Treatment For Knee Arthritis
From Conservative Care to Knee Replacement Surgery
I treat the pain of early arthritis with a combined, conservative approach. A good first step is trying over-the-counter pain and anti-inflammatory medication.
- Extra-strength Tylenol (pain reliever)
- Advil, Aleve, or Ibuprofen (anti-inflammatory)
It’s important to check with your primary doctor to make sure you are allowed to take these medicines. If over-the-counter medications aren’t working, I can prescribe you a prescription-strength, long-acting anti-inflammatory like Celebrex or Meloxicam.
For people who still have knee pain, injecting medicine directly into the knee can provide months of relief for some patients. This is a quick and relatively painless procedure that can be done in the office during your appointment. Joint injections are available in a few different formulations and can be repeated every 3-6 months if they are providing excellent relief.
De po Medrol plus bupivacaine (Anti-inflammatory plus instant pain reliever) Hyaluronic acid (Lubricant)
In addition to medications and injections, strengthening and supporting the muscles around the knee can also relieve knee pain for some patients.
- Physical therapy – strengthen specific muscles around your knee and help offload arthritic areas.
- Specialized knee braces – used to unload the patient’s weight from an affected area of the knee while walking.
Conservative management is always the first step of treatment. For many patients, conservative treatment can offer months to years of pain relief without the risks of surgery.
While joint replacement is one of the safest surgeries, all surgeries carry the risk of infection, nerve or blood vessel injury, or complications from anesthesia.
Procedure: Partial Knee Replacement
MIS: Minimally Invasive Surgery
My approach is considered minimally invasive, which minimizes or avoids damage to muscles, tendons, and ligaments around your knee joint while still replacing the arthritic joint. The steps of a partial knee replacement are as follows:
- Prior to surgery, epidural anesthesia is administered that numbs your legs and you are given a sleeping medication that allows you to sleep during surgery while still breathing on your own.
- Next, your leg is cleaned with a series of cleaning solutions and sterile drapes are applied to minimize contamination of the surgical field
- A small incision is made over the front of your knee, and the knee joint is exposed in a way that avoids the muscles, tendons, and ligaments of your knee.
- The arthritic surface of your knee is shaved off while protecting the healthy areas of your knee.
- The correct shape and size components are measured and trial components are placed in your knee to triple check fit and function of your knee.
- Small adjustments are made until I am 100% satisfied with the outcome of your surgery.
- Permanent implants are glued onto the bony surface of your knee with a specialized polymer
- The knee is closed in layers with sutures that will dissolve over the next few weeks. The top layer is glue that will fall off on its own. A waterproof dressing is applied that stays on for 7 days.
- Patients are brought to the recovery room where they will eat and drink, walk with an assistive device, and practice stairs with a physical therapist before either going home or staying one night in the hospital.
Expected Outcomes
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While partial knee replacement may seem like a bridge to total knee replacement, partial knees are designed to last your lifetime. Ten years after surgery, about 90% of partial knee replacements done in the U.S. still function well, and 15 years after surgery, more than 85% of patients are still doing well. These numbers are similar to total knee replacements.
One advantage of a partial knee replacement is that if the rest of the knee wears out, it can usually be switched to a total knee replacement that is almost as good as a first-time knee replacement, compared to a more involved re-do surgery when a total knee was done initially.