What are the surgical methods for treating osteoarthritis of the knee?

The most accurate way to find out how far osteoarthritis of the knee has progressed is to see the articular cartilage surface of the knee directly. Arthroscopy can do this without cutting into the joint and with minimal trauma, and currently seems to be the most ideal way to do this.

The arthroscope not only allows you to see inside the joint cavity, but it also allows you to flush the knee joint with sterile saline under the arthroscope to clean out synovial debris and cartilage fragments, and to drill holes in areas of severe wear and tear to promote the repair of new cartilage, which is of course different from the original cartilage and is fibrocartilage instead of the "original" hyaline cartilage. The new cartilage is, of course, different from the original cartilage in that it is fibrocartilage rather than "original" hyaline cartilage. Fibrocartilage is far less biomechanically functional than hyaline cartilage, but it can play a compensatory role, and it can slow down further cartilage destruction.

Therefore, many patients with osteoarthritis of the knee have been treated with arthroscopic surgery, which has yielded good results in the near term. Arthroscopic surgery can provide temporary relief of osteoarthritis symptoms, and in some cases, this relief can last for a long time. However, arthroscopic surgery cannot be 100% effective. Even if the surgery is successful, it can only relieve the condition and cannot solve the problem fundamentally. Most patients with osteoarthritis of the knee improve after arthroscopic surgery, while a few do not.

Arthroscopy can also be used in cases where a joint is locked up by free cartilage or bone fragments. If intra-articular steroid injections are needed 1 - 3 times a year to relieve symptoms, the option of arthroscopic surgical treatment is also appropriate.

2. Osteotomy

Osteotomy is suitable for joints that have incorrect force lines, uneven load distribution, overloading on one side while the other side is intact, or knee valgus or valgus deformities. Osteotomy can correct the abnormal force line, so that the more intact side of the joint surface to bear more weight, improve the joint weight-bearing state, thereby reducing symptoms. In principle, tibial osteotomies should be performed for inversion and supracondylar osteotomies should be performed for valgus. Tibial osteotomy can be divided into high tibial osteotomy and low tibial osteotomy, the specific surgical method should be decided by the doctor according to the patient's specific condition.

Osteoarthritis tends to affect the medial compartment of the knee much more than the lateral compartment, resulting in a mild bow-legged appearance of the lower extremity, known medically as an inversion deformity of the knee. As a result, the line of gravity of the lower extremity shifts inward through the medial compartment of the knee instead of through the middle, causing more pressure to be applied to the medial articular surfaces, ultimately leading to medial knee pain more severe and faster degeneration.

In this case, it is necessary to realign the angle of the lower extremity's line of gravity to the lateral compartment of the knee, which may allow most of the weight-bearing forces to be shifted to the relatively healthy lateral compartment, resulting in a reduction of pain in the medial compartment and a slowing of the degenerative process in the medial compartment. This procedure is called an "upper tibial osteotomy," and is classically performed by removing a wedge-shaped piece of bone from the lateral aspect of the upper end of the tibia, turning the knee inversion into a mild knee valgus in the lower extremity, which generally reduces the pain, but does not necessarily eliminate it completely.

The advantage of this procedure is that it is more suitable for patients who have knee valgus and have a lot of activity and do not want to undergo an artificial joint replacement. A bone cut heals and does not limit the level of activity, but the effect of the proximal tibial osteotomy is also temporary for patients with osteoarthritis, and it is generally believed that this procedure buys time for the patient before the eventual replacement of the artificial joint, and that the procedure is successful. The results last roughly 5 - 8 years.

3. Chondroplasty

In the past, chondroplasty involved surgical removal of degenerated articular cartilage surfaces and sclerotic subchondral bone plates or drilling holes in the subchondral bone plates to promote cartilage repair. Although the repair was of fibrocartilage rather than normal articular cartilage, fibrocartilage acted as a surrogate to some extent and slowed down the destruction of the joint.

Recently, the concept of chondroplasty has changed. The degenerated cartilage is removed arthroscopically, and a small amount of healthy normal articular cartilage tissue is also excised, which is cultured in the laboratory for two weeks and then reimplanted into the joint. The cultured cartilage tissue stimulates the regeneration of the previously destroyed cartilage tissue. This procedure is effective in treating cartilage defects in early osteoarthritis in young people, but the results in older patients with osteoarthritis are not yet clear. Due to the limitation of conditions, this surgical method has not been widely carried out in China at present.

4, joint cleanup

Joint cleanup is suitable for patients over 40 years old, with swollen joints, pain, obvious osteophytes on the edge of the joints, free bodies in the joints, and the effect of conservative treatment is not good for the middle-term osteoarthritis patients, and those who are unwilling to do or can not do the artificial arthroplasty can also choose this type of surgery.

The procedure mainly involves the removal of inflammatory synovial tissue, hyperplastic bone spurs and ruptured meniscus, the removal of free bodies, and the complete removal of mechanical impediments and irritants. At present, hospitals with good technical conditions perform arthroscopic joint cleaning surgery without cutting the joint. However, joint cleaning surgery can only relieve the symptoms, and after a few years, osteophytes will continue to occur and joint pain and dysfunction may recur. Therefore, patients should try to avoid excessive weight bearing after surgery and adhere to functional exercises to prolong the time of symptom relief.

5. Joint fusion

This kind of surgery involves removing the joint surface and fusing the bone with the bone, which can relieve pain and restore stable weight-bearing ability, but at the expense of joint movement, and is suitable for young heavy laborers.

With the emergence of artificial joints, this surgery has been done less and less, but joint fusion still has its special value, due to the limitations of China's national conditions, especially in remote rural areas, heavy physical labor, the patient does not have the conditions of artificial joint replacement, joint fusion is also a better choice, in the face of the failure of artificial joint replacement patients, joint fusion can be the The only choice.

6, artificial joint replacement

Knee osteoarthritis of the final solution is to replace the articular surface with an artificial knee joint, generally only 60 years of age or older patients to consider artificial joint replacement, for young patients, unless there is no other choice, generally do not consider artificial joint replacement.