When knee joint pain, from either a condition or injury, interferes with everyday life, most people look to nonsurgical treatments to find relief. Physical therapy, medications, injections and lifestyle changes are often first steps that work well for many patients.
But when knee pain persists after trying these methods, it may be time to consider orthopedic surgery as the next step to relieving pain and restoring mobility.
“Surgery is elective, but something I greatly recommend to improve patients’ quality of life when performed for the correct indications and when more conservative, or nonsurgical, treatment options have failed,” said Travis Liddell, MD, orthopedic surgeon of Avera Orthopedics in Sioux Falls, SD. “It depends on the condition and its progression.”
If you’ve been diagnosed with severe arthritis, or if the tibia and femur ends are rubbing against each other, orthopedic surgery may be recommended sooner than later. Fortunately, your surgeon will suggest the knee procedure that’s right for addressing your ongoing pain, condition or injury.
Total Knee Replacement
The knee joint is made up of three parts that flow together: the patella (under the kneecap), medial (inside the knee, between tibia and femur) and lateral (outer side of the joint). Liddell described it like an open floor plan of a house.
A total knee replacement occurs when all three parts need replacing.
During a total knee replacement, an incision is made to the knee. The goal of any surgery is to leave surrounding tissue as untouched as possible, so few incisions are made to the quadricep muscles and smaller tendons — it just depends on the patient. Your surgeon will utilize muscle-sparing techniques when feasible, which means gently maneuvering the muscles to access and replace the joint.
When might this be used?
Most patients are candidates for minimally invasive joint replacements. However, if you have a very scarred, stiff or deformed knee — some medical complexity — your surgeon may need to cut into the surrounding muscle.
Pros and cons:
A successful knee replacement restores mobility and eliminates pain. Recovery takes time, but potentially quicker if the muscles are left intact. If the surgeon cuts into your muscles, recovery will take longer to ensure these internal stitches hold the muscle together until new tissue forms.
“The term ‘minimally invasive approach,’ in regard to joint replacement surgery, means the procedure is performed through internervous and intermuscular planes with the intention to preserve those structures as much as possible,” said Liddell.
Muscle-Sparing Knee Replacement
Muscle-sparing knee replacement is a total knee replacement where the quadricep muscles and smaller tendons are pulled aside to perform the whole knee replacement.
“A benefit is that it uses a muscle-sparing subvastus approach,” said Liddell, which is the same concept of moving aside and/or maneuvering the muscles to access the knee joint. “Many highly trained orthopedic surgeons have been using muscle-preserving approaches like this for decades in knee replacement surgery.”
Also, surgeons who perform a muscle-sparing knee replacement use the same implants as for traditional knee replacements, choosing the implant that is best for the patient.
When might this be used?
This might be considered as an alternative to traditional knee replacement, based on the recommendation of your surgeon.
Pros and cons:
The surgeon doesn’t cut through muscles or tendons, promoting a potentially faster recovery. However, retracting the muscle during surgery could cause muscle strain.
Partial Knee Replacement
Remember the open floor plan idea? During a partial knee replacement, just part of the knee affected by arthritis or worn cartilage is replaced. Small incisions are made to the knee and only the damaged cartilage is removed. Metal components and/or plastic spacers are fitted between the tibia and femur in that section.
When might this be used?
A partial knee replacement is recommended when only a small portion needs replacing, and nonsurgical methods like injections or physical therapy haven’t relieved joint pain.
Pros and cons:
This procedure is naturally less invasive than a total knee replacement. It preserves the anterior and posterior cruciate ligaments (ACL and PCL) and requires small incisions. However, since it only fixes one damaged section, arthritis could still affect other areas of the joint.
Knee Cartilage Repair
This joint-preserving surgery restores damaged areas of the surface inside the joint. Liddell described it as paving a pothole on a road.
There are a few different procedures the fill the pothole. A common one is called osteochondral autograft/allograft (OATS) in which bone or cartilage, either from your own body (autograft) or from a donor (allograft), fills in the defect.
When might this be used?
“Cartilage repair might be used if an isolated defect is found on an MRI,” said Liddell.
Pros and cons:
Patients who undergo cartilage repair relieve pain and preserve the natural function of the knee. However, it requires a gentle and long recovery period before the introduced cartilage is firm and integrated into the surrounding cartilage and bone.
Read More: 6 Solutions for Joint Pain that Don’t Involve Surgery
Questions Patients Should Ask About Knee Surgery
When your physician has recommended surgery as a next step, Liddell suggests that you ask these questions to help you feel empowered and more informed about your options:
- What are the surgery options that will address my condition?
- Am I a candidate for partial knee replacement? If not, why?
- Will my procedure be robotically assisted?
- Do you do this surgery regularly?
- What are the outcomes regarding this surgery?
- What are the risks?
- What does post-surgery recovery look like?
The most important part to your surgery, advises Liddell, is having a highly trained orthopedic surgeon prescribing and performing the most appropriate procedure for your situation.
