What is it ?
Arthritis is a degenerative process of joints, due to wear and tear of the cartilage because of ageing and may be enhanced by trauma, overweight, lower limb deformity (varus or valgus), meniscectomy, rheumatism.
Cartilage pathology
Osteoarthritis
Clinical presentation
Arthritis is painful; the pain appears progressively over years, and get chronic. In early arthritis, the pain is “mechanical”, related to activity, and are then worse in the evening. Once arthritis is severe, the pain is more “inflammatory”, with stiffness in the morning and pain at night, sometimes swelling of the joint, and limping.
When to consult a specialist?
A knee specialist should be consulted when pain is resistant to basic treatments as pain-killers, anti-inflammatory drugs, and cryotherapy.
Non surgical treatment
The goal of the conservative treatment of arthritis is to maintain knee range of motion, muscular strength, and balance: cycling, stretching, aquagym, swimming, pilates, are recommended. Stopping physical activity is prohibited. Pain-killers and anti-inflammatory drugs help to lower the pain and inflammation of the knee. Intra-articular injections (corticoid, hyaluronic acid, PRP) can also be used to decrease pain and inflammation, in order to be more active and confortable.
This conservative treatment should lasts as long as possible before considering a total knee arthroplasty.
Surgical treatment
In case of a severe arthritis, the only way to get back to comfort and function is to implant a total knee prosthesis. During knee replacement surgery, the orthopaedic surgeon will resurface your damaged knee with artificial components, called implants: a metal femoral component, a metal tibial component, and a plastic spacer called polyethylene in between; sometimes the patella needs to be resurfaced so a a dome-shaped piece of polyethylene is implanted. The metal parts of the knee prosthesis are made of cobalt-chromium based alloys; in case of allergy, titanium implants are used.
In case of focal arthitis, limited to one compartment of the knee, a unicompartimental knee arthroplasty (UKA) may be indicated.
Postoperative follow-up
The procedure to implant a total knee prosthesis lasts between 2h and 2h30, under epidural anesthesia or general anesthesia. The next day of surgery, physiotherapy begins: walking is allowed with crutches and movements of flexion/extension of the knee are recommended to get the range of motion back and avoid stiffness. Usually it takes approximatively one month to be able to walk without crutches (time to get the strength and confidence back).
Patients are hospitalised the day before surgery and spend 5 to 8 days in the clinic, before going home with a daily rehabilitation program at home; patients living alone may need a journey in a rehabilitation center for 1 or 2 weeks before going back home.
Risks and complications
A total knee arthroplasty is a tiring procedure for the patient which may feel weak after the surgery. To reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery, the “enhanced recovery after surgery” has been developed, with pre- intra- and post-operative phases.
Tobacco and alcohol consumption and obesity are risk factors for post-operative complications, such as infections, deep veinous thrombosis, stiffness, implants loosening.