entails consideration of the femur (thigh bone), tibia (shin bone), and patella (kneecap) components.

  • Bone stock deficiencies are classified according to several grading systems. Lysis, fracture, or stress shielding can lead to bone loss.
  • The failed components are removed by a combination of surgical methods and specialized instruments. Reconstruction may require implants with extensions to reach better-quality bone and that effectively replace lost ligament stability.
  • Ground-up or bulk bone graft may be used.
  • An implant is fixed in place through cemented or bone in-growth techniques.