If you have knee arthritis, you may be wondering if a total knee replacement is the only option for treatment. If you’re wondering about how to avoid a total knee replacement, you might watch Dr. Bennett’s video talk on that topic. In this video, Dr. J. Michael Bennett talks about advancements in knee arthroplasty or knee replacements, cartilage implantation and micro-fracture — all knee replacement alternatives as treatments for arthritis of the knee. He’s a Knee Specialist who also specializes in treating injuries of the shoulder and elbow, plus some hand and wrist injuries like carpal tunnel syndrome.
Dr. Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Physician with offices in Sugar Land, near First Colony Mall and in Houston, near the Houston Galleria. Call 281-633-8600 for appointments at our Sugar Land office and 713-234-3152 for appointments at our Houston office.
This is a summary of Dr. Bennett’s video:
When steroid injections no longer work, another option would be viscosupplementation, which is a lubricant-type injection that we actually inject into the knees in a series of five shots. If all of these measures fail, then the other option would be a total knee replacement.
There have been many advancements in the area of total knee replacements over the last few years. Now we can actually give you a custom knee, whereas previously a surgeon had to rely on standard tools that were made forone-size-fits-all type of procedures. Please see our article about the Vanguard Complete Knee.
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We can take an MRI of your knee, look at your body anatomy and your alignment from your hip, knee to your ankle joint, and send that MRI to a knee implant manufacturer. The knee manufacturer builds custom jigs that allow us to map your knee and place the implant according to your anatomy. We hope this will increase the longevity of total knee replacements past the current expected outcome of about 15 years.
So basically once we get the MRI out to the manufacturer, we receive models of the knee. In addition to the model of the knee we receive these jigs (he picks up a jig). These are the custom jigs that are made accordingly to the patient’s knee. These fit on the patient’s knee during the surgery, and fit on the arthritic spurs and all, and allow us to make our markings and our drill holes accordingly. So when we make our cuts, these cuts are being made and adjusted according to your anatomic alignment.
So this is for the femur, and this is for the tibia. You have one for either side of the bone. Femur and tibia look like this (refers to model) and you’re flexing and extending the knee. Once we make our appropriate drill holes, we make our cuts regarding the knee replacement and then put in the implant. The total knee implant is constructed of stainless steel as well as the polyethylene implant. This allows you to have adequate glide with flexion and extension of the joint whereas before surgery you were having eroded bone rubbing on eroded bone which created pain. Now you have a fluid motion resembling that of a normal knee.
If one side of the knee is involved, let’s say the medial side of the knee is involved, and only this side isarthritic, there are other options. In older patients, one option is to resurface or replace just part of the knee, and this is called a partial, or a unicompartmental arthroplasty. You keep your kneecap cartilage, you keep the cartilage on the outside of the knee, and then on the inside of the knee you replace this with a mobile bearing implant. And this is the
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Left knee-joint from behind, showing interior ligaments. (Lateral meniscus and medial meniscus are cartilage.) (Photo credit: Wikipedia) |
polyethylene here that allows it to glide and slide. This can significantly help a patient’s pain and allow her to get back to regular activities. But you can only do this in a patient that has isolated arthritis on the medial side of the knee. Here’s more information about the partial knee.
Prior to this, if you have a patient that has isolated arthritis in one particular area, there are a number of options for treating this depending on the patient’s age, activity level and expectation. One option is micro-fracture, where we drill small holes into this lesion and allow it to scab over and heal up, which creates what appears like cartilage, meaning it’s like cartilage but it’s not cartilage. That allows you to have some sort of lining to patch up that area. You can usually do this in small lesions. If you have a lesion that is greater than about two centimeters, these micro-fracture techniques do not work.
If that is the case this is when we take a biopsy of cartilage from outside this area of the joint, outside the weight bearing portion of the knee, and we send it off to a lab where they replicate cartilage cells for us. At that point we go back for a second procedure and implant those cells in this defect. That allows this defect to fill in with what appears like cartilage, gives you the support and addresses some of the pain associated with that lesion. Usually this is more for those two-centimeter lesions in our young patients. So there are many options regarding cartilage resurfacing and cartilage implantation.
This is an animation describing micro-fracture.
The third option which I will mention as well is where we actually take plugs from the non-weight bearing portion of the knee which is out here on this outside region where you’re not putting weight when you walk, and we take those plugs and plug them into the area that you’re putting weight on. Once again it has to be a small lesion and it has to be in an area where the other side is pristine without any cartilage loss at all. But there are options regarding arthritis, regarding cartilage loss, no matter what the age.
As I’ve said before, if you’re experiencing any symptoms such as knee swelling, knee pain, locking or instability, or have had chronic pain for many years, or have even noticed a deformity in your knee, I would recommend evaluation by an orthopedic specialist to talk about your knee replacement alternatives. If you’re interested in cartilage implantation and some of these procedures, then I’d recommend a sports medicine specialist who has experience in doing these procedures.
This is an animation describing cartilage implantation or Osteoarticular Transfer System, commonly known as OATS.
Please call our Sugar Land office at 281-633-8600 or in Houston, call 713-234-3152 if you’d like an appointment with Dr. Bennett to talk about knee arthritis and alternatives to total knee replacement. Our Sugar Land office is located near First Colony Mall at the corner of Sweetwater and Lexington Boulevards, and our Houston office is located near the Galleria.
Dr. Bennett has also recorded a video describing an orthopedic knee examination. So if you’re wondering what kind of examination might be associated with determining your knee replacement alternatives, this video should answer many of your questions.
