When you get up from a chair after being seated for a while, do you need to take a few moments to get your knee “adjusted” before you can begin walking? Once you start walking do you find that you can’t go as far as you used to because your knee starts to get sore? Do you need to lean on the grocery card to relieve the pain in your knee so that you can finish your shopping? If you turn over the wrong way in bed does pain your knee awaken you? If so, you, along with millions of other, may be suffering from arthritis in your knee.

There are countless causes of knee pain. But since the knee is one of the major weight-bearing joints in your body (along with the hip) it has a tendency to wear out over the years, and that process of wear is known as osteoarthritis or degenerative arthritis. The most common symptoms of knee arthritis are pain, stiffness, swelling and deformity (bowed legs or knock knees). Early on in the process of arthritis there may be a number of treatments to help try to control the problem. Non-steroidal anti-inflammatory medications (NSAIDs), weight reduction, ambulatory assistive devices (canes, etc.), braces or injections of cortisone or joint-lubricating substances (Synvisc or Hyalgan) may provide some relief. Recent evidence has shown that, strictly for the treatment of arthritis, arthroscopic surgery is of little or no lasting value. For those who can no longer adequately control their symptoms and for whom the progress of the arthritis has resulted in an unacceptable limitation in activity level, total knee replacement provides the only opportunity to truly “cure” the problem.

Last year alone, more than 267,000 knee replacements were performed in the United States. The operation, which can be performed under general, spinal or epidural anesthesia, takes about ninety minutes. In it the joint is not removed and replaced as a unit, but rather the worn and rough surfaces of the joint are carefully and precisely cut away and replaced with new metal and plastic surfaces. Your ligaments and muscles are left in place to stabilize the knee so that it won’t give way and so that you can control the motion of the knee. You can begin bearing weight on your new knee the day after surgery! The hospitalization can be as short as three days and will be followed by a period of therapy to help you regain the strength and range of motion of your knee to provide optimal function.

Knee replacement is a very reliable surgical procedure and well over 90% of patients achieve good and excellent results. Complications can occur and not all patients are candidates for the operation, usually due to conditions that preclude a major operation or anesthetic. Since the new joints are artificial they may wear out. And since the “parts” are held in place with bone cement (which is more like a grout than an adhesive cement) they can loosen with time, just like the tiles in your shower. Despite that, statistics show that 93% of replaced knees last for 15 or more years. And in many, but not all, cases in which the prosthesis wears out or comes loose a second (or even third) replacement can often be successfully performed.

The first knee replacements were performed in 1968. In the ensuing 34 years many improvements have been made in both materials and surgical techniques. And the process evolution is continuing. Some of the new techniques will prove to be improvements, and others will fail. The technique of placing metal spacers is very new and now has a complication rate of at least 30%. So that’s not a procedure we’re yet willing to perform, but with time it may be perfected and available for widespread use.

One of the recent proven advances is uni-compartmental knee replacement, in which only a part of the knee is replaced while areas with normal surfaces are left in place. Versions of that operation have been available for more than 20 years but until recently the failure rate was unacceptably high. Now partial knee replacements using the newest materials and techniques give success rates of over 90% after 10 years, nearly matching the results of total knee replacement in properly selected patients. And these partial replacements can be performed through “mini” incisions of three to four inches, which greatly hastens recovery. In fact, the first such mini-open partial knee replacements performed in Aurora were performed by the physicians here at Castle!

Not everyone with knee pain has arthritis. And not everyone with knee arthritis needs a knee replacement. But when all else fails a replacement can provide the “cure” for an arthritic knee. We’ll keep abreast of the latest advances and if you need a total or partial knee replacement our commitment to you here at Castle Orthopaedics and Sports Medicine is to provide you with state-of-the-art techniques with proven results to get you back on your feet.

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