Surgical Options
The available Surgical interventions include:
1.
2.
3.
Arthroscopy
Osteotomy
Knee replacement


Unicompartmental knee replacement
Total knee replacement
Arthroscopy
Arthroscopy involves:
• Cleaning or debridement of joint
• Repair of damaged cartilage
• Removal of loose bits of cartilage &
bone
• Draining of infected or excess synovial fluid
• Removal of diseased synovium
Surgical Interventions
• The aim of surgical treatment of OA is to decrease or
eliminate pain and to improve function
• The particular choice of procedure for the individual
patient is determined by a complex set of variables:
 pain severity
 degree of functional impairment
 evidence for structural joint damage
Arthroscopy
• Arthroscopy done under regional anesthesia
• Does not involve any blood loss
• Usually offers temporary relief of symptoms for
somewhere between 6 months - 2 years
Osteotomy
• Osteotomy literally means “bone cutting”
• The deformity is corrected by removing or adding
triangular wedges of bone
• Useful in preventing deterioration of joints with OA due
to a pre-existing deformity such as bowleggedness
Osteotomy
• This procedure will reduce pain, eliminate deformity.
• Best results are obtained with patients younger than 55
years ,involvement of either medial or lateral
compatment only.
Knee Replacement
Unicompartmental knee replacement
Total knee replacement
Myths
• Hip replacement works but knee replacement doesn’t
• Knee replacements are still experimental
• Knee replacements only last 8-10 years may be 15 years
maximum
• I am too fat - my implants might break
Myths
•
TKR surgery is too costly
•
TKR is not successful
•
After TKR, I have to be bedridden for 3 months
•
A total knee replacement implies that everything about the
joint is being replaced
Indications of Knee Replacement
• Knee pain that has failed to respond to conservative therapy
• Knee OA
• Pain - at rest
- at night
- with activity
• Loss of function
• Knee tumors
• In short PAIN , PAIN & PAIN.
Unicompartmental Knee Replacement
• Only a small part of the knee is replaced in this
procedure
• Recommended for patients with
 medial or lateral compartment disease
 moderate to severe pain and functional impairment
• It is intended to relieve pain and preserve function for as
long as possible, before a total knee replacement is
become necessary
Unicompartmental Knee Replacement
Unicompartmental Knee Replacement
Advantages
•
•
•
•
Minimally invasive
Short hospital stay
Rapid recovery
Satisfactory conversion to TKR
Disadvantages
• Long - term (>15 years) result unknown
• Not recommended for heavy manual work
Total Knee Replacement
• The ultimate solution for OA of knee is to replace the
worn-out parts of the knee with an artificial joint
• The prosthesis that is used is made up of plastic and
metal and is placed on the joint surface of each bone
• This surgery has been widely used for many years with
excellent results especially for knees
Total Knee Replacement - Prostheses
Intraoperative - TKR
Day 1 - Post-Op TKR
AP
Lateral
Common Post-Operative (TKR) Course
• Day 1
Standing, bending and sitting out in a chair
May take a few steps with help
• Day 2
Walking (with aids)
• Day 4/5
Stair climbing
• Day 5-7
Home (with 2 walking sticks)
• Week 6
Walking unaided (or 1 stick)
Driving
• Week 10-12
Full recovery
Benefits of TKR
• TKR can relieve pain that doesn't respond to other
treatment options
• Pain reduction in 90 to 95% of the patients
• Reduced stiffness and improved joint movement
• Increased walking ability
• Improved alignment of deformed joints