pathologies
Knee
Osteoarthritis of the knee
treatment
The treatment comprises several stages.
I reassess the analgesic treatment and physiotherapy sessions are prescribed.
Balneotherapy and physiotherapy sessions are welcome and provide significant relief.
I then offer intra-articular infiltrations. Several products are used, and the response to treatment depends largely on the level of wear. I've had very good results with infiltrations using an "orthopaedic cocktail", visco-supplementation or the adjuvant use of growth factors (PRP).
The use of various products injected into the joint can temporarily improve cartilage quality and reduce pain. This allows us to postpone surgery.
When the indication for surgery is accepted, the surgeon has a choice of prosthesis types and techniques. I prefer a partial prosthesis for patients whose osteoarthritis affects only part of the knee.
The surgeon must be certain that wear does not affect all compartments of the knee. The lifespan of a half-prosthesis is shorter, but if the indication has been chosen correctly, recovery after surgery is much quicker, as the internal ligaments of the knee remain intact. On the other hand, if wear and tear continues in the other compartments, you can expect to have to undergo another operation with a total prosthesis years down the line.
A total knee prosthesis consists of several parts:
- A metal femoral component (chromium cobalt alloy or titanium) that is fixed to the femur with or without cement
- A metal tibial component that is fixed to the tibia with or without cement
- A polyethylene intermediate piece between the two metal components
- When the patella is replaced, a polyethylene implant is usually used.
When should I decide to have surgery?
The answer is: when it hurts too much!
Pain is the fundamental argument for surgical decisions.
There is no reason to operate too early if the discomfort is not too great. However, given the quality of results that can be expected in 2020, it would be a pity, especially if you are active, not to profier a knee prosthesis when knee pain and deformity are significant.
Rehabilitation
It begins the day after surgery when pain relief treatment is efficient.
It involves gentle, manual knee mobilization by the physiotherapist, combined with passive movements effected on electric mobilization machines.
Patients can start moving their feet and ankles themselves, and contracting their leg muscles on the evening of the operation.
Full weight-bearing is generally allowed from the first days after surgery, first with a walker (a kind of tripod) and then, gradually, with two crutches.
At home
The dressing should be changed twice a week until the wound has healed. The fils should be removed after 16 days. Anti-coagulant injections should be continued for 1 month after surgery.
You can sleep in any position you like.
If the knee is still painful, I recommend regularly applying an ice pack for 15 minutes every 3-4 hours.
You will usually be able to drive again around the 6th week.
You'll be able to go cycling fairly quickly. You can go swimming once the wound has completely healed.
Patients will be encouraged to stay active, maintain the same lifestyle and take part in sports (golf, hiking, cycling, swimming), but avoid contact sports.
Recovery of the knee will be complete between 6 and 12 months after surgery.
Your surgeon will see you again in consultation, usually after 2 to 4 weeks, with a follow-up X-ray.
Alternatives for prosthetic knee replacement
In some cases, other procedures may be suggested before a knee prosthesis is fitted. It all depends on age, severity of wear and deformity of the knee, occupation, presence of other diseases, etc.
Cartilage grafting using OATS
(Osteochondral Autograft Transfer System)
The main components of the knee joint are the end of the femur, the end of the tibia and the patella. To ensure smooth gliding during movement, the bony surfaces are covered with an elastic tissue called cartilage (which wears away in osteoarthritis). There's also synovial fluid (an oil that washes these surfaces to improve gliding).
Articular cartilage is a tissue with low regenerative capacity, making repair impossible.
The wear and tear of this cartilage, and the thinning of its thickness, is known as osteoarthritis.
Sometimes these lesions are localized and circumscribed, and it is for these cases that we propose cartilage greffes afin to fill this loss of substance.
I personally use the O.A.T.S. (Osteochondral Autograft Transfer System) technique.
These cartilage lesions are often diagnosed by an additional work-up (MRI, CT scan) or visualized during a previous arthroscopy. After the operation, you must not lean on the operated side for 4 to 6 weeks.
Possible complications
Results depend very much on the surgeon's skill. American studies have shown that results are best if the surgeon performs at least 6 knee replacements per year, and if the department performs at least 25 knee replacements per year. Complications are not the rule! but... there's no such thing as risk-free surgery!
Surgery is more difficile in obese patients.
The fièvre
In the first week after surgery, the fièvre is often due to the operation itself; if, however, the fièvre were to continue, this is a sign of inflammation.
Hematoma
Infection of the surgical site
If diagnosed early (within the first 3 weeks), it requires rigorous antibiotic treatment.
When the infection is deep-rooted and involves the prosthesis, arthroscopic joint cleaning is often required.
Thrombosis
In thrombosis, an unwanted clot forms in a blood vessel, most often in a calf vein. The leg becomes very painful. Contact your GP or go to the emergency room.
Pain around the kneecap
Sometimes the patella doesn't work properly, or it remains very sensitive. Bending and stretching the knee is very painful. These pains diminish with time.
Stiff knees
It occurs later. In the event of stagnation or insuffisante recovery of mobility, mobilization under general anesthesia may be proposed.
Loss of feeling in the anterior aspect of the knee
It is caused by the severing of small nerves in the skin. Although recovery of skin sensitivity around the scar is not always complete, it rarely causes discomfort.
diagnosis
Confirmation of the diagnosis can be straightforward, sometimes requiring a simple X-ray.
Additional examinations are rarely necessary. It is used to rule out associated lesions or to assess the level of wear. The surgeon may ask you to undergo ultrasound, arthro-scanner or magnetic resonance imaging.
symptoms
Patients are in pain.
Knees are painful during the day, but often wake up at night because of the pain.
The first steps, especially in the morning, are difficult and the knee is stiff.
Noises and friction can be heard in the joint (especially when climbing stairs).
After taking painkillers, the pain gradually stops.
Definition
Before long, you'll have to decide, or perhaps you've already decided, to undergo surgery on your worn-out knee.
Knee replacement is one of the most frequent orthopedic procedures (300,000/year in the USA, 50,000/year in France). Your worn-out knee joint is replaced by an artificial joint, known as a knee prosthesis. The aim of the operation is to relieve you of the pain caused by your worn-out joint.
The knee has a cartilage-covered surface and 2 menisci designed to absorb shock and smooth movement.
When this cartilage is worn down ... it's arthritis.
Cartilage wear can be accelerated by different factors.
Normally, cartilage is nourished by joint fluid, which "washes" the cartilage surface with each movement. With wear and tear, joint cartilage becomes less elastic and dries out. The fissures appear and the cartilage becomes irregular. The bone is no longer covered by the cartilage, is exposed and in fin the bone surfaces are in direct contact. This triggers severe pain. The knee becomes deformed (X- or O-shaped position).