“My Knee Hurts… But I Don’t Want a Total Knee Replacement”
Many people come to our office with knee pain daily, and the age ranges anywhere between a 20 year old to a 90 year old. What we find is that most likely these people come with a similar problem when it starts to become severe. That is, “my knee feels unstable”… or, “it hurts when I get up and when I walk for long periods of time”… and one of the most common complaints being, “I can’t rest at night”.
In all reality, there are only three real indications from our point of view that someone needs surgery.
- I am tired of the pain.
- I am unstable when I try to do things like walk, stand, go up and down stairs, inclines, etc.
- I can’t take care of myself and do the things I want to do, such as: keeping a job, playing sports or taking care of my children.
These indicators leave us with a couple of things that need to be done in order to “My knee hurts, but I don’t want knee surgery”. First of all, it is important to understand that there is a natural history of osteoarthritis that is slow to progress. This is usually an intrinsic condition from trauma, inflammation, malalignment that becomes a mechanical obstacle in one’s ability to ambulate. There are no specific tests for osteoarthritis as there are for rheumatoid and psoriatic arthritis.
Over 52 million people in the United States suffer from arthritis, and it is the most common joint disorder in the U.S. Osteoarthritis of the knee affects approximately 37% of Americans over 60 years old. Most of the affected patients are female in a breakdown of approximately females for ever 2 males. The knee is affected most commonly because it is the weight-bearing joint affecting the lower extremity when running, walking, lifting or bending. Any form of malalignment causes it to wear more aggressively, because 60% of the weight is encountered through the medial compartment. The three compartments of the knee are the patellofemoral joint, the lateral femoral tibial compartment and the medial femoral tibial compartment. Unfortunately, most of the arthritis in the knee occurs on the medial side. Cartilage, which is hyaline cartilage, is rubbery, smooth and slick. As it increases its water content, the collagen content is reduced and the cartilage starts to be destroyed. This can affect the entire knee or focal parts of the knee.
Is there an alternative to a total knee replacement?
It is important to understand the the average patient between 40-70 who has osteoarthritis is affected in the medial compartment that is the inside of the knee. That medial compartment, which does bear the most weight is affected in the first phase 75-80% of the time. If caught early enough, the medial compartment can be replaced with what is considered a medial condylar, unicompartmental knee replacement (half knee replacement). This process is significantly easier to recover when one is suffering from osteoarthritis of the knee.
Having performed unicompartmental knee replacements for over 30 years now, some of our longest patients have lasted 27 yearm having received it in their 50’s only to be in their late 70’s at this time. The average patients survival is around 15 years. However, the selection and the compliance, and of course the surgical delivery have to all be coordinated to achieve the optimal result.
To perform a medial compartment, unicompartmental knee replacement, a minimally invasive incision of 3-6 inches is made. The operation typically takes less than 30 minutes and can be performed as an outpatient procedure. Usually patients can begin ambulating within 24-48 hours, and in our hands over the last 30 years, we have seen our patients return to work somewhere within a 7-14 day timeframe in most cases.
A unicompartmental knee replacement is a very valuable procedure not commonly performed in most orthopedic surgeon clinics. If you have osteoarthritis there are several directions your care can go. It takes an assessment and an x-ray. 30% of the time an MRI may be helpful, but the history and the alignment of the x-ray can conclude directions of care clearly.
The physical exam on a patient will be done in order to get an idea of the patients condition and what symptoms of knee pain will occur. When symptoms occur more than 3-6 months, or if they affect the ability to live a normal life, a physical examination by a trained orthopedic surgeon may be advisable. The key to unicompartmental knee replacement is that 90% of the pain needs to be located in the medial compartment and the patellofemoral joint. In this case, the knee cap involvement will be minimal and there is also no evidence or history of ACL deficiency.
In our experience, this is a very successful procedure. The key to joint care is very simple as there are 3 key components:
- PREVENTION – Work to prevent joint deterioration and focus on joint health.
- PROTECTION – Joint protection and management of a condition, and making necessary changes for future protections.
- PERFORMANCE – Management of the condition include being active and performing in your daily life, work, and activities.
If you have persistent knee pain, we would love to help you overcome that pain. Request an appointment with Dr. Bramlett today.
If you would like to learn more about conditions of the knee, please visit https://kennethbramlettmd.com/knee-conditions/