Arthritis of the knee is a condition which is commonly suffered by millions Americans each year. Technically what arthritis is, is any inflammation or damage to the knee cartilage. There are two types of cartilage in the knee. The meniscus which is the main cushion between the femur and tibia. The second type of cartilage is articular cartilage. Any damage to the articular cartilage is technically considered “arthritis”. There are various causes of arthritis. Most commonly is wear and tear or osteoarthritis. However, also we can see a traumatic arthritis, or an inflammatory arthritis and condition such as rheumatoid arthritis, gout and other similar entities. Damage to the articular cartilage is typically a progressive disorder and the end result is loss of all of the cartilage with bone-on-bone contact. The patient with bone-on-bone contact experiences significant pain about the knee joint, itself and is typically described as a dull toothache, constant pain. Advanced Orthopaedic Specialists (AOS) treats thousands of patients each year with arthritis of the knee. We are commonly asked what the different options are. There is essentially two options. Nonoperative and operative. Before moving forward with operative treatment, we focus on the nonoperative treatment of arthritis. Typically, we recommend activity modifications, avoiding heavy impact activities, and a weight loss program. If this fails, we place patients on medications such as anti-inflammatories or Tylenol. We avoid narcotics in patients that have arthritis in the knee. A brace is a common option for the arthritic knee as it can help to stabilize the knee and to take pressure off of the area of arthritis.
Should the aforementioned fail, we have had excellent success with various types of injections. Corticosteroid injections or (cortisone) are very safe and easy to do. These are safe to do every three months for the patient. They have very little associated risks and can help to get rid of the inflammation and subsequent pain within the knee. These are safe as long as given no sooner than every 3 months and as long as they are not continuing to be administered while they are no longer working. Another injection to improve the inflammation is a “Toradol injection”. This is similar to cortisone but has more of an anti-inflammatory effect and again, can be given every 3 months.
Viscosupplementation is very commonly used for arthritic knees that don’t have “bone-on-bone contact”. These are typically approved by the insurance companies. It’s a series of 3-5 injections. Its purpose is to lubricate the knee, to stimulate the knee to make more of a normal lubricating fluid and also has a pain-relieving or anti-inflammatory effect. These typically work well for arthritis that is non-end stage.
A more recent type of injection at AOS are stem cells. There are a variety of stem cells as outlined below:
A. Platelet Rich Plasma. This is where blood is drawn from the patient and the platelets are isolated and injected back into the knee. We have had excellent success with this. It is an in-office procedure.
B. Amniotic stem cells. This is an off the shelf stem cell injection, again with excellent results.
C. Adipose stem cells injection. This is a procedure done in the office where some stem cells are taken from adipose or “fat tissue” from the patient. The stem cells are then spun down within the office and injected into the knee joint.
D. Bone marrow aspirate stem cells. This is done in the office as well with local anesthetic where some bone marrow cells are aspirated from the patient’s pelvis and the stem cells are isolated and injected into the knee. We have had excellent results with all four of these stem cell modalities. Unfortunately, these are not covered by insurance.
If all of the aforementioned fails and the patient continues to have significant knee pain, the next step would be a total knee arthroplasty. Advanced Orthopaedic Specialists does over 500 knee replacements per year. If arthritis isolated to one of the three portions of the knee, the patient may be a candidate for a partial knee replacement or a unicompartmental arthroplasty. If the arthritis is located to two of the three compartments, then a total knee is necessary.
Technology has advanced dramatically in the modalities of total knee arthroplasties. They typically take 1 hour to perform. Some patients are able to go home the same day whereas the majority go home the following day or two days later. The infection rate for total knees across the country is 1-3%. AOS has an infection rate of approximately 0.5%. We feel that this is because of the multitude of total knees which we perform and the system which we use to perform the total knee replacements. A total knee is performed in approximately one hour and although the patients thinks that the doctor cuts off the entire end of the thigh in the shin, it actually is more of a “resurfacing arthroplasty”. We do it through a less invasive incision and place a cap on the end of the femur as well as on the tibia and behind the patella with plastic in between. The patient walks on the knee approximately one hour after the surgery and is discharged to home once they are independent in therapy which ranges from the same day to two days later.
If you have disabling knee pain, please contact Advanced Orthopaedic Specialists to learn of your treatment options.
Written by, Dr. Christopher Arnold