Orthopedic Surgery

Spare the knee, ease the pain

Not sure if you’re ready for a total knee replacement? For many patients, joint pain does not have to equal a total knee replacement. Johns Hopkins orthopaedic surgeon V. Franklin Sechriest, M.D., has coined what he calls the “4 Rs” to help patients understand the joint-sparing options available to them.

“This is a simple concept I have used for years to help my patients understand complex joint-sparing options,” says Dr. Sechriest. “No matter how much medicine and technology advance, you still have only four basic surgical tactics to treat knee problems.” Could you be a candidate for one of these jointsparing procedures?

First R: Remove

The least invasive of the 4 Rs, this arthroscopic surgery technique uses a small scope to evaluate what is causing a patient’s knee pain, and to remove the damaged tissue or cartilage that is contributing to problems in the knee. A small camera allows doctors to minimally invasively gather information and find out what further treatment a patient needs. Patients with injuries like a torn meniscus or torn cartilage can benefit from the “remove” technique. Total recovery time is usually two to six weeks after arthroscopic surgery.

Second R: Realign

Some people, including some with arthritis, experience knee pain because their joint is not properly aligned. If this is the case, a realignment procedure may be a good treatment option. An X-ray and physical exam are used to diagnose the poor alignment. To restore proper mechanics to the knee joint, a surgeon may use plates and screws to manipulate the bone, or try a soft-tissue realignment by releasing or tightening tissue. “This option does have a longer recovery time because it takes time for the bone to heal,” says Dr. Sechriest. “Patients will require aggressive rehab after this procedure.” But the reward is also great—realigning the knee can ease pain and prevent further damage to the joint.

Third R: Repair

Certain patients can see pain relief in their joints by repairing diseased or damaged cartilage in the knee through a cartilage transplant. For this procedure, cartilage can be transplanted from other areas of the patient’s own knee, or from a donor. Dr. Sechriest says this operation is ideal for younger patients who aren’t yet ready for a total knee replacement. The recovery time varies based on what you are having repaired.

Fourth R: Resurface

The “resurface” option refers to partial knee replacement surgery. “This approach typically means less surgery, less risk, less pain, less time recovering, and a more natural feeling knee,” says Dr. Sechriest. The knee has three parts: the femur, the patella, and the tibia (see illustration). In a total knee replacement, all three parts are resurfaced with artificial parts; in a partial knee replacement, only one or two of the parts are resurfaced. Dr. Sechriest says that this procedure has excellent durability, thanks to improved techniques and materials, and that patients will be able to bear weight on the joint and have mobility right after surgery.

The ideal patient for the “resurface” option would be an active younger person with arthritis who isn’t yet ready for a total knee replacement, or an elderly patient who can’t tolerate the major stress of a total replacement.

The important thing to remember when considering these options is that there are no hard and fast rules for which procedure would be best for a particular patient. Dr. Sechriest works with patients to diagnose their problems, learn about their lifestyles, and hear their expectations before recommending one of the 4 Rs, or a combination of a couple different procedures. “It’s very individualized care—everybody deserves that,” he says. “Patients need to feel empowered, because they have options.”

To discuss a case or refer a patient call +1-443-287-6499

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