Surgical Options

2. Surgical Options The available Surgical interventions include: 1.Arthroscopy 2.Osteotomy 3. Knee replacement • Unicompartmental knee replacement • Total knee replacement

3. Arthroscopy Arthroscopy involves: • Cleaning or debridement of joint • Repair of damaged cartilage • Removal of loose bits of cartilage & bone • Draining of infected or excess synovial fluid • Removal of diseased synovium

5. Surgical Interventions • The aim of surgical treatment of OA is to decrease or eliminate pain and to improve function • The particular choice of procedure for the individual patient is determined by a complex set of variables: • pain severity • degree of functional impairment • evidence for structural joint damage

6. Arthroscopy • Arthroscopy done under regional anesthesia • Does not involve any blood loss • Usually offers temporary relief of symptoms for somewhere between 6 months - 2 years

7. Osteotomy • Osteotomy literally means “bone cutting” • The deformity is corrected by removing or adding triangular wedges of bone • Useful in preventing deterioration of joints with OA due to a pre-existing deformity such as bowleggedness

8. Osteotomy • This procedure will reduce pain, eliminate deformity. • Best results are obtained with patients younger than 55 years ,involvement of either medial or lateral compatment only.

9. Knee Replacement Unicompartmental knee replacementTotal knee replacement

10. Myths • Hip replacement works but knee replacement doesn’t • Knee replacements are still experimental • Knee replacements only last 8-10 years may be 15 years maximum • I am too fat - my implants might break

11. Myths • TKR surgery is too costly • TKR is not successful • After TKR, I have to be bedridden for 3 months • A total knee replacement implies that everything about the joint is being replaced

12. Indications of Knee Replacement • Knee pain that has failed to respond to conservative therapy • Knee OA • Pain - at rest • - at night • - with activity • Loss of function • Knee tumors • In short PAIN , PAIN & PAIN.

13. Unicompartmental Knee Replacement • Only a small part of the knee is replaced in this procedure • Recommended forpatients with • medial or lateral compartment disease • moderate to severe pain and functional impairment • It is intended to relieve pain and preserve function for as long as possible, before a total knee replacement is become necessary

14. Unicompartmental Knee Replacement

15. Unicompartmental Knee Replacement • Advantages • Minimally invasive • Short hospital stay • Rapid recovery • Satisfactory conversion to TKR • Disadvantages • Long - term (>15 years) result unknown • Not recommended for heavy manual work

16. Total Knee Replacement • The ultimate solution for OA of knee is to replace the worn-out parts of the knee with an artificial joint • The prosthesis that is used is made up of plastic and metal and is placed on the joint surface of each bone • This surgery has been widely used for many years with excellent results especially for knees

17. Total Knee Replacement - Prostheses

18. Intraoperative - TKR

19. Day 1 - Post-Op TKR Lateral AP

20. Common Post-Operative (TKR) Course • Day 1 Standing, bending and sitting out in a chair May take a few steps with help • Day 2 Walking (with aids) • Day 4/5 Stair climbing • Day 5-7 Home (with 2 walking sticks) • Week 6 Walking unaided (or 1 stick) Driving • Week 10-12 Full recovery

21. Benefits of TKR • TKR can relieve pain that doesn't respond to other treatment options • Pain reduction in 90 to 95% of the patients • Reduced stiffness and improved joint movement • Increased walking ability • Improved alignment of deformed joints