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

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

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  

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

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

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.

Unicompartmental knee replacement Total knee replacement

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

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

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.

Unicompartmental Knee Replacement Only a small part of the knee is replaced in this procedure Recommended for patients 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

Unicompartmental Knee Replacement

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

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

Total Knee Replacement - Prostheses

Intraoperative - TKR    

Day 1 - Post-Op TKR Lateral AP

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 Mr Sefton will talk in more detail about the rehabilitation and possible risks and complications with knee replacements.

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