There's a wide variety of surgical approaches to problems in the knee, many of which are also used in other joints. Fusion, or arthrodesis, for example, fixes an arthritic joint in place, fusing bone to bone. While the joint will no longer bend, fusion does relieve the pain.
For people with inflammatory arthritis in one (or both) of their knees, occasionally a synovectomy - removal of the inflamed lining of the joint, often performed arthroscopically - can in some cases slow down the progress of the disease into adjoining tissues and postpone more radical surgery. Removing the lining eliminates the major source of inflammation, and may preserve the cartilage; however, the operation is generally only successful for very early disease in a relatively healthy joint. Once the cartilage is destroyed, a synovectomy isn't much help. The synovium will generally regrow after surgery, but it may redevelop with the disease process intact. And although the operation can be repeated, it probably won't be that rewarding.
Another procedure that's sometimes helpful in the early stages of arthritis is an osteotomy - cutting and realigning the bones so that some of your weight on the hips and knees is shifted on to good cartilage. (In the majority of young, high-demand patients, osteotomy can buy at least 10 years before they require a total joint replacement.) An internal metal staple holds the bone in position until it heals, usually in eight to 12 weeks, with optimum improvement about a year after surgery. If it's done early enough, an osteotomy may delay or even eliminate the need for total joint replacement surgery.
Total knee replacement is still a relatively young procedure, trailing hips by a decade or so, but the technique has definitely caught up: Total knee surgery now achieves results as good as total hip surgery. Where total knees are sometimes less successful is in people with RA who have multi-joint involvement, says Toronto orthopaedic surgeon Dr. David E. Hastings: 'If you hear of somebody who's very unhappy with total knees, it makes you wonder if she's got bad hips. If you have that combination - bad hips, knees and feet - you've got to really look at your priorities.'
In other words, if you have several joints that need replacing, it may be best to begin with the largest joints (hips) before proceeding to your knees and ankles. Surgeons prefer to postpone knee surgery as long as possible, unless you're in severe distress, with conservative strategies. The less often a revision is necessary the better. Any surgery involves a slight risk of infection, and in hip and knee surgery there's also the possibility of blood clots forming in the legs, which can break off and travel to the lung, causing a pulmonary embolism (a blockage in the blood vessels of the lung). Normally blood thinners are administered to prevent the problem.
|The most common condition that results in the need for knee replacement surgery is osteoarthritis, a degenerative, joint disease that affects mostly middle-aged and older adults. Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the knees. Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury can also lead to degeneration of the knee joint. In addition, fractures, torn cartilage, and/or torn ligaments also can lead to irreversible damage to the knee joint over the years.