Knee Osteoarthritis Treatment Options/Operative--Surgical 

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Surgical Treatments

Arthrscopy:  Arthroscopic debridement for osteoarthritis is only rarely indicated.  If a patient has a symptomatic mechanical problem such as a catching or locking of the knee due to a meniscus tear or loose body, simple knee arthroscopy will help.  If the patient has generalized complaints, knee arthroscopy may not be beneficial and may actual worsen their situation.

Arthroscopic Cartilage Stimulation (Microfracture Surgery) :  This technique uses sharp instruments to access the bone marrow type cells that are under the articular cartilage inside the knee.  These cells can then migrate to the surface and produce a scar type cartilage that acts like a tire patch.  This type of surgery is usually done for patients with smaller isolated cartilage defects.   Several studies indicate that this type of surgery improves overall function in certain patients.  A recent study found good to excellent results in 67% of patients treated with this technique.  It is not, however, helpful in all patients and typically doesn’t work for patients with advanced disease.  More data.

Cartilage Transfer Procedures (OATS):  Occasionally, a surgeon can transfer cartilage from one side of the knee to the other to fill a defect.  This technique can be done arthroscopically or via open incisions.  It can be quite useful for patients with smaller defects or patients with a specific disorder known as osteochondritis dissecans.  “Autologous osteochondral grafting with the OATS technique is a safe and successful treatment option for focal osteochondral defects of the knee. It offers a very satisfactory functional outcome and does not compromise the patient's future options.”  More data.

Cartilage Growth Procedures:  For many years, surgeons have been able to take a small piece of cartilage out of the knee, grow it in cell culture and then reimplant it.  It sounds like an excellent idea but the long term results have been no better than microfracture techniques and it is rather expensive ($20-30,000).  It still, however, may be a useful technique for isolated lesions in younger patients.  More data.

Knee Realignment Surgery:  Osteotomy or cutting of the bone to realign the knee joint may be useful in selected patients with limited forms of osteoarthritis.  The ideal patient is a younger patient with medial (inside) compartment disease.  This is a technically demanding procedure so it should be done by someone with significant experience.  “Proximal tibial osteotomy is a valuable procedure to achieve pain relief and to restore knee function in selected patients. Localized knee osteoarthritis of the highly motivated, older, active patient can also be included in the extended indications of the high tibial osteotomy”.  More data.

Knee Replacement Surgery:  Partial or full replacement of the knee joint with plastic and metal implants is a time tested excellent solution for severe arthritis.  This surgery has changed the lives of millions of people worldwide.  The indications and techniques for this type of surgery are rapidly evolving.  Minimally invasive surgery is the latest topic of debate.  “Developing the techniques of minimally invasive total knee arthroplasty may be difficult and time-consuming, but patient benefits and satisfaction should outweigh the extra effort required. These changes require well-designed clinical studies to further document their effectiveness”.  More data.