Knee Osteoarthritis Surgery
Arthroplasty and Other Types of Surgery for Knee OA
Surgery is typically a last resort for knee osteoarthritis (OA). Before knee replacement surgery, your doctor will most likely suggest non-surgical treatments for knee OA, such as medications, physical therapy, and exercise.
But if you've tried non-surgical treatments for several months, and they aren't enough to cope with the pain, swelling, stiffness, and other symptoms of knee OA, your doctor may suggest knee replacement surgery or another type of surgery.
The American Academy of Orthopaedic Surgeons recently released new clinical practice guidelines for the surgical treatment of knee osteoarthritis. The guidelines focus on the surgical procedure most commonly performed for this condition, total knee replacement (TKR). Among the key recommendations:
- Reduction of risk factors, such as weight and smoking
- Administration of multi-modal anesthesia, including local anesthetic and nerve blockade around the knee joint to decrease pain and opioid use following TKR
- Treatment with tranexamic acid to decrease postoperative blood loss and transfusions following TKR
- Starting rehabilitation the same day TKR is performed to reduce length of hospital stay.
The goal of surgery for knee osteoarthritis is to help you return to your normal activities. After recovering from surgery, you may notice you're able to move more easily, and you may feel less pain and swelling in your knee joint.
Here are the different types of surgery used to treat knee osteoarthritis.
- Arthroplasty (total knee replacement): With this type of surgery, your surgeon replaces all of the damaged cartilage in the knee joint (called total knee arthroplasty) or just a part of the joint (called partial knee arthroplasty) using artificial parts. These artificial parts are called prostheses, and they can last for years. Prostheses are commonly made of plastic, ceramic material, or metals, such as titanium.
- Arthroscopy: This procedure is less invasive than joint replacement because your surgeon makes a tiny incision and works with small instruments and tools during surgery. Your surgeon will clean up your knee joint by removing any debris (damaged cartilage or tissue) to prevent further joint deterioration. Although arthroscopy may sound more desirable than total knee replacement, it's often not the best option. Talk to your surgeon about whether arthroscopic surgery is an option for you.
- Osteotomy: For an osteotomy, the surgeon will remove part of the bone. ("Osteo" means bone and "otomy" means removal). This is done to improve the alignment of the knee joint and to re-position the bones in the knee to decrease stress on the part of your knee that has developed arthritis. This can help decrease pain and other knee OA symptoms.
Your doctor will take into account several factors to determine whether you're a candidate for knee osteoarthritis surgery: your age, occupation, severity of pain and other symptoms, and the degree to which arthritis interferes with your daily activities. However, the decision to have surgery for knee osteoarthritis is ultimately up to you.