2. Surgical Options The available Surgical interventions include:
1.     Arthroscopy
2.     Osteotomy
3. Knee replacement
Unicompartmental knee replacement
Total knee replacement

3. Arthroscopy Arthroscopy involves: Cleaning or debridement of joint
Repair of damaged cartilage
Removal of loose bits of cartilage &
bone
Draining of infected or excess synovial fluid
Removal of diseased synovium

5. Surgical Interventions
The aim of surgical treatment of OA is to decrease or eliminate pain and to improve function
The particular choice of procedure for the individual patient is determined by a complex set of variables:
pain severity
degree of functional impairment
evidence for structural joint damage

6. Arthroscopy Arthroscopy done under regional anesthesia
Does not involve any blood loss
Usually offers temporary relief of symptoms for somewhere between 6 months - 2 years

7. Osteotomy Osteotomy literally means “bone cutting”
The deformity is corrected by removing or adding triangular wedges of bone
Useful in preventing deterioration of joints with OA due to a pre-existing deformity such as bowleggedness

8. Osteotomy 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.

9. Unicompartmental knee replacement Total knee replacement

10. Myths Hip replacement works but knee replacement doesn’t
Knee replacements are still experimental
Knee replacements only last 8-10 years may be 15 years maximum
I am too fat - my implants might break

11. Myths TKR surgery is too costly TKR is not successful
After TKR, I have to be bedridden for 3 months
A total knee replacement implies that everything about the joint is being replaced

12. Indications of Knee Replacement
Knee pain that has failed to respond to conservative therapy
Knee OA
Pain - at rest
- at night
- with activity
Loss of function
Knee tumors
In short PAIN , PAIN & PAIN.

13. Unicompartmental Knee Replacement
Only a small part of the knee is replaced in this procedure
Recommended for patients with
medial or lateral compartment disease
moderate to severe pain and functional impairment
It is intended to relieve pain and preserve function for as long as possible, before a total knee replacement is become necessary

14. Unicompartmental Knee Replacement

15. Unicompartmental Knee Replacement
Advantages
Minimally invasive
Short hospital stay
Rapid recovery
Satisfactory conversion to TKR
Disadvantages
Long - term (>15 years) result unknown
Not recommended for heavy manual work

16. Total Knee Replacement
The ultimate solution for OA of knee is to replace the worn-out parts of the knee with an artificial joint
The prosthesis that is used is made up of plastic and metal and is placed on the joint surface of each bone
This surgery has been widely used for many years with excellent results especially for knees

17. Total Knee Replacement - Prostheses

18. Intraoperative - TKR

19. Day 1 - Post-Op TKR
Lateral AP

20. Common Post-Operative (TKR) Course
Day 1 Standing, bending and sitting out in a chair May take a few steps with help
Day 2 Walking (with aids)
Day 4/5 Stair climbing
Day Home (with 2 walking sticks)
Week 6 Walking unaided (or 1 stick) Driving
Week Full recovery
Mr Sefton will talk in more detail about the rehabilitation and possible risks and complications with knee replacements.

21. Benefits of TKR
TKR can relieve pain that doesn't respond to other treatment options
Pain reduction in 90 to 95% of the patients
Reduced stiffness and improved joint movement
Increased walking ability
Improved alignment of deformed joints