With so many options for treatment, you should have an experienced and compassionate clinic to talk you through this very important decision. At the OrthoTeam Clinic, we are always ready to help and answer your questions personally.
What is Knee Arthroscopy?
Arthroscopic surgery, or Arthroscopy, is an outpatient surgical procedure usually done under a general anesthetic. Two small incisions are made around the knee. Through these incisions a small telescope (arthroscope) is placed to view all aspects within the joint. A high definition miniature television camera is used to project the image on a plasma screen. This allows the surgeon to see into the joint with an incredible amount of clarity. Small instruments can be used to perform a variety of procedures in the knee joint.
The most common indication for arthroscopy in a knee with osteoarthritis is to remove a torn meniscus or a loose piece of joint surface (loose body).
At the same time the joint surface is examined and can be debrided (cleaned up) as necessary. In certain situations the cartilage defects can be grafted or treated with techniques such as microfracture of the bone beneath the cartilage defect, done through the scope.
The type of symptoms associated with osteoarthritis are aching pain and stiffness, often accompanied by swelling. The pain is usually predictable and increases as the day progresses. Knee arthroscopy has not been found to be useful for treatment of osteoarthritis with this pattern of pain. It is common however to have the meniscus in the knee fray and then tear causing an increase in pain and swelling. This usually presents as an exacerbation of sharp pain that comes on suddenly, and then recurs in an intermittent and unpredictable fashion. The pain occurs when the torn part of the meniscus shifts and gets stuck between the joint surfaces. The pain may be short-lived or the meniscus can become stuck and the knee may lock. In this case you cannot straighten your knee. If this is a persistent problem the meniscus tear is large enough that it will not go away by itself.
In this case, arthroscopy is recommended to remove the fragment and inspect the knee. The arthroscopy should return the knee to the way it was prior to the exacerbation. The length of time that it takes to improve depends on the severity of the arthritis.
Osteoarthritis
Osteoarthritis is also known as degenerative joint disease. This is simply caused by a wearing out of the joint surface in the knee faster than the body can repair it.
Injury
Injury to the knee at any point in your lifetime can make the knee more susceptible to arthritis. There is almost always a history of past injury when the arthritis is predominantly in one knee.
Instability
Knee laxity or instability, from an injury or naturally present, may increase the stress on the knee joint because of abnormal movements that increase shear or scraping forces on the joint surface.
Weight
For every one pound we carry whether it is body weight or lifting, we place an additional three pounds of stress on the knee. When we climb stairs, squat, get up from a chair or out of a car we are putting 5-10 times our body weight through the knee joint.
Alignment
You have probably noticed that sometimes it seems that knee arthritis runs in families. If it does in your family, it is not due to any specific gene, but is probably related to the inherited overall alignment of your leg.
Activity level
The design of our knees allows us to participate in a tremendous number of strenuous activities. In the absence of other risk factors the knees are safely able to run ultra marathons and ironman triathlons. However, if risk factors are present, high impact activities such as running and jumping can deteriorate a knee joint at a quicker rate than low impact activities such as swimming and biking.
Recognition of your own risk factors and maintaining an active lifestyle are important ways to maintain the health of your knee. For the most part, conditioning, activity modification, and prompt careful treatment of injury are the most important steps to a long lasting knee.
Who is a Candidate for Knee Arthroscopy?
Patients with knee pain or limited knee function may be candidates for arthroscopic knee surgery. Most people who suffer from a knee injury or degeneration and who have not found the relief they need through nonoperative treatments can benefit from a minimally invasive procedure.
If you would like to talk to someone and discuss your specific needs more, please give us a call.
We will discuss the best plan of action for you and your situation.
Non-Surgical Alternatives
Before proceeding with surgery, there are nonoperative, conservative options for treating your knee pain your physician will consider.
Medications for arthritis
The mainstay for medical treatment of osteoarthritis is the nonsteroidal anti-inflammatory drug (NSAID). These medications are all pain relievers as well as inflammation reducers. Both of these actions can help the person with arthritis feel better and enjoy more activity, but none of the medications are without side effects.
Bracing and Orthotics
Osteoarthritis in the knee is usually associated with alignment problems. The most common misalignment is varus (bowleggedness). When standing on that leg, the weight of the body is not centered in the knee, but instead is concentrated in the medial compartment. This causes the knee to wear out medially (the inner aspect of the leg). In many individuals with varus the knee shifts even more when weight bearing causing a feeling of instability, lack of confidence in the knee, and more pain. If the knee has excessive valgus (knock-kneed) the same progression occurs on the lateral (outer aspect) of the knee. Bracing and/or orthotics are usually used in conjunction with other conservative measures such as medication, exercise or injection.
Physical Therapy
Orthopedic physical therapists are knowledgeable and talented professionals who contribute to the treatment of many painful conditions of the knee including osteoarthritis. Their contributions are too numerous to mention in this short passage. The main contributions are in maximizing function and reducing pain through exercise, massage, and many additional modalities as well as education and establishment of independent exercise programs. We use physical therapy in all aspects of care, especially in recovery from injury, arthritis exacerbation and surgery.
Steroid injection
Cortisone and other steroid injections have been used for many years for arthritic pain. It is a strong anti-inflammatory medication that is absorbed into the knee joint lining and decreases the swelling and aching pain frequently associated with flares of arthritis. It is especially helpful in inflammatory arthritis such as rheumatoid arthritis, gout or pseudogout. It is useful in advanced osteoarthritis when there is a flare of acute pain. It may help delay the need for a knee replacement, or be a means of treatment for patients who are not healthy enough for surgery. There is a known side effect of joint surface cartilage softening and therefore is not a good choice in early arthritis in younger people. There is a risk of infection in any joint injection so it must be placed using sterile means.
Visco-supplementation
These thick gel-like preparations are the product of the combs of chickens or they can be synthetically produced. They have been used for over ten years with good success in the properly selected patient with osteoarthritis. Unlike the steroid injection it does not work in days, but it usually takes 4-6 weeks to get the desired pain relief. The injections are given in a series of three to five, each spaced a week apart. If a good response is achieved, it will typically last for 6-8 months. The indication for their use is osteoarthritis with persistent pain despite conservative measures such as NSAIDS, or the inability to take NSAIDs. The patient’s knee x-rays should show at least some joint space remaining, as this is not usually effective if the knee is bone on bone. The preparation is a natural product and is chemically similar to the normal lubricant we have in our knee. It is felt to decrease friction in the knee, but the main benefits for pain relief seem to be related to the decrease in inflammation seen in 4- 6 weeks. Unlike the steroid injection it has not been shown to cause any joint surface injury and theoretically may help the joint. Therefore it is safe in younger individuals with less severe forms of osteoarthritis. The injections can be repeated every six months as long as they are effective and can delay the need for a joint replacement. Ultimately the relief obtained becomes unsatisfactory as the joint surface is lost and the knee becomes” bone on bone”.
Weight Loss
The stresses across the knee joint are directly related to body weight and the length of time that the weight exceeds ideal body weight. This factor is even greater in the patella-femoral (kneecap) part of the joint. This can become a real problem as a painful arthritic knee doesn’t allow a person to exercise. The lack of ability to exercise makes it very difficult to lose weight. It is very important to keep your weight under good control, especially if you have other risk factors such as previous knee injury, positive family history of knee arthritis or poor knee alignment. Many people find themselves in this predicament of being overweight and having knee arthritis. We can treat the arthritis using all of the previous listed methods as well as diet modification, however, we may need to proceed with surgical treatment. If surgery is recommended increased body weight escalates your surgical risk of infection and development of post operative blood clots.
