The knee is a "hinge" joint where the thigh bone (femur) and the shin bone (tibia) meet. The knee cap (patella) glides over the femur when the knee moves. In a healthy joint, a layer of smooth cartilage cushions the bone ends, working together with muscles, tendons and ligaments to allow you to bend your knee easily. Arthritis - particularly "wear-and-tear" arthritis or osteoarthritis - as well as certain knee injuries and diseases, can damage the cartilage, causing the bones to rub together and leading to pain and stiffness.
Patients with arthritis of the knee may find relief in a number of non-surgical and surgical treatments before considering joint replacement surgery. The goals of these treatments are to relieve pain, to increase mobility and restore quality of life. Patients often undergo some combination of the following:
Steroid and viscoelastic supplementation injections are advanced treatment options for patients with arthritis and other sources of joint pain that have not responded well to exercise and oral medications. These injections deliver relief directly to the source of the pain and are considered safe for nearly all patients.
Corticosteroid injections consist of cortisone and provide immediate anti-inflammatory relief directly to the affected joint. Some injections may be administered with a local anesthetic to reduce any potential discomfort. Results can vary significantly from a few days to a few months.
Viscoelastic supplementations such as Synvisc and Supartz are made from hyaluronic acid, a substance naturally found in healthy joint fluid, to help cushion, protect and lubricate the knee for significant symptom relief. These injections are administered on a weekly basis and can relieve pain for up to six months, although results may vary depending on the individual and the type of injection.
Knee replacement may be recommended if the pain and stiffness of the joint is severe and other treatments have not brought sufficient relief. Our doctors will conduct a thorough medical examination that includes a series of questions, x-rays, and strength and range-of-motion tests to determine if total knee replacement is right for you.
The total knee replacement procedure is performed in a hospital under general anesthesia. During the procedure, an incision is made in the knee to access the joint and allow your surgeon to remove the damaged bone and cartilage on the end of the femur and tibia. Precise removal is essential to achieving successful results for each individual procedure.
Once the damaged tissue is removed, the prosthetic device is inserted and may be cemented into place. These artificial parts allow the joint to move smoothly so the patient experiences pain relief and a better quality of life. Knee replacement can also help restore motion to the joint, straighten the leg and improve stability.
After the procedure, the patient rests in a recovery room and then in a hospital room. A short hospital stay is likely needed, depending on the type of procedure performed and the overall health of the patient. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort, which can be managed with pain medication provided by your doctor.
Physical therapy starts right away in the hospital to speed healing and to ensure that the patient enjoys full use of the joint. Therapy progresses from use of walkers and crutches to walking on stairs and slopes, with home exercises to supplement formal sessions. In addition, continuous passive motion (CPM) machines can reduce recovery time and the risk of muscle contracture without straining the joint.
Knee replacements today last about 20 years in 85-90% of well-selected patients. Patients can enjoy effective pain relief and restored motion that allow them to resume an active life. Like natural joints, these devices will wear out over time and frequent use, at which point patients may require an additional procedure.