Knee Arthritis

What is knee arthritis?

Knee arthritis, much like hip arthritis, is a degenerative condition of the cartilage surface in the knee. As the cartilage wears out, the bone of the knee joint begins rubbing together, causing significant discomfort and disability. Cartilage degeneration is largely due to age and overuse. However, a genetic component may predispose one person to developing arthritis earlier in his or her life than others. Unfortunately, once the degenerative process has begun, there isn’t much that can be done to “reverse” the process. Interventions such as “stem cell therapy” have not been proven in the literature to be beneficial and often come at a great expense to the patient. As the disease process progresses, patients will often experience stiffness, progressive deformity and difficulty with mobilization. In extreme cases, arthritis may lead to the continuous use of a cane, walker or even wheelchair. Dr. Davis’s goal will be to treat your pain and discomfort as conservatively as possible while still preserving your quality of life. 

Treatment

Initially, arthritis may be relatively mild, resulting in pain late in the day or at night that is responsive to medication. At this point, Dr. Davis will recommend ice, over the counter anti-inflammatory medications and activity modification to preserve your natural anatomy while improving your symptoms. As symptoms worsen, you may be a candidate for a steroid injection in the joint. This allows for focal administration of medication that decreases inflammation and can minimize the symptoms of an arthritic “flare”. Injections may be given every three months as long as they remain effective. However, it should be noted that a three month break will have to occur prior to any operative intervention. This is due to the slightly increased risk of infection associated with steroid injections just prior to an operation. Lastly, weight loss can be a very effective method to treating arthritic pain. Although difficult, weight loss provides a way to significantly offload the stress your knee joints see every step. It has been reported that 4-7 times your bodyweight travels through the knee joint during activity. Therefore, weight loss or weight gained has a significantly large effect on the knee joint. Weight loss, if possible, with the assistant of a nutritionist, will be pursued as well. These options and the treatment plan will all be discussed at your first visit with Dr. Davis

Surgical Intervention

If non operative management has failed or is no longer effective and quality of life is dwindling, Dr. Davis will begin to discuss the operative options for knee arthritis. For young patients with pain on the inside, radiographic assessment will be utilized to determine of symptoms are arising from an angular deformity of the leg, causing increased pressure on the inside of the knee. These patients may be candidates for a procedure called a high tibial osteotomy (HTO). An HTO is a procedure that cuts the tibia bone and introduces some angular correction. The tibia bone is cut, corrected and fixed with a plate and screws. This indication is fairly rare and, if needed, may be discussed during your office visit. If no angular deformity is present and the arthritis is focused on a single side of the knee, a unicompartmental knee arthroplasty, or partial knee replacement may be an option. This procedure involves removing the arthritic bone/cartilage and replacing it with artificial parts consisting of highly polished medical metal and plastic. The benefits of the unicompartmental knee arthroplasty include a smaller incision, less blood loss, quicker recovery times, and a more native feeling knee due to minimal soft tissue insult. If the previous to surgical intervention options are not available, total knee arthroplasty, or a total knee replacement, is the gold standard treatment. This involves removing the arthritic bone/cartilage and replacing this with metal and plastic parts, with care to balance the soft tissues. This eliminates the pain generator and maintains range of motion, with the goal of returning the patient to work or activities of daily living that have been hindered by pain.

Post Op

Postoperative protocol will be tailored to the specific procedure that occurs. However, with knee replacement, motion and weight bearing will begin immediately with physical therapy. Your procedure may be done on an outpatient basis, preventing a night in the hospital. Or, commonly, one night in the hospital is required for anesthesia reversal, therapy and pain control. A blood thinning medication will be administered for 30 days postoperatively to prevent blood clots. Your initial 2 week postoperative visit will be utilized to assess your incision for healing and rule out the presence of any early complication such as infection. At the 6 week mark, range of motion and daily pain should be near normal and you should feel as if your life has been returned, pain free. Please call Dr. Davis’s office to schedule your knee arthritis consultation!