OrthoWertz
Ken Wertzberger, M.D.
Shane Alford, P.A.
Arthritis
This sheet is in regard to arthritis, and it's alternatives. Arthritis is the wear of
the gristle material(articular cartilage), like the material on the end of a chicken leg when
you cook it, in each of your joints.
There are a number of alternatives for your arthritic problem. They are generally speaking,
as follows:
1. Tolerate the problem as you have. Toleration means using every kind
of method of making your knee feeling better, including anti-arthritic medications, pain pills,
heating pads, walking aids, limitation of activities, rub on lotions, etc.
2. Injections: As the first type of injection, usually cortisone injection to see how that
works. If not beneficial, then a trial series of what's called visco-supplementation, a
lubricant of sorts. It benefits 50% of people
3. If the decision has been made to not continue as you are, then surgery will be
needed. The options of surgery are:
A. Realignment of the joint to take more weight on the good portion. This is done by
breaking the bones and realigning them. This is a good procedure in the younger
population, usually age 45 and below. It is a hard operation to go through, and only
gives partial pain relief.
B. Simple debridement, or so-called arthroscopy of the joint to smooth out the rough spots
and take away some of the arthritis. The short-term relief of this procedure
sometimes is good, but the long-term is very poor. This would only be offered to you
if you had a very mild case of arthritis, and a cartilage (meniscus) tear.
D. Replacement of the joint surfaces which are arthritic. This is a so-called total joint, or
joint replacement. It would replace the areas that are rubbing together with metal
and plastic artificial parts. This has been done in U.S. since 1969.
Complications include:
1. Infection - This is by far the most serious complication. Antibiotics and sterile techniques are used
to prevent this. Infections can occur after the surgery, but also can occur late. This happens when
bacteria get into the blood stream and land in the operated area. Although rare, it is very serious, and
could ruin the joint. If you have infection present anywhere in your body, you should be on antibiotics
after having had a total joint replacement. Certainly before any dental surgery or procedure is
performed we strongly recommend prophylactic antibiotics be prescribed and continued afterwards.
Other problems, like prostate operations or infections around the feet should be treated with
antibiotics.
2. Phlebitis is something that anyone can get after any surgery. There
is a greater tendency after extremity surgery and, in order to prevent this, sequential compression
devices will be put on your leg the first 48 to 72 hours after surgery.
3. Lack of range of motion and need for a manipulation - Sometimes some
patients have difficulty in getting their bending of the knee back. On rare occasion manipulation
needs to be carried out to get that. Range of motion from zero to 105 degrees would be considered
more than adequate. You will not get full range of motion back in your knee.
4. There is a possibility of the components loosening and needing to be
replaced. This is now becoming a less frequent problem. However, it may occur, and can even occur
within the first year.
Patients are usually admitted the day before the operation, and stay in from 10 to 14 days on
average. Anesthesia given may be general or spinal anesthesia, the patient having his/her choice.
The operation lasts approximately two hours. Post-operatively the knee hurts, but narcotics are given
for pain relief. Intravenous medication is usually continued for approximately 48 hours.
After having a total knee, one should not run or jump, but can engage in
swimming, golfing, riding a bike, etc.
The ultimate durability of these joints is not known.
The main objective of total knee replacement is pain relief. If you do not consider your pain
serious, you should not go through the operation. If you do feel the pain is affecting the enjoyment of
your life and everyday living, then you should consider the operation. It frequently boils down to that
question, which the patient needs to ask himself.