Joint Preservation Surgery for Osteoarthritis of the Knee

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Consultant Orthopaedic Knee Surgeon, Mr Alexander Dodds, explains about treatment options for Osteoarthritis.

One of the most common reasons why patients develop pain in their knees, is due to development of osteoarthritis (OA). Osteoarthritis can develop for several reasons, commonly reasons are obesity, leading to increased pressure through the joint; previous injuries leading to abnormal biomechanics; inherited problems effecting the cartilage of the joint; and mechanical malalignment of the joint.

The mechanical alignment of the limb is one area that can be addressed to relieve symptoms. In an ‘ideal’ patient, the biomechanical axis would go from the centre of the femoral head in the hip, through the centre of the knee and then pass through the centre of the ankle joint. This would ensure even distribution of pressure within the knee. However, most people are to some degree ‘bow legged’ (in medical terminology ‘varus alignment’) which means that they tend to overload the inside (medial) part of the knee leading to pain due to OA development in this area of the knee.

In severe osteoarthritis (where the cartilage has run out) one option is to replace just the inside part of the knee with an artificial knee made of metal and plastic (partial knee replacement surgery). Whilst this is an effective procedure for pain, it is replacing the natural parts of the joint with artificial metal and plastic and for this reason has limitations with a what young patient would expect, and with time, the artificial joint will wear.

For younger patients who are having pain but are not yet ready for an artificial joint replacement there are a number of measures which can improve biomechanical alignment. Simple non-operative measures include attempting to improve the alignment of the limb with very specific physiotherapy strength/realignment exercises and/or medial arch supports in shoes (custom made orthotics). Another option is to use a custom-made brace over the knee which can transfer pressure from the inside part of the knee to the outside (medial offloader brace). Surgically, the same effect can be produced in a procedure called a high tibial osteotomy where the tibial bone is realigned and then held with a metal plate, and this surgery means that the joint itself is preserved.

Alexander Dodds is a specialist Knee and Hip Orthopaedic Surgeon. For more information go to www.alexanderdodds.co.uk
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