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Knees arthritis

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Written by Garotta Lorenzo   

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Knees, like all articulations, have a cartilaginous surface: progressive wear of the cartilage leads to osteoarthritis. When the the cartilage wears down to  the bone and the articular contact is "bone against bone", the pain can be very severe and may be associated with a maximum functional impotence. The treatment of knees osteoarthritis is initially medical, subsequently surgical.


Causes of osteoarthritis ...

There are many factors that play an important role in the development of a knee arthritis.

Excessive  weight is definitely a contributing factor. An axial anomaly of the two lower limbs (genu varum or genu valgum) can also lead to wearing of the cartilage. Inflammatory diseases (polyarthrite rhumatoide, chondrocalcinose, haemophilia...), diseases of the bone on the femoral condyles (osteonecrose), or the after-effects of  fractures around the knee and a rupture of the anterior cruciate ligament or of the menisci can all be responsible for a knee arthritis.


Symptoms

Knee pain is the first symptom of osteoarthritis: it can be invalidating and progressive. It is accentuated by activity (walking, staircases, etc.). It is the pain, in general, which persuades a patient to consult the doctor. An effusion of the knee is the second symptom: this is when the membrane of the knee (synovial membrane) reacts to the presence of some cartilaginous remains by producing a viscous and yellowish liquid. As soon as the effusion is sufficent, the hyperpression created accentuates the pain, which can be felt by the patient, in the posterior part of the knee. In severe osteoarthritis, a deformation of the lower limb is the third symptom: it is the wearing away of the cartilage which deforms the knee in varus or in valgus.


X-rays

Simple X-rays are essential: with the patient in a weight-bearing situation, they can show any articular wear. It is also necessary to study the patella with axial views of the kneecap; patellar osteoarthritis is rare and is accompanied by severe pain when climbing staircases.


Surgical and medical treatment

The treatment of an osteoarthritis of the knee is, in the beginning, primarily medical. The goal is to relieve the pain. As soon as the medical treatment is no longer effective, surgery can be considered.

In less advanced knee arthritis, an articular arthroscopical "washing" can "lubricate" the articulation (similar to changing the oil in an engine) and it allows the repair of small meniscal lesions: irrigation with physiological saline solution allows the ablation of cartilage remains, and often provides good relief, although only temporary (a few months or years). The two most important surgical therapeutic possibilities are osteotomies and prostheses of the knee. Knee osteotomy corrects the axis of the lower limb, transferring the weight of the patient onto the opposite compartment where the cartilage is healthy. Total knee (total knee replacement), on the other hand, replaces a damaged cartilage.

Finally we have to point out that a cartilage graft should not be considered when there is an osteoarthritis present. Cartilage grafts have their strongest surgical indication when there is a localised and specific osteochondral loss on an isolated surface (tibial plateau, femoral condyle ...), as in the after-effects of an osteochondritis or of a traumatism of the knee with an isolated loss of cartilage.


Knee rehabilitation

Knee rehabilitation is essential in obtaining a good result. The objectives of rehabilitation of the knee after a total knee replacement or an osteotomy are currently well established. The goal is, in any case, to begin mobilization immediately after intervention. You will have to wait between 4 to 6 weeks before finding complete autonomy.

(On the website you can find indications of a general nature: it is in any case necessary to follow " to the letter" the indications of your treating surgeon and your physiotherapist.)


Frequent questions

  • Are there any complications ? 

Yes: a total knee replacement can give rise to both early and late complications. 
Among the early complications are, rarely, a cutaneous necrosis,  phlebitis, haematoma, paralysis of the external sciatic nerve poplity, fracture of the tibia or femur ...: these complications, with a frequency ranging between 0,3% and 2% according to various studies, can be serious and require complementary surgical operations. Infection is found in less than 1% of  cases. Every effort is made to avoid this complication. It is a serious complication and often requires re-intervention and the administration of antibiotics. 
Among the late complications are mobilisation of the prosthesis, often related to the wear in the polyethylene. Infection is occasionally incurred remotely: it is caused by bacteria which, transported in the blood, localize around the implant. For this scenario it is necessary for there to be a remote infection: a whitlow, osseous infection, urinary or dental infection ... The infection must be tracked and treated.

 

  • How long is it necessary to wait before walking ?

Generally the patient is able to walk quite soon: depending on the health of the patient, one, two or three days after intervention. Obviously for the first steps, your kinesitherapist will help you to walk with two crutches or a walking frame.

 

  • How many days of hospitalization are likely?

    Hospitalization is about 5-7 days: a stay in a rehabilitation center is generally advised.

     

  • I will not feel any more pain after ...?

The aim of a knee prosthesis is to relieve pain: in general, for  95% of operated patients, the pains disappear and one year after the operation, the patient feels his replaced knee to be "normal". Often, indeed, the operated knee continues to improve during the whole first year.

 

  • After how long can I return home ?

The return home following rehabilitation is at about 3 weeks to 8 weeks after intervention. Certain young patients,  with suitable support, can return home direct from surgical hospitalization, 5-6 days after intervention: however, it is not the rule.

 

  • Can I take a shower?

Personal hygiene before and after any intervention in orthopedic surgery is very important: nevertheless, the wound should not be allowed to become wet - by taking a bath for example , because the risk of infection is high if correct healing is not obtained. Nowadays there is the possibility of applying water-tight bandages, which allow one to take a shower without any problem.

 

  • When is it necessary to remove the wires?

Wires fall away within 10-15 days, if they are the resorbable type. If not, they should be removed approximately 14 days after intervention (and you will not have any pain....).

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Last Updated on Saturday, 04 June 2011 12:25