Knee Pain Relief: Surgical Treatment Options

Most people will not need knee surgery but, in many cases, surgery may be effective in minimising or eliminating your knee pain when other treatment methods have failed. Many advances have been made, allowing for surgical procedures that are much less invasive. Such minimally invasive procedures are revolutionising the way patients experience and recover from surgery, often resulting in less post-operative pain, a faster recovery period, and a shorter hospital stay.

Often the first surgical treatment for knee osteoarthritis is arthroscopy, a procedure used to see, diagnose, and treat problems inside the joint. Arthroscopy typically involves inserting a small camera into the knee and then treating identifiable problems. Some of the more common procedures performed during arthroscopy include:

• Trimming damaged cartilage
• Removing loose debris within the knee (debridement)
• Irrigating the inside of the knee (lavage)
• Repairing defective joint cartilage with a graft
• Removing/repairing a torn meniscus (cartilage) or reconstructing a damaged ligament

This type of knee surgery involves a restructuring of the bones to shift stresses from diseased tissue to more healthy tissue.

In knee replacement surgery, the bone surfaces and cartilage that have been damaged are removed and replaced with artificial surfaces (implants) made of metal and a very durable plastic material.

In cases where significant damage is limited to only one side of the knee joint (unicompartmental osteoarthritis), your doctor may consider a procedure that preserves the healthy side of your knee. This is called a unicompartmental knee replacement. In a partial knee replacement, only one side (the diseased portion) of the joint is resurfaced, leaving the healthy portion untouched.

A successful unicompartmental knee replacement can relieve pain and preserve more of your natural anatomy. It may delay, and, in some cases, prevent a more extensive total knee replacement, which replaces all three compartments of the knee.

A total knee replacement is usually considered when the surfaces on both sides of the bones, as well as the underside of the patella, are significantly damaged. In total knee replacement surgery, the surface of the thighbone (femur) is replaced with a contoured metal component designed to fit the curve of your bone. The surface of the shinbone (tibia) is typically replaced with a flat metal component and a smooth plastic component that serves as cartilage. The under surface of the kneecap may also be replaced with an implant made of plastic, or a combination of metal and plastic.

The US National Institutes of Health (NIH) study concluded that total knee replacement is extremely successful, resulting in "rapid and substantial improvement in the patient's pain, functional status, and overall health-related quality of life in about 90% of patients." More than 250,000 people a year undergo the procedure in the United States alone.¹