Knee Operative Treatments
When are Patients a Candidate for Surgery?
When it comes to the treatment options for your knee arthritis, there are a few key factors used to determine whether you are a candidate for joint replacement surgery. Below are the main factors that are evaluated:
- Pain, pain, pain…
- The impact of the pain on the activities you would like to do and your own quality of life.
- Near end stage (very thin cartilage remaining between bones) to end stage (no cartilage left, bone on bone) levels of degeneration as seen in X-rays.
When is it Time for Surgery?
Joint replacement surgery is an elective surgery. It is up to you when you want to have surgery! There is no right or wrong time. As long as you can maintain motion in your joint, there is no amount of joint wear that we cannot fix. If you choose to wait to have surgery, additional wear your joint has will not impact your surgical outcomes. The decision to have surgery is an individual decision based on how much pain you are having and how that pain is impacting your daily activities.
Other Factors to Consider
During surgery we are not just treating your joint, your general health is important. While we operate on patients with the health concerns below, we first try and maximize the treatment of the concerns before surgery. That way, after surgery, complications related to these concerns can be reduced.
- High Blood Pressure
- Heart and Lung Disease (we maximize treatments of co-morbidities prior to surgery to minimize risk of complications post surgery)
- Weight/BMI
- Smoking - we recommend patients stop smoking 4 weeks before surgery. However, it is best to give smoking up completely!
- Strength & Conditioning - whatever you do before surgery will significantly help with recovery.
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Dig Deeper on these Topics with Dr. DiGioia
Surgical Treatments
There is a spectrum of surgical interventions for joints. The options are different for hips and knees. Some of these treatments have fallen out of favor as modern treatments have proven to provide better outcomes.
Knee Operative Treatments
Injections
Total Knee Replacement (Knee Arthroplasty)
Total knee replacement surgery is the tried and true treatment for patients with near end, or end stage arthritis. A total knee replacement is a complete resurfacing of the knee that cures patients of arthritis and is similar to a “retread” for tires when they are worn.
During the procedure, the worn joint surface is removed and replaced with metal and plastic components. We leave all the good bone that supports the implants intact.
After the surgery, you will be “cured” of your arthritis. The worn cartilage and bone rubbing on bone, the source of pain and inflammation that patients experience, is completely removed and can no longer cause pain. A joint replacement can last a lifetime and can be a truly life changing procedure.
During the procedure, the worn joint surface is removed and replaced with metal and plastic components. We leave all the good bone that supports the implants intact.
After the surgery, you will be “cured” of your arthritis. The worn cartilage and bone rubbing on bone, the source of pain and inflammation that patients experience, is completely removed and can no longer cause pain. A joint replacement can last a lifetime and can be a truly life changing procedure.
Check out this video to learn what happens during the surgery:
Partial Knee Replacement
A partial replacement is a procedure that resurfaces only one section of the knee. In a partial replacement, patients can have any one of the three “compartments” or parts of the knee replaced, the medial (inside), lateral (outside) or the kneecap.
Patients are only eligible for a partial knee replacement if they have arthritis in only ONE section of the knee. The rest of the knee must be in good condition. If there is wear in two or more sections of the knee, then the patient is a candidate for a total joint replacement.
Only about 4-5% of surgical candidates at the Bone and Joint Center are candidates for a partial replacement. Eventually, patients with partial replacements may need to be converted to a total joint replacement down the road.
Patients are only eligible for a partial knee replacement if they have arthritis in only ONE section of the knee. The rest of the knee must be in good condition. If there is wear in two or more sections of the knee, then the patient is a candidate for a total joint replacement.
Only about 4-5% of surgical candidates at the Bone and Joint Center are candidates for a partial replacement. Eventually, patients with partial replacements may need to be converted to a total joint replacement down the road.
Other Knee Procedures for Knee Arthritis
- Arthroscopy: A joint “wash out” procedure. Not a common procedure anymore as studies show only 50% of patients improved and only in the short term. The procedure can also make the knee feel worse because the scope can cause inflammation in knee. NOT RECOMMENDED!
- Osteotomy: Cutting the bone, used when someone is bow-legged and for active young patients who are trying to preserve their cartilage. Must have good cartilage on the other side of the knee.
RESERVED for very young patients that are doing heavy manual labor. - Shims and Spacers: A metal spacer placed inside the joint space created by arthritis. The hard metal does not remove the arthritis or provide any shock absorption. Found to be ineffective and phased out in favor of joint replacement surgery. NOT RECOMMENDED!
RESERVED for very young patients that are doing heavy manual labor. - Cartilage Replacements: Limited to very small areas of cartilage damage. RESERVED for younger patients with sports medicine injuries and never for arthritis.
Learn More about Operative Procedures with Dr. DiGioia
Possible Adverse Events
While joint replacements are some of the most successful procedures in modern medicine, it is important be informed on the potential adverse effects of surgery.
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Success after Joint Replacement
- Joint replacement surgery is one of the most successful surgical procedures in modern medicine.
- Over 90+ % of joint replacements are still functioning well after 20 years.
- Joint replacements do wear or loosen, but this happens slowly over the years and are user dependent based on weight, activity level and general health. However, this is the reason that we always recommend that you have X-rays of a replaced joint every three years, even if you are feeling well.
Your Role in Surgery
You and your family have an important role in your treatment. There are factors that you can help with to improve your outcomes.
- Your "Coach", typically a family member, will be your second set of ears and eyes throughout the education and operative processes. Importantly, your Coach will be a part of the care team at home. Having a Coach is clinically proven to improve your surgical outcomes.
- Education: Your knowledge, skills, ability, and willingness to learn about and manage your own health and care is also very important.
Remember: The best prepared patients have the best outcomes!
Additional Resources
The Bone and Joint Center’s Knee Surgical Experience Education Video:
