Severe osteoarthritis of the knee, also known as DJD or Degenerative Joint Disease
What Is Osteoarthritis?
Osteoarthritis refers to any condition of a joint where either through trauma, inflammation, or wear and tear, the joint wears out and the cartilage is lost, leaving both bones on each side of the joint free to rub together, which is where the pain of arthritis comes from.
What About Osteoarthritis Of The Knee?
In the case of the knee, the loss of cartilage usually begins with an injury or with a torn or lost meniscus sometime in the patient’s earlier years, but not always. Some patient can get arthritis of the knee just through wear and tear or through such conditions as rheumatoid arthritis, where for whatever reasons the cartilage on the end of the femur and the top of the tibia wear away such that the patient has pain in the knee with each step and eventually as it gets bad enough even when the patient is resting.
Common symptoms of endstage osteoarthritis of the knee are basically pain, oftentimes swelling, sometimes catching or locking of the knee, and in many cases deformity of the knee. Many patients whose arthritis progresses significantly enough will notice a severe bowed leg or a severe knock knee, depending on which part of the knee, the inside or medial compartment, or the outside or lateral compartment, that is involved.
How Can This Condition Be Treated?
This condition can be treated a number of ways, starting out with anti-inflammatory drugs, or so-called NSAIDS, which are the common arthritis medicines such as Aleve, ibuprofen, Celebrex, Indocin, Naprosyn, Advil, Mobic, Relafen, etc.
The second line of treatment involves injection therapy, either with something such as cortisone, which is an older drug and has a shorter efficacy, or, #2, a different type of injection can be tried, so-called viscosupplementation. There are about five different products on the market, and basically viscosupplementation is a way of injecting a substance called hyaluronic acid into the knee in order to improve the lubrication and thereby decrease the pain of arthritis in the knee. Hyaluronic acid is a normally-occurring knee fluid component. As a person gets arthritis, he stops producing hyaluronic acid in the normal amounts. In viscosupplementation therapy, hyaluronic acid is injected once a week for three to five weeks into the patient’s knee and over that period of time the patient begins to notice pain relief and usually increased motion if this is going to be effective. Viscosupplementation is effective in about 75% of patients with severe arthritis.
The third line of treatment involves surgery. Sometimes if patients have moderate or mild arthritis and have a torn cartilage, such as a torn meniscus, in their knee, arthroscopic surgery can be an effective means of treating this condition, though the effects of it are somewhat less predictable and may only last at the most a year, in which case the patient’s arthritis might progress requiring them to have more definitive treatment.
The fourth and most definitive line of treatment for endstage osteoarthritis of the knee is knee replacement surgery. In this operation, the arthritic surfaces of the knee are removed. In other words, the very end of the femur is removed and shaped in such a way to allow a metal cap to be placed on the end of the femur. Likewise, the top of the tibia is also removed and a plate is placed on the top of the tibia, which allows the tibia to be resurfaced, and in between these two metal components are placed a polyethylene bearing surface. This surface then becomes the bearing surface of the new knee. There is also a cap placed on the back, or posterior side, of the kneecap so that there is no rubbing of the arthritic kneecap onto the femur, which can also be a source of pain. So, thereby a total knee replacement is when all the arthritic surfaces of the knees are replaced.
What About A Partial Knee Replacement?
A partial knee replacement is appropriate in certain patients whose bone-on-bone arthritis is isolated to one compartment only in their knee, usually the medial compartment or the compartment on the inside of the knee. Likewise, the end of the femur on the medial side and the medial side of the tibia are the only parts of the knee replaced and the rest of the knee is left intact. This is truly minimally invasive knee replacement surgery.
The typical rehabilitation process following knee replacement surgery is fairly extensive. It generally requires a minimum of six weeks of physical therapy, the first three days of which are done in the hospital. The patient then either goes home on the third day and has a therapist come to the house, or maybe spends a week in a rehab unit in a hospital until he or she feels comfortable enough to go home. The best therapy occurs once the patient feels good enough to go to an outpatient physical therapy center, where he can work with a therapist in a physical therapy department using the equipment and exercise techniques available more uniquely in these centers.
How Long Does It Take Until I Am Completely Better?
It can take as little as three months or as long as six months. Knee replacement surgery is a big undertaking. It is a difficult rehabilitation process, but if you are like most people, specifically 93% of people, at the end of your rehabilitation process, you will be rewarded with a good-to-excellent result and will be absolutely certain that knee replacement surgery was the right treatment for your knee.
What About Minimally-Invasive Surgery?
Be careful, minimally invasive surgery is a somewhat over-marketed and underdeveloped technique. The partial knee replacement noted above is easily done through a minimally-invasive technique. However, the total knee replacement still is most consistently done with best results through a standard technique. Certainly the incisions are smaller than they used to be years ago with what is now considered the standard technique, but with minimally-invasive total knee replacements, there have been a myriad of complications and the results are still lacking long-term results.
What Can I Expect If I Have Severe Osteoarthritis Of The Knee And I Do Not Treat It?
Pain. Some knee arthritis will go on to fairly significantly deformity where the knee will become so bowed or so knock-kneed that you will have more and more difficulty walking. However, it is rare that arthritis gets to the point that you would not be able to walk, although in certain severe cases that could be possible.