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School of Medicine
The Johns Hopkins orthopaedic surgeons at Johns Hopkins Bayview Medical Center specialize in numerous proven and innovative treatment options for debilitating knee pain. There are several different factors that could determine which knee procedure you may benefit from the most. Your Johns Hopkins surgeon can help you decide what is right for you. Options include:
- Arthroscopic Knee Surgery
- High Tibial Osteotomy
- Partial Knee Replacement
- Total Knee Replacement and Common Questions
This is a surgical technique involving two to three small incisions and the use of fiber optic technology to see into your knee, without the need of a large surgical incision. During the procedure, which usually takes less than an hour, your Johns Hopkins orthopaedic surgeon will use the arthoscope and another instrument to remove or repair damaged tissue.
Arthroscopic knee surgery can be used to help treat these types of common knee problems:
- Meniscal tear
- Articular cartilage damage
- Ligament damage
High tibial osteotomy is a surgical procedure performed for arthritis in younger (under 55 year old) patients. By cutting the bone and realigning it, the forces in the knee can be changed to decrease pain and improve function. It is a good surgical option for patients who perform heavy lifting, have a demanding job, or who want to continue participating in contact sports.
Also known as unicompartmental knee replacement, it is used in those cases where only one side of the knee joint is damaged and is in need of repair/replacement. Because only one side of the knee is being replaced, a smaller incision may be used. The small incision is sometimes referred to as "minimally-invasive" surgery. With a smaller incision there is less bleeding, quicker recovery and less bone loss than with a total knee replacement.
Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who undergo total knee replacement are over age 55, but the procedure is performed in younger people. The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:
- You have daily pain;
- Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living;
- You have significant stiffness of your knee;
- You have significant instability (constant giving way) of your knee; or,
- You have significant deformity (knock-knees or bowlegs).
What happens during knee replacement surgery?
A total knee replacement is really cartilage replacement with an artificial surface. The knee itself is not replaced. An artificial substitute for the cartilage is inserted onto the end of each of the bones. This is done with a metal alloy on the end of the femur and tibia, with a medical-quality plastic inserted between them. The cartilage on the undersurface of the kneecap also can be replaced with plastic. Replacement of the worn cartilage with the metal and plastic implant creates a new, smooth cushion and functioning joint.
Although not a normal knee, a replaced knee provides relief from the arthritis pain. Most patients have a marked decrease in their pain with substantial improvement in function after a knee replacement, which allows them to remain active and enjoy activities that had been limited because of pain.
What are the types of implants?
Many different companies made orthopaedic implants. Implants may either be press-fit (this allows the bone to grow into a rough surface of metal on the implant) or cemented (bone cement is used to attach the implant to bone). Both types of implant have high success rates.
When can a partial knee replacement be done?
A small number of patients have arthritis in only one area of the knee. These patients may be candidates for a partial knee replacements. Partial knee replacements can be done through smaller incisions. Ask your doctor if you are a candidate for partial knee replacement.
What "approach" is best for me?
Knee replacement is performed through an incision on the front of your knee. Minimally invasive approaches are now available; however, the benefits of this approach are unclear. Smaller incisions make the correct placement of the knee replacement implant very difficult and may increase the risk of leaving excess bone cement in the joint.
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