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Do I Need Surgery: The Big Question in Knee OA Treatment

28th June 2021

Knee osteoarthritis is a condition that affects 1 in 5 adults over 45 in England. Although physical therapy coupled with exercises and weight loss can aid the treatment, the symptom in some patients may continue to worsen. This might require a more effective intervention, such as surgery or knee replacement. Not knowing when you need one of these treatments can be daunting, so brief information about surgery and knee replacement can help you decide when you will need any of these.

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Do You Really Need Surgery for Your Knee OA?

As helpful as it is, knee OA surgery is not an easy task because you will need to make some lifestyle changes for a full recovery. Before deciding to go through with surgery, you should discuss the following with your doctor:

  • How intense is the pain?
  • Can you carry on with your daily activities, such as walking, getting on a bus, or climbing stairs?
  • Is osteoarthritis affecting your sleep quality?
  • Is osteoarthritis affecting your job performance?
  • Do pain medications help relieve the pain? Do you experience adverse effects from these medications?

The X-ray and MRI images can also provide clarity. If your doctor sees a significant loss of cartilage and the resulting friction between the bones, they might suggest that you consider surgery.

The Types of Surgery for Osteoarthritis

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Total Joint Replacement (Arthroplasty)

If your osteoarthritis is at a level where you can’t even rest without experiencing pain, total joint replacement can provide long-term pain relief. In this procedure, the surgeon removes the damaged parts of the joint and replaces them with an artificial joint (prosthesis).

Arthroplasty is the most common and successful surgery method for severe knee osteoarthritis, due to its reasonable recovery rate, safety, and long-term impact. According to the American Academy of Orthopedic Surgeons, 90% of the patients can resume daily activities like shopping, cooking, and driving within 3-6 weeks. The infection risk during the surgery is only at 2%. Most importantly, 82% of the replacements remain functional after 25 years [1].

Despite the promising success rate, arthroplasty comes with a few risks. Besides the infection and clotting risks, there are also long-term risks such as osteolysis. This occurs when the knee implant causes inflammation, and the knee joint loosens. Although the chances are fairly low, it might require a second operation within the first ten years [2].

Arthroscopic Surgery

Knee arthroscopy used to be one of the most common surgical methods for knee OA; however, a growing body of clinical trials proved its inefficacy in long-term treatment.

In arthroscopy, the surgeon inserts a flexible tube called an arthroscope inside the joint. With the help of an attached camera, the surgeon makes small incisions to remove the damaged cartilage or loose bone.

Although the recovery period is much shorter compared to arthroplasty, several studies indicated that it did not alleviate pain or improve the range of motion, except for a subset of patients who simultaneously suffered from recent trauma or meniscal tears [3].

Today, the American Academy of Orthopaedic Surgeons recommends against arthroscopy, while still emphasizing that its benefit depends on the individual’s condition and should be discussed with the doctor.

Osteotomy

In younger patients who are physically active and involved in sport, osteotomy may be recommended to delay the need for arthroplasty for a few years.

In an osteotomy, the main focus is to fix the deformities such as the bowleg by shifting the weight from the damaged part to the healthy part of the cartilage. The surgeon usually does this by removing a piece from the tibia near the damaged area and then fusing the remaining bones.

This type of surgery is most suitable for younger patients who want to postpone total joint replacement. Clinical studies show a success rate of 91% for five years, but the ten-year survival rate ranges between 50-80% [4]. Nevertheless, keep in mind that it does not compensate for a healthy diet, exercise, or weight loss and that you might still require a total joint replacement later in your life.

Arthrodesis (Knee Fusion) You can think of arthrodesis as the last resort for knee OA treatment. The surgery involves the fusion of the shin and thigh bones to create a continuous bone structure. The bones are secured further by using screws or metal rods, which will prevent rotation in the knee joint. At the end of the day, you will be rid of the joint pain for a lifetime. There is usually a six-month recovery period that involves using crutches and commitment to physical therapy to strengthen the leg. However, the downside is that your knee will lose its flexibility and range of motion. Nevertheless, you will still be able to walk and carry on with daily activities after full recovery. Arthrodesis is rarely recommended unless you tried and failed in every other therapy or surgery, including a total knee replacement [5].

Arthrodesis (Knee Fusion)

You can think of arthrodesis as the last resort for knee OA treatment.

The surgery involves the fusion of the shin and thigh bones to create a continuous bone structure. The bones are secured further by using screws or metal rods, which will prevent rotation in the knee joint.

At the end of the day, you will be rid of the joint pain for a lifetime. There is usually a six-month recovery period that involves using crutches and commitment to physical therapy to strengthen the leg. However, the downside is that your knee will lose its flexibility and range of motion. Nevertheless, you will still be able to walk and carry on with daily activities after full recovery.

Arthrodesis is rarely recommended unless you tried and failed in every other therapy or surgery, including a total knee replacement [5].

Conclusion

While a knee surgery can help relieve joint pain, it is only necessary when the pain keeps getting worse and affecting the quality of your life despite medication and therapy. You should also remember that exercise and a healthy diet will still be integral to your life after the surgery. Last but not least, always consult with your doctor to find out whether knee surgery is on the table for you.

[1] Evans, Jonathan T., et al. "How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up." The Lancet 393.10172 (2019): 655-663.

[2] Burnett, R Stephen J et al. “Revision total knee arthroplasty for major osteolysis.” The Iowa orthopaedic journal vol. 29 (2009): 28-37.

[3] Felson, David T. “Arthroscopy as a treatment for knee osteoarthritis.” Best practice & research. Clinical rheumatology vol. 24,1 (2010): 47-50. doi:10.1016/j.berh.2009.08.002

[4] Wolcott, Michelle et al. “High tibial osteotomies in the young active patient.” International orthopaedics vol. 34,2 (2010): 161-6. doi:10.1007/s00264-009-0944-5

[5] MacDonald, James H., et al. "Knee arthrodesis." JAAOS-Journal of the American Academy of Orthopaedic Surgeons 14.3 (2006): 154-163.

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