Knee Arthritis: Treatment Options

Knee Arthritis: Treatment Options

This video will review the treatment options for knee arthritis. As the cartilage in the knee joint wears down to the bone, it cannot heal itself. As a result, pain can persist and often worsens over time without treatment. Treatment usually begins with nonsurgical options aimed to reduce pain and improve knee function.

Activity modification includes adjusting daily activities to reduce stress on the knee, such as decreasing high-impact exercise or using a cane for support. Knee bracing may help offload pressure from the inside or outside of the joint. Physical therapy that includes stretching and strengthening exercises can support knee motion and reduce stiffness. Nonsteroidal anti-inflammatory medications like ibuprofen or naproxen can reduce inflammation and relieve pain. Corticosteroid, hyaluronic acid, or biologic injections can provide pain relief and improve symptoms. Although the duration of relief varies from patient to patient. While these treatments can help manage symptoms, they do not restore the damaged cartilage.

If symptoms continue despite nonsurgical treatment, surgical options may be considered. There are several types of surgery for knee arthritis, and the surgeon will select the best one based on the severity of the condition and the patient's specific goals. Arthroscopy is a minimally invasive procedure used to remove loose pieces of cartilage or bone to help the joint move smoothly. While this addresses side effects of arthritis to provide temporary pain relief, it does not treat the underlying damaged cartilage, so pain may return.

A high tibial osteotomy may be recommended for certain patients whose arthritis is caused by knee alignment issues. In this procedure, the inside portion of the tibia is cut at a specific angle to relieve uneven pressure. When making the bone cut, or osteotomy, the surgeon may use a cutting guide specific to the patient's anatomy to secure the realignment, the surgeon can choose between a strong plastic wedge and bone anchors, or a specialized metal plate and screws. While this procedure does not remove the damaged cartilage, it shifts the pressure off of the damaged area to slow the progression of arthritis.

For more severe arthritis, knee replacement, also called knee arthroplasty, may be recommended. This involves removing damaged cartilage and replacing it with metal and plastic implants to restore function. There are 2 types of knee replacement surgery partial knee replacement, and total knee replacement. Additionally, robotic assisted technology is available for both surgeries. When determining which option is best, as well as the specific implant for the patient, the surgeon will evaluate factors such as age, activity level, severity of arthritis, bone quality, and overall health.

The knee has 3 compartments the medial, or inside; the lateral, or outside; and underneath the kneecap. For patients with severe arthritis in only one compartment, a partial knee replacement, also called unicompartmental knee arthroplasty, may be a good option. Here, only one compartment of the knee is replaced with metal and plastic implants. Due to its smaller incision and less bone involvement, it is considered less invasive and has a faster recovery than total knee replacement.

For patients with severe arthritis in multiple or all compartments in the knee, a total knee replacement or total knee arthroplasty may be a good option. Here, all of the damaged cartilage is cut away from the bone and replaced with metal and plastic implants.

This features a larger incision and more bone removed, so recovery may be longer. However, this procedure is a definitive solution for any amount of arthritis in the knee and provides significant pain relief and improved function. If total knee replacement is selected, the surgeon may choose to use robotic-assisted technology to improve precision during the surgery. Here, the robotic system makes a 3-D map of the patient's anatomy and helps the surgeon place the implants in the correct position.

After the implants are placed, the incision is closed with the surgeons preferred method, and a bandage is applied. Some advanced dressings may help create a healing environment and reduce bacterial growth. It is important to follow incision care instructions to maintain healing and reduce the risk of infection. After surgery, the patient will begin a structured rehabilitation plan according to their procedure. Pain medication may be prescribed. Assistive devices such as a walker may be needed temporarily. Early range of motion exercises will be recommended to prevent stiffness in the knee joint. Physical therapy will be added to restore strength, movement and function to support the patient returning to their daily activities. Recovery times vary between patients and it is important to follow instructions and attend follow-up visits.

In summary, knee arthritis does not heal on its own. Nonsurgical treatment may improve symptoms but will not fix the damaged cartilage. Surgical treatment may be selected based on the severity of arthritis and patient goals. Knee replacement will definitively address the damaged cartilage.