| CHRIS SERVANT |
| KNEE REPLACEMENT |
What are the alternatives to a knee replacement? |
Non-operative treatment |
The following measures should be considered first:
- Modification of activity: you should avoid impact activity (such as running, jumping or carrying heavy loads) and patients with patellofemoral arthritis should minimise the amount of stair climbing they do
- Exercise: regular non-impact activity (such as swimming and cycling) and knee exercises are useful; a knee exercise sheet is available
- Reduce the load across the knee: use a stick (held in the opposite hand) and lose weight
- Pain killers: paracetamol and an anti-inflammatory painkiller (such as ibuprofen) are usually helpful; you may consult your GP for further advice
- Glucosamine + chondroitin tablets: some patients find these dietary supplements helpful
- Injections into the knee joint of either corticosteroid (cortisone) or hyaluronic acid (e.g. Synvisc) may provide some temporary relief in early arthritis
All of these measures tend to become less effective as the arthritis worsens.
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Arthroscopy |
| Keyhole surgery performed via two or three small holes at the front of the knee, usually as day case surgery.
Using special instruments the knee is ‘cleaned up’ by smoothing off any rough, unstable parts of joint surface or
meniscus (‘cartilage’) and washing out any debris – this is known as an ‘arthroscopic debridement’. |
| Arthroscopy should not be seen as curative and but it can give temporary benefit and the
risks of surgery are lower than for a knee replacement. However, in some patients arthroscopy can aggravate the
arthritis. It is not a helpful option for knees that have become deformed due to the arthritis.
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Osteotomy |
| An osteotomy involves cutting either the tibia (shin bone) or femur (thigh bone) to
re-align the knee and unload the arthritic part of the knee joint. |
| It is an option for younger patients who have unicompartmental arthritis (only one part
of the knee is affected) and who wish to continue with impact activity, such as running or carrying heavy loads.
An osteotomy can be expected to give around 10 years of pain relief, following which a knee replacement can then be
performed.
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