Knee Arthritis: Anatomy
The knee joint is made up of the three bones:
1) The Femur (thigh bone)
2) tibia (shin bone)
3) patella (Knee cap).
There are 3 compartments of the knee. Medial which is the area between the legs, lateral which is on the outside, and the patellofemoral compartment which is under the knee cap
Over time, with wear and tear, you can have damage in one, two, or all three of these compartments. If there is arthritis in all three, that is called tricompartmental arthritis
Knee Arthritis: X-Rays
Here are xrays of a healthy knee. There is space between the femur and the tibia meaning there is cartilage in between and no bone-on-bone arthritis.
Here the femur and the tibia are touching each other on the medial side and there are bone spurs throughout. The cartilage has been worn out and there is bone-on-bone arthritis.
The underlying cause of pain in arthritis is inflammation within the joint. There are many conservative treatment options to reduce the inflammation. and improve the strength of the muscles around the joint.
Oral Medications: Oral non-steroidal anti-inflammatories such as over the counter ibuprofen can help to provide relief. There are also prescription anti-inflammatories that can can provide greater relief. These medications work well however they are not delivered directly to the hip or knee in high doses.
Injections: Strong anti-inflammatory medications can be delivered to the joint itself with hip or knee Injections. There are various types of injections that can be performed to help reduce the inflammation and lubricate the joint.
Physical Therapy: Physical therapy can lessen your pain by teaching better posture or “form” for your day-to-day activities, like getting in and out of a chair. Exercises also help
Weight Management: Eating healthier and low impact exercise such as swimming, walking, elliptical and cycling can help with weight loss. This leads to reduced forces across the joints and less pain. Every 1lb of weight loss equals 4lbs less force across the joints.
Bracing: Braces can be beneficial for certain patterns of arthritis. This can be discussed individually with each patient.
Surgery: Anti-inflammatories, band-aids to reduce pain however they don’t address the arthritis itself. If all else fails, surgery is the last option. For the right indications, joint replacement provides immediate and long lasting pain relief with the ability to return to your normal function
Partial Knee Replacement (PKA)
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If only one of he three compartments of the knee is arthritic, a partial knee replacement can be done.
In a partial knee replacement, a few millimeters of bone is removed from both the tibia and femur. This is then replaced with a metal prosthesis. A durable highly cross-linked polyethylene (plastic) is placed between. This acts as the new "cartilage" in the knee.
A partial knee replacement is minimally-invasive, preserves all the ligaments in the knee, and can be done as a same-day procedure. Recovery and range of motion is much quicker than a total knee replacement.
Total Knee Replacement (TKA)
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If all the compartments of the knee are worn, than a total knee replacement is done.
During a total knee replacement, a few millimeters of bone is removed from both the tibia and femur. This is then replaced with a metal prosthesis. A durable highly cross-linked polyethylene (plastic) is placed between. This acts as the new "cartilage" in the knee.
Recovery to normal daily activities for a knee replacement is~ 2-3 months.