Minimally Invasive Knee Treatments and Knee Replacements
Dr. J. Michael Bennett is a Board-Certified orthopedic surgeon and sports medicine physician with many years of experience treating conditions like knee pain, arthritis of the knee, knee locking, and knee injuries. If you're experiencing knee pain or knee joint locking, call us at 281-633-8600 for an appointment and a medical evaluation of your knee. We can treat many knee problems with minimally invasive procedures if we see you before serious deterioration of the knee joint sets in. If you wait too long, the only option remaining might be a total knee replacement.
Conditions Leading to Knee Replacement Surgery - Medical Treatment for Your Knees
As we get older and the more active we are, the more likely it is that we will wear down and weaken the cartilage in the knee joint. That cartilage is the lining within the knee that acts as a shock absorber and lubricant between your leg bones at the knee, and it can degenerate over time. If the cartilage deterioration is bad enough, you'll get to the point where instead of a nice, slick cartilaginous covering of the knee, you'll have more of a degenerative, bumpy type of surface, leading to exposed bone-to-bone contact within the knee joint.
There are many minimally invasive procedures that can address and treat these cartilage issues before the knee gets to the point of bone-on-bone contact. With these
minimally invasive procedures we can either stop the cartilage degeneration or slow it down.
However, sometimes people have a predisposition for arthritis, perhaps because of genetics. They might experience significant degenerative changes over time in their
joint because of a history of rheumatoid arthritis or osteoarthritis, and then they're more likely to develop the wearing down of the cartilage surface in the knee.
If patients fail conservative medical treatment or minimally invasive measures such as arthroscopy or injections or therapy and their radiographs or x-rays reveal that they have bone rubbing on bone in the knee joint, or bone spurs and wearing down of cartilage, then they become candidates for a knee resurfacing or knee replacement type of procedure.
If you're experiencing knee pain, it's always a good idea to come in for a medical evaluation of your situation before your situation becomes serious. If you're dealing with knee pain, or swelling of the knee, or your knee is locking, then it's always a good idea to have it looked at. It's probably not something that's just going to go away without treatment, so it's better to at least get a diagnosis so you can understand what you have going on, and then you can make the decision if you want to have something else done. Not every knee needs surgery, and ninety percent of the time, our patients don't need surgery, and they can be treated with therapy and non-invasive measures.
For the ten percent who do require surgery, it's always better to have a diagnosis early before it gets to the point that your knee issue is really bad and you need a more invasive procedure.
Minimally Invasive Knee Treatments
Under the minimally invasive procedures, injections are one option and those injections can include steroid injections or viscosupplementation. Viscosupplementation is the injection of a preparation of hyaluronic acid to supplement or replace the natural synovial fluid in the knee joint. This injected fluid is very thick, viscous, and sticky and it acts to boost the effectiveness of the knee joint's remaining synovial fluid to improve the function of the joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid. It acts as a lubricant to enable bones in the knee joint to move smoothly and the joint fluid is a shock absorber for the knee joint. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints.
Viscosupplementation may be a minimally invasive treatment option for individuals with osteoarthritis of the knee.
These injections of hyaluronic acid are also known as rooster comb injections. The hyaluronic acid injections we use are produced in a lab-controlled biochemical process but the original versions were extracted from the combs of roosters and the name has stuck. Despite advances in medical technology and medical manufacturing over the years the name "rooster comb injections" is still used.
Viscosupplementation or rooster comb injections can be very helpful for someone with moderate arthritis. Unfortunately, patients with severe arthritis of the knee tend to not do as well with these injections. Patients can get up to six months or even a year of relief with rooster comb injections, and many patients decide to do the injections for awhile before they elect to do a knee replacement.
If you do have arthritis or wearing down of the cartilage, you can also do things like autologous chondrocyte implantation or ACI. The idea of an ACI procedure is to take a few cartilage cells from the knee, use these few cells to grow millions of them in the lab, and then inject the cells back into the defects in the knee joint. To be a candidate for ACI, the patient must have early arthritis or at least isolated arthritis in one area, and ACI can make a big difference in preventing long term problems in the knee joint. As we noted earlier, it's better to catch knee problems earlier and treat them earlier than later.
Types of Knee Replacement or Knee Arthroplasty
Which parts of the knee are involved can determine the type of knee replacement or resurfacing that patient can get. A patient can have isolated arthritis underneath the knee cap and that patient might be a candidate for a resurfacing or replacement of that kneecap region. Or a patient can have an isolated area of arthritis on the inside of the knee, which is the medial compartment of the knee, and that patient can be a candidate for a partial knee replacement. Or if a patient has involvement of all three compartments of the knee, that patient becomes a candidate for a total knee replacement or knee arthroplasty.
Obviously the rehabilitation is significantly different in all three of those, but the long term outcome is the same. The goals of those three knee procedures are improved knee function and pain relief. The outlook for patients with knee replacements is significantly better now than it was about ten or 15 years ago, since the technology has significantly improved. The types of knee replacements or knee prostheses that are out now can withstand long term use and wear. So knee replacements now are lasting from 20 to 30 years in some cases. That improved durability has a lot to do with the type of knee implant, in other words, what that knee implant is composed of, as well as improvements in the way these knee implants are being put in.
Custom Knee Replacements
Many of the knees that we see, especially the total knee replacements that we do are custom knee replacements. We typically obtain an MRI before proceeding with the
surgery to outline that patient's anatomy and look at what we call the mechanical axis of the patient. The mechanical axis is really the natural alignment of the patient's leg. Based on the mechanical axis, we make jigs specifically made for that patient's knee that allows us to make the cuts for the implant more customized and specific to that patient. This is relatively new technology that's come out over the last five years, and we believe that this new custom implant technology will create better longer term results for total knee replacement.
However, we need to emphasize that the patient has to fail all conservative and minimally invasive treatments and options, and it really comes down to a quality of life issue before we recommend a knee replacement. If arthritis starts to affect the quality of life, then a knee replacement can be a good option for the patient.
Some people facing a double knee replacement ask whether they should do both knee replacements at the same time. Although every patient is different, we usually
recommend that patients do one knee replacement at a time. It can depend on how healthy the patient is, how old the patient is -- these are all factors we take into account in recommending a specific knee replacement to a patient. With a knee replacement, there is a significant period of operative time that the patient's asleep under anesthesia and there is blood loss during surgery. For most patients, it's best to try to minimize the period under anesthesia during one procedure, and having one knee replacement done at a time can help that.
After patients go through even a total knee replacement, they can usually resume their normal activities. Most patients who get a total knee replacement are typically older so the sports they're involved in are usually lower impact, like golf, bicycling and swimming.
We typically recommend low-impact activities like walking. As far as long distance running or anything like that, the more pounding that you do across the knee, the faster you're going to wear it out. However, we do have some younger patients who have knee replacements because of arthritis, and they're able to get back to their normal activities.
The knee implants are mostly metal with plastic or polyethylene components. The durability of the artificial knee after a knee replacement is determined by the wearing down of the plastic component. Nowdays, the manufacturers are making those plastic or polyethylene components a lot stronger and less susceptible to wear. So from a technological standpoint, the new types of polyethylene used in knee implants these days really do make a difference.
If you have any questions about knee treatments or knee joint replacements, please call our office at 281-633-8600.
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