Arthritis of the knee is one of the most common diseases I encounter in my clinic. Fortunately many treatment options are available for the management of knee arthritis. Before we progress any further let’s define what arthritis means. Arthritis is a term used to describe the degeneration or wearing down of our cartilage (joint) surfaces. Cartilage is defined as the smooth, gliding surface on the ends of our bones that allows our joints to glide smoothly over one another. Therefore, when the cartilage surface becomes damaged the surface is no longer smooth and this irregularity in the joint surface causes pain. The pain is generated by changes in the load bearing pressure to the underlying bone as well as from inflammation resulting from the damaged cartilage. It’s important to remember that the term arthritis represents a spectrum. Having arthritis can mean having a small amount of cartilage wear or it can be severe, resulting in complete cartilage loss leading to bone on bone wearing between the joints. Thus having arthritis does not always mean that you need surgery to correct it.
Now that arthritis is defined, let’s talk about the treatment options available for arthritis. For mild arthritis, the treatment can be as simple as taking an anti-inflammatory (i.e. advil, aleve, etc.) for the pain. Once the arthritis progresses the next step would be to consider an injection into the knee joint. These injection options include a corticosteroid injection or possible viscosupplementation injections (i.e. synthetic joint fluid made from rooster combs). If injections and medications fail to deliver appropriate relief, then the next option would be to consider surgery. The surgical options available include cartilage restoration procedures (i.e. cartilage transplantation, osteochondral transfer, and microfracture) or total knee replacement. These surgical options depend a lot on your age and the type of cartilage injury that you have. Knee replacement is better indicated for patients older than age 60, although special situations do arise in which a knee replacement is necessary at a younger age. One of the most important reasons to delay having your knee replaced for as long as possible is because the replacements don’t last forever. Studies indicate that about the best results for implant longevity vary between 15-20 years. These numbers can vary widely based upon the activity level of the patient. Once it fails, a knee revision has to be performed, which carries increased risks and decreased patient satisfaction than with first time replacement.
In regards to total knee replacements, a lot of new technology has been introduced over the past several years. Some of the biggest improvements have come in the technology involved with the plastic insert that sits between the two metal components. This plastic piece is called the polyethylene liner and serves as the main weight bearing or wear surface for a knee replacement. Other improvements have been made with regard to using 3D navigation to help guide the bone cutting portion of the surgery, but this has been met with mixed results. One of the newer technologies I have introduced into my practice is the use of MRI to make cutting blocks for each individual patient based upon their own anatomy. This essentially provides them with a custom fit knee replacement. The specific system I use is made by Smith & Nephew and involves the Visionaire system using Genesis II replacement system. This system also incorporates the use of oxinium metal, which has been shown to have some of the lowest wear rates in the industry. The theoretical advantages of using this new MRI based custom fit knee model involves decreased surgical time, better fitting prosthesis, and improvement in deformity correction. All of these theoretical advantages can potentially add up to a significantly improved knee replacement experience and better long results.
Advancements in knee replacement technology will continue to be discovered. LOC looks forward to being able to offer them to our patients. Please call (402) 436-2000 for an appointment with Dr. Seifert. You can also go to www.ortholinc.com for more information.
Top photo: Step 1: MRI Based System tailored to your individual anatomy
Middle photo: Step 2: Custom cutting guides are creating
Bottom photo: Step 3: Custom cutting blocks are then sterilized and processed for use during surgery to provide for more precise fit and alignment in knee replacement.