Total knee replacement, or total knee arthroplasty, is a surgical procedure in which parts of the knee joint are replaced with artificial parts (prostheses)
A normal knee functions as a hinge joint between the upper leg bone (femur) and the lower leg bones (tibia and fibula). The surfaces where these bones meet can become worn out over time, often due to arthritis or other conditions, which can cause pain and swelling.
REASONS FOR KNEE REPLACEMENT
Total knee replacement is one option to relieve pain and to restore function to an arthritic knee. The most common reason for knee replacement is that other treatments (weight loss, exercise/physical therapy, medicines, and injections) have failed to relieve arthritis-associated knee pain.
The goal of knee replacement is to relieve pain, improve quality of life, and maintain or improve knee function. The procedure is performed on people of all ages, with the exception of children, whose bones are still growing. It is important to have significant pain and/or disability prior to considering this procedure.
ALTERNATIVES TO KNEE REPLACEMENT
While total knee replacement can be helpful under the right circumstances, you should discuss the risks, benefits, and alternatives with a doctor. Alternatives to total knee replacement include:
- Nonsurgical treatment — Nonsurgical treatment methods are initially recommended for patients with osteoarthritis or inflammatory arthritis. This includes:
- Weight loss. The knee sees about four pounds of pressure for each pound of body weight, so even a small amount of weight loss can lead to reduced pain.
- Exercise/physical therapy. Strengthening the muscles around the knee help take pressure off the knee. Motion of the joint helps to keep it from getting stiff.
- Medications, including over-the-counter and prescription. These include pain relievers such as acetaminophen and antiinflammatory drugs such as ibuprofen or naproxen. Patients should discuss use of these medications with their primary care provider and pharmacist to be sure the risk of side effects is acceptably low.
- Knee bracing or shoe inserts, both of which may help align the knee and balance the weight on the joint.
- Injections, either with a cortisone-like drug or a hyaluronic acid derivative.
Arthroscopy — Arthroscopy is a minimally invasive surgical procedure in which a doctor examines the inside of a joint with a device called an arthroscope. The doctor can repair any damage through small surgical incisions in the skin. Arthroscopy is only helpful for a certain type of knee problems. Arthroscopic surgery has not demonstrated significant benefit for patients with osteoarthritis.
- Osteotomy — Osteotomy is a surgical procedure that involves cutting the leg bone, realigning it, and allowing it to heal. It is used to shift weight from a damaged part of the knee to a normal or less damaged one. Osteotomy is not recommended for patients older than 60 years of age or for those with inflammatory arthritis (such as rheumatoid arthritis).
- Partial knee replacement — A “partial” or unicompartmental knee replacement involves replacing only one part of the knee joint. There is debate about the benefit of partial knee replacement compared with total knee replacement, but some studies have shown favorable results. You should talk to your doctor about the possible risks and benefits.