Call 281-633-8600 for an evaluation of your knees and arthritis and your options for knee arthritis treatments by a knee specialist with many years of experience in treating knee injuries. Dr J. Michael Bennett specializes in treating issues of the shoulders, elbows, knees, and some hands and wrist injuries like carpal tunnel syndrome and trigger finger.
Knee Specialist, Doctor J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician with a Certificate of Added Qualification (CAQ) in Sports Medicine. During his Fellowship training, he served as assistant team physician for the Tampa Bay Buccaneers and the University of Miami Hurricanes. Dr. Bennett serves patients from all over the Metro Houston area through two clinic locations — one in Sugar Land, near First Colony Mall and one in Downtown Houston, near the Houston Galleria. Please call us at 281-633-8600 to schedule an appointment.
This video discusses knee arthritis treatments and especially some of the options for treatment. This information is for educational purposes only. It’s not intended as a substitute for professional medical advice, diagnosis, or treatment. You should not start an exercise program or act upon any information provided here without first seeking medical advice from a physician.
In addition to these types of knee pains, you can also have just basic arthritis. Arthritis is a softening or wearing down of the condyle or cartilage surface of the joint. As I mentioned before, here’s your bone, the yellow is bone and the blue is cartilage. When the cartilage starts to soften, sometimes it will fissure, meaning it will split. Sometimes there will be pieces or little flaps that detach. And sometimes they’ll wear away and little flecks of cartilage will be found in the joint.
The size of the defect or the size of the involvement, determines the treatment. Most chondral lesions or arthritic symptoms, if they’re mild can be treated with anti-inflammatory medications and modifying activities. We usually recommend low impact activities — things like swimming and biking and elliptical trainers and staying away from high impact activities to avoid further damage to the condyle surface or the cartilage.
Now in patients that are very active and let’s say have isolated lesions, pinpoint lesions throughout these areas and not diffuse, and it’s important to make the distinction. There are many patients that have diffuse arthritis, meaning they have wearing down of the cartilage throughout that joint. On both sides of the joint, here and here and underneath the knee cap. Those patients are better treated with options such as injections, steroid injections, or therapy, or even viscosupplementation, which are lubricant injections for the joint to help with pain and inflammation. And eventually, if the arthritis is bad enough, they may need either a partial or total knee replacement. Please see my video about how to avoid a total knee replacement.
In younger patients who have isolated lesions, where there is cartilage wear or where there is cartilage that’s unstable, there are different options. One option is where we identify the cartilage lesion arthroscopically. Which means that we put a camera in the knee – a poke hole here and a poke hole there – and use the camera to see where this lesion is, and once we identify the lesion, and depending on the size of that lesion, will determine the treatment.
If it’s smaller than 2 cm or so, many times we can treat that with what’s called a chondroplasty, where we smooth down the cartilage edges and maybe a microfracture. We drill small holes into that area that’s bare, and allow a little area of bleeding in that area, which will solidify, almost like a scab, and create fibrocartilage, which is like cartilage, and help with the knee pain in that area. That will give you stable cover. If you think of that as almost like filling in a pot hole. So that can help.
Now that works well with small lesions. If it’s a large lesion, then you have to weigh different options. One option would be an OATS transfer where we use the patient’s own cartilage. We take a plug of cartilage from a peripheral area here, which is not part of the weight bearing area of the joint, you do not use when you’re walking or bending your knee. We just take some small plugs from this area, and we move them to the area that has the defect.
The benefits of that is that it’s your own tissue, it’s your own bone, and it may have better incorporation because it’s your own cells that we’re planing in that defect. If it’s a very large lesion, sometimes we’ll take a little biopsy of cartilage, we’ll send it off, get more cartilage cells produced, and go back a second time, find the defect and actually implant your cartilage cells in that defect. That’s called autologous chondrocyte implantation, also known as ACI. That can help in covering these larger defects.
If it’s much larger, and covers the whole condyle, there are other options such as using an allograft or a cadaver cartilage, where we resurface this area with the cadaver cartilage. Or you can use options such as metal resurfacing on those chondral lesions.
[Demonstrating with the knee model] This is a picture of certain areas of the joint. For instance, this is patella femoral, the kneecap here. We remove the knee cap, and this is the trochlea, the groove, and this is arthritis. There are options where if there’s a large amount of arthritis like this, it doesn’t fall into any of those categories. It may fall into an autologous chondrocyte implantation (ACI) option, but another option is that we remove the arthritic portion of the joint. We remove the arthritic portion and we place an implant in that groove to give the trochlea a smooth surface. So the kneecap can track within a smooth surface of the joint. Now the indications for this are very rare, but if the patient has to have a well balanced knee, they have to have arthritis on only one side, unless you plan to resurface the kneecap as well, and the patient should have failed all conservative measure.
Now the other options is a partial replacement or a replacement of just this inner aspect or outer aspect of the knee, where you do a resurfacing of this inner aspect here. You remove the arthritis and you place an implant here, once again restoring the contour of the condyle, and giving your body a smooth surface. But to do this by itself, you have to make sure you do not have arthritis on the other side. If you have arthritis on the other side, the results aren’t as good.
You can resurface the portion over here with a plastic or polyethylene plug. But if you have significant arthritis in this compartment, sometimes the best option is a realignment procedure, where we unload this joint by realigning this tibia, which is a more invasive procedure. It’s called a high tibial osteotomy where we make a cut across the tibia here and straighten out the joint and that unloads this compartment. That’s only in severe cases of severe arthritis involving the inner aspect of the joint in young patients. Otherwise these resurfacing options or arthroscopic options that we talked about are better options.
Another option is a partial replacement where instead of just removing the areas that are arthritic, you remove the whole inner aspect of the joint, and replace the inner aspect here with a condylar implant here as well as a tibial implant here. The great thing about these implants is that the joint here, this is the concave area of the joint, is mobile, so when you extend and flex, this little plastic portion here will move with the joint – it’s a mobile implant. Which means that there’s less wear on the implant, which means that these implants last a good period of time.
So those are some basic ideas of what consists of knee pain in general. There are many other pathologies and possibilities within the knee, but more often than not with interior knee pain, medial knee pain, lateral knee pain and arthritic knee pain can all be differentiated, particularly if you go see an orthopedic surgeon and he or she gets some standard x-rays to look at the joint space and undergo a basic physical exam. Occasionally, an MRI is also indicated to confirm whether or not there is cartilage of ligamentous injury, however, that’s up to your orthopedic surgeon’s recommendations.
So if you have any further questions about knee arthritis treatments, please call my office at 281-633-8600 and we’d be happy to schedule an appointment for you.
If you haven’t watched Dr. Bennett’s video on avoiding total knee replacements, it’s worth taking a few minutes to do that. You can do things to strengthen your knees, lose weight, use arch supports, and use low impact exercises to lessen the wear and tear of your active lifestyle on your knees. Perhaps conservative measures like losing weight or strengthening your knees can prevent or delay the need for partial or total knee replacement surgery. If you have questions about this video or questions about your knee pain or knee arthritis, please call us for an appointment at 281-633-8600 or 713-234-6346 in Houston.
