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Surgical Solutions for Knee Arthritis

David J. Jupina, M.D.

Your knee is the largest joint in your body. Essentially, the knee is a hinge that joins your thigh bone (femur) to your shin bone (tibia). Cartilage provides a cushion between the bones preventing them from grinding directly against one another when you bend and extend your leg. Muscles and tendons connect the bones and keep the joint stable. When the knee is healthy, all of these things work together unnoticed, gliding smoothly and without pain.

Knees can become painful due mostly to osteoarthritis or, less commonly, to inflammatory arthritis such as rheumatoid arthritis. Osteoarthritis can develop in the knee joint after an injury, excess body weight, a genetic predisposition or even wear and tear. Over time, it damages and wears away the cartilage inside the knee joint. Eventually, the knee bones rub directly against one another, causing pain and further damage of the joint.

Physical therapy, exercise, loosing weight, using a brace or cane, and taking pain relieving medications may help, but usually the effects are often temporary.

Surgical replacement of the damaged portion of the knee is a long term and widely available treatment option that is performed on more than a quarter million people per year in the United States. Total knee replacement, also known as total knee arthroplasty, is a proven technique with a high success rate. Over the last 30 years, total knee replacement has become the accepted procedure to address advanced arthritis of the knee. The procedure has been proven to be highly successful at alleviating pain and restoring mobility to the joint. Within the last few years, there has been an interest in performing total knee replacement in a less invasive manner. Traditional knee replacement surgery can have a lengthy and painful rehabilitation. In both traditional knee replacement surgery and the newer minimally invasive surgery, the damaged areas of the joint are removed and replaced with a combination of implants that allow the newly resurfaced joint to glide and bear weight and perform like a natural knee.

This newer technique called MIS, for minimally invasive surgery, uses the same clinically proven implants as traditional surgery, but the technique to replace the implants is less invasive. During traditional surgery, the surgeon makes an 8-12 inch incision and cuts through or manipulates muscles and tendons to access the ailing joint. With the MIS technique, the surgeon makes a 4-6 inch incision and uses special instruments and techniques to avoid cutting and manipulating key tissues. The mini incision technique involves removing or resurfacing the damaged portions of the knee through an incision that begins at about the same point below the knee cap as the incision used in traditional knee replacement surgery; however, the mini incision does not extend as far up into the quadriceps muscle as the traditional incision. Quadriceps muscles and tendons control the bending of the knee. Less cutting of this muscle group during surgery leads to potential patient benefits.

The main goals of this newer technique are to cause less tissue trauma through a smaller incision which will hopefully allow for a shorter total rehabilitation with less blood loss. Also, the goal is for the patient to experience less postoperative pain and undergo a shorter hospital stay. It is encouraging at this time to report that our early short term results with this newer approach have been favorable. There has been a positive response from the patients and the goals listed above are being obtained.

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