Surgery Alternatives

Total knee replacement is by far the best solution to most problems involving severe arthritis of the knee. But occasionally in certain circumstances other alternatives may be more appropriate. In patients who are under 40 who have a severe problem with only one knee and are otherwise healthy, consideration should be given to knee fusion (arthrodesis). After this operation the thigh bone (femur) grows to the lower leg bone (tibia) such that no motion occurs at the knee. This completely relieves pain and provides a stable leg for walking. Its advantages are that there are no implants that can come loose or fail in the future. There are no activity restrictions as are required after total knee replacement. For a manual laborer it may be ideal because there are no lifting restrictions. The disadvantage is that the knee no longer bends. Sitting in a tight space may be difficult, especially for tall people.

For patients in the 40 to 60 age group, with bowed legs or knock-knee deformity, a bone realignment (osteotomy) may be the best operative procedure. This is where the upper end of the tibia bone, or lower end of the femur bone, near the knee is cut and a wedge of bone removed to realign the leg. This procedure requires that some portion of the knee still has good cartilage on it and it is not possible when the cartilage is completely destroyed. This procedure has approximately a 70% success rate where success is defined as improvement of symptoms rather than complete freedom of pain. It is, however, an operation that preserves the knee joint and can allow full activity without restrictions.

Another alternative is cleaning out the knee joint (arthroscopic debridement). An instrument called an arthroscope is inserted into the knee and various other instruments are used to remove arthritic debris from the joint. Using only several small puncture wounds in the skin areas of complete loss of cartilage may be drilled or abraded. This procedure may give temporary relief of approximately six months and occasionally can work for several years. If there is x-ray evidence of severe arthritis, arthroscopic debridement is usually not successful.

A final alternative is partial knee replacement (unicompartmental knee replacement). This may be applicable if only one compartment (medial or lateral) is worn away and the remainder of the joint still has good cartilage. This is usually not recommended under age 60, when a realignment might be tried.

In your particular case one of these alternatives may be applicable. This should be discussed with your surgeon.