2Surgical Options The available Surgical interventions include: 1. Arthroscopy2. Osteotomy3. Knee replacementUnicompartmental knee replacementTotal knee replacement
3Arthroscopy Arthroscopy involves: Cleaning or debridement of joint Repair of damaged cartilageRemoval of loose bits of cartilage &boneDraining of infected or excess synovial fluidRemoval of diseased synovium
5Surgical Interventions The aim of surgical treatment of OA is to decrease or eliminate pain and to improve functionThe particular choice of procedure for the individual patient is determined by a complex set of variables:pain severitydegree of functional impairmentevidence for structural joint damage
6Arthroscopy Arthroscopy done under regional anesthesia Does not involve any blood lossUsually offers temporary relief of symptoms for somewhere between 6 months - 2 years
7Osteotomy Osteotomy literally means “bone cutting” The deformity is corrected by removing or adding triangular wedges of boneUseful in preventing deterioration of joints with OA due to a pre-existing deformity such as bowleggedness
8Osteotomy This procedure will reduce pain, eliminate deformity. Best results are obtained with patients younger than 55 years ,involvement of either medial or lateral compatment only.
9Unicompartmental knee replacement Total knee replacement
10Myths Hip replacement works but knee replacement doesn’t Knee replacements are still experimentalKnee replacements only last 8-10 years may be 15 years maximumI am too fat - my implants might break
11Myths TKR surgery is too costly TKR is not successful After TKR, I have to be bedridden for 3 monthsA total knee replacement implies that everything about the joint is being replaced
12Indications of Knee Replacement Knee pain that has failed to respond to conservative therapyKnee OAPain - at rest- at night- with activityLoss of functionKnee tumorsIn short PAIN , PAIN & PAIN.
13Unicompartmental Knee Replacement Only a small part of the knee is replaced in this procedureRecommended for patients withmedial or lateral compartment diseasemoderate to severe pain and functional impairmentIt is intended to relieve pain and preserve function for as long as possible, before a total knee replacement is become necessary
15Unicompartmental Knee Replacement AdvantagesMinimally invasiveShort hospital stayRapid recoverySatisfactory conversion to TKRDisadvantagesLong - term (>15 years) result unknownNot recommended for heavy manual work
16Total Knee Replacement The ultimate solution for OA of knee is to replace the worn-out parts of the knee with an artificial jointThe prosthesis that is used is made up of plastic and metal and is placed on the joint surface of each boneThis surgery has been widely used for many years with excellent results especially for knees
20Common Post-Operative (TKR) Course Day 1 Standing, bending and sitting out in a chair May take a few steps with helpDay 2 Walking (with aids)Day 4/5 Stair climbingDay Home (with 2 walking sticks)Week 6 Walking unaided (or 1 stick) DrivingWeek Full recoveryMr Sefton will talk in more detail about the rehabilitation and possible risks and complications with knee replacements.
21Benefits of TKRTKR can relieve pain that doesn't respond to other treatment optionsPain reduction in 90 to 95% of the patientsReduced stiffness and improved joint movementIncreased walking abilityImproved alignment of deformed joints