Osteoarthritis and Knee Replacement

Arthritis of the knee is a common condition. This occurs when the cartilage in the knee wears down over time leading to discomfort in the knee. When the cartilage completely erodes in the knee, there is bone that rubs against bone, which is painful and uncomfortable. If the arthritis pain becomes very advanced, patients can have difficulty walking and sleeping due to the discomfort. In this fashion, arthritis of the knee can limit patients’ quality of life.

How it happens

Arthritis is generally due to “wear and tear” of cartilage. Some individuals may be more susceptible to knee arthritis than others, possibly due to their genetic makeup. Other patients may develop osteoarthritis related to a previous knee injury.

How it feels

Arthritis pain in the knee is generally felt as a deep, dull ache. The knee pain is usually worse with activities such as walking. When knee arthritis pain is very advanced, running will be impossible. After increased activity, such as a long walk, knee arthritis pain will usually be more severe. Generally, knee arthritis is easily diagnosed with plain x-rays. MRI is generally not required to make this diagnosis.

How it is fixed

Knee arthritis is treated initially with non-operative management. This includes medication, such as non steroidal anti-inflammatory drugs, as well as Tylenol. Chondroitin and glucosamine have been proven to be effective for alleviating pain related to knee arthritis. Physical therapy is a very valuable non-operative management option to improve the pain related to knee arthritis and increase function. Injections may also be useful including cortisone or visco-supplementation (injection of sodium hyaluronate). A brace may help some patients with advanced knee arthritis. A cane can also be of assistance to patients with knee arthritis. If non-operative management does not sufficiently improve the symptoms, surgery may be required. Most commonly, total knee replacement (also known as total knee arthroplasty or TKA) is the procedure of choice. In some cases, a partial knee replacement can be performed. Knee replacement surgery involves resurfacing the ends of the bones with metal and plastic components, so that the bone on bone is eliminated; therefore the pain is reduced.

Recovery/Post-Surgery

After total knee replacement surgery, patients generally stay in the hospital for three to five days. Physical therapy begins the day after surgery, and the patient gets out of bed and begins to walk. Range of motion exercises are also started on the first day after the knee replacement. Patients are usually able to walk without assistance within two weeks, and most patients can walk without a limp (or minimal limp) within two months. The recovery period following total knee replacement usually lasts between three and six months. Physical therapy is required to regain range of motion and to improve walking ability.

Additional Resources

Additional preoperative and postoperative instructions and guidelines from Hospital for Special Surgery regarding total knee replacements are available for the left knee and the right knee.

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