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MMC Home | Orthopedics
Total Knee Replacement:
The Most Effective Treatment for Worn-out, Arthritic Knees
By Jean-Francois Reat, M.D. Orthopedic Surgeon, Methodist Medical Center
The knee is a complicated joint that endures rolling, sliding, and twisting motions during normal activity. Damage to any of its protective structures or simply a lifetime of wear and tear can result in thinning, roughening, or complete loss of the cartilage that acts as a cushion between the bones.
Once damage occurs, the knee joint does not move smoothly. It can become painful and swollen, making daily activities such as walking, kneeling, or climbing stairs an ordeal. With proper treatment, however, people with arthritis can live active, healthy lives.
The most effective surgery for a worn-out knee is total knee replacement. An orthopedic surgeon removes the diseased areas and usually replaces the entire joint surface with a metal and plastic implant. The implant is usually secured to the bones with cement.
Total knee replacement surgery gives patients excellent pain relief and helps them regain knee function. A limited form of the operation, called compartmental knee replacement, may be appropriate in patients with damage that is limited to one side of the knee.
Surgical techniques and implant materials have improved dramatically since the 1970s. The most successful implant is a metal alloy of cobalt chrome combined with ultra-high molecular weight plastic. It provides a low friction joint surface.
Ceramics have recently shown promise as a replacement for metals in total joint surgeries. Their major benefit is superior wear properties. They not only resist abrasion, but also are easier on the plastic surface used with them. This means a longer lasting joint even in very active people. The U.S. Food and Drug Administration (FDA) has approved a zirconia-zirconium material for knee implants, but ceramics are still used mainly in total hip replacement.
Other Treatments for Arthritic Knees
Medications
Acetaminophen and other pain relievers taken by mouth may help in mild cases of arthritis. Anti-inflammatory drugs such as ibuprofen, naproxen, and numerous other medications are usually more effective when the condition worsens.
Injections
Doctors may periodically inject cortisone to relieve pain and swelling in arthritic knees. Purified hyaluronic acid, a substance found in normal, healthy cartilage, is also available in injectable form. It improves the function of diseased cartilage without the side effects of cortisone injections and may reduce mild to moderate arthritis symptoms for 6-18 months.
Dietary Supplements
Chondroitin sulfate and glucosamine sulfate are supplements that appear to relieve the pain of osteoarthritis in a majority of patients. Consumers should be cautious, though, because these substances are sold as food supplements and are not regulated by the FDA. Consequently, the amount of active ingredients may vary considerably from one brand to another or even between batches of the same brand.
Braces
Braces shift the body's weight away from the diseased side of the joint to the healthier side. This makes walking less painful.
Jean-Francois Reat, M.D., is an orthopaedic surgeon on the staff of Methodist Medical Center of Oak Ridge. He is a graduate of the Baylor College of Medicine in Houston, Tex., and completed an orthopaedic surgery residency at Baylor College of Medicine affiliated hospitals. Dr. Reat is a member of the American Academy of Orthopaedic Surgeons, Tennessee Medical Association, American Medical Association, and the Roane-Anderson County Medical Society. He is in practice with Tennessee Orthopaedic Clinics, P.C., in Oak Ridge.
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