OSTEOARTHRITIS

Articular cartilage lines all three bones in the knee (the femur, tibia, and patella). Cartilage protects the ends of bone. It can withstand a significant amount of impact and is significantly smoother than ice. Patients who have arthritis have developed advanced wear of the cartilage that lines the bones in the knee. As the smooth cartilage lining over bone breaks down, patients with arthritis feel pain, stiffness, and other symptoms. Arthritis can occur due to many different factors; there is a genetic component as arthritis is more common in those patients who have a family history. Arthritis may also develop due to many other factors, including previous meniscus injury, previous cartilage injury, previous surgery, inflammatory conditions (such as gout), or obesity.

Symptoms

• Swelling of the knee at the end of the day
• Stiffness after sitting in one place for a long period of time
• Catching in the knee
• Pain after walking or running for an extended period of time

Diagnosis And Treatment

Dr. Welch considers each patient’s symptoms, as well as a detailed physical examination, x-rays, and sometimes and MRI of the knee to make the diagnosis. Dr. Welch recommends non-surgical management for most patients with arthritis. Low impact exercise, weight loss, and a dedicated physical therapy program may help alleviate some symptoms. Physical therapy focuses on range of motion in the knee and strengthening of the core muscles, hip muscles, and quadriceps. Other non-surgical options for treatment include unloader braces, which are designed to take pressure off of the side of the knee with the most cartilage damage. Other options include oral anti-inflammatory medications (such as Motrin or Aleve) and injections, including steroid injections, visco-supplementation, and platelet-rich plasma (PRP). In those patients who do not improve with non-surgical management, Dr. Welch may recommend surgical intervention.

In those patients who fail non-surgical management and have advanced damage in one “compartment” of the knee, the best surgical option is usually partial knee replacement. In those patients with advanced cartilage damage (“arthritis”) in multiple compartments in the knee, the best surgical option is total knee replacement.

Recently, a few companies have developed robotic-assisted knee replacement surgery. One company, MAKO, was recently acquired by Stryker. Dr. Welch had extensive training using the MAKO system as a fellow at the Kerlan Jobe Orthopaedic Clinic in Los Angeles. The benefit of MAKO robotic-assisted surgery is that it helps eliminate human error during surgery and enables surgeons to position the implants very accurately. Dr. Welch prefers and strongly endorses robotic-assisted partial knee replacement or total knee replacement for patients with arthritis who have failed non-operative treatment.

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