If you are suffering from a knee injury or chronic knee pain, it is a good idea to be evaluated by an orthopedic surgeon. A good musculoskeletal examination and proper imaging will help determine if surgical intervention is necessary for you. If surgery is the next step, it is important to decide if arthroscopic surgery is or a more invasive surgery is necessary. So, the question is, is arthroscopic knee surgery right for you?
Knee arthroscopies usually have a very low complication rate and often result in a quicker recovery. Sounds like a no brainer! But I will explain why it isn’t always the right choice. A knee arthroscopy is performed through two small incisions in the front of the knee. The knee is then filled with fluid and a camera and shaver are introduced into the knee to remove a loose bodies and/or torn cartilage. One of the most common reasons to get a knee arthroscopy is due to a torn meniscus. You have a medial meniscus and lateral meniscus in each knee that are susceptible to tearing during an acute knee injury or you can get degenerative tears in them due to ‘wear and tear’ and arthritis. (See previous blog about “Common Knee Injuries”). There are many factors that go into deciding if a person is a candidate for a knee arthroscopy including, age, activity level and severity of tear. For instance, a 20-year-old athlete with an acute meniscus tear would be a better candidate for a knee arthroscopy than a 75-year-old individual living a fairly sedentary lifestyle with a degenerative meniscus tear.
Unlike knee arthroscopies, total knee replacements are associated with more complications, including infection, blood clots, longer anesthesia time, nerve/vessel injury, and hospital inpatient complications. It is done through an incision in the front of the knee about 4-6 inches in length. The knee joint is cut into and the ends of the femur and tibia and the underside of the knee cap are removed. Titanium implants are then cemented to the ends of the femur and tibia and a plastic piece is placed between them as well as on the back of the knee cap. This allows the joint to move smoothly. Total knee replacements are performed on a knee joint that has significant arthritis and has become debilitating to the patient.
Things can get complicated when a middle-aged patient has significant knee pain but their exam and studies show she has underlying knee arthritis as well as an acute meniscus tear. What surgery is right for this patient? A knee arthroscopy or a total knee replacement? Is surgery the right option at all? This is why it is important to seek an opinion of an orthopedic surgeon who can help you make the best decision for you. If the above mentioned patient has a knee scope to remove the torn piece of meniscus, it is important that they understand this may not get rid of all of their pain. They will still have underlying arthritis as a pain source and this individual may have gone through a pointless surgery that did not help them at all. But if this patient were to get a total knee replacement instead of a scope in this same situation, this may be premature for her because her arthritis may not be to the point of needing a replacement and you want to hold off on knee replacements basically as long as you can tolerate it. It is very important to exhaust all non-surgical options including medications, physical therapy and injections prior to moving on to surgery. Sometimes a patient can put off surgery for some time using these conservative options. Once these options have failed, surgical intervention may be the next step and at that point, it will important to discuss with your orthopedic surgeon what option is best for you as an individual.
If you have knee pain, or any joint pain, Three Rivers Orthopedic Associates would be happy to help you alleviate your pain and answer any questions you may have. Give us a call at 412-782-3990 and schedule an appointment with one of our physicians.
Bethany Wink PA-C