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Knee osteoarthritis: Local and surgical treatments

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Knee: Local and surgical tre

 

The local and surgical treatments available for osteoarthritis of the knee are described below. However, the information provided in this section can in no way replace a consultation.

 

Only your doctor is able to prescribe a suitable treatment for your condition, which will effectively relieve your pain.

 

For more information on classes of drug, simply click on each one of them.

Knee: Corticosteroid injections

 
WHAT ARE THEY USED FOR?

Injections may be prescribed for osteoarthritis when the anti-inflammatory drugs and analgesics have failed to relieve a flare-up.

HOW DO THEY WORK?

This technique involves injecting an anti-inflammatory cortisone-based product directly into the joint. Cortisone has the advantage of acting on both pain and inflammation. In no case does it damage the cartilage; but some patients on seeing their painful symptoms regress or even disappear push their joint too hard at a time when it is still fragile.  

The injection generally gets good results because the majority of the injected product remains in the joint. It acts on the pain and swelling within hours or days.

Its effect is prolonged, lasting from a few days to two months, depending on the case.

 

WHAT PRECAUTIONS NEED TO BE TAKEN?

Injections are often feared but, in actual fact, they are not really worse than a blood test if your doctor is experienced. However, it is always possible and sometimes useful to use a local anaesthetic beforehand.

Go easy on your joints for a few hours after the injection.

Sometimes the pain increases for several hours following the injection. These problems disappear spontaneously within a few hours and are not a contraindication for further injections.

However, for pain that occurs 48 hours after the injection, you should go and see your doctor immediately to rule out the possibility of an infection. Although this risk is very low (1 in 50,000 injections) you need to be particularly vigilant.

There is no need for a special diet: the passage in the blood of cortisone administered locally is far too low to lead to weight gain. However, if you have diabetes, this may cause a temporary imbalance.  

It is recommended not to perform more than three injections per year per joint for the simple reason that if the first three did not have a sufficient effect, it is unlikely that the fourth will be more effective.  

Keep track in a notebook or your health record of the date, the product used and the effectiveness of the injection.

 

Knee: Viscosupplementation

 
WHAT ARE THEY USED FOR?

The principle consists in injecting a viscous substance rich in hyaluronic acid directly into the painful joint. Hyaluronic acid is a component of joint fluid that normally serves to lubricate the cartilage and protect it from shocks. In osteoarthritis, this fluid has the particularity of deteriorating both in quality and quantity: hence, the cartilage of the joint is less lubricated and thus much more vulnerable to friction and shock  

By providing hyaluronic acid, viscosupplementation makes it possible to absorb shocks, reduce lesions to the cartilage and thereby restore the mobility of the joint.

 

HOW DO THEY WORK?

Currently this procedure applies only to the knees. The injection of a synthetic hyaluronic fluid is performed like any intra-articular injection with strict aseptic rules and sterile disposable equipment.  

It usually involves three to five injections a week apart. This technique provides good results on both pain and mobility. The effectiveness is felt in general after a few days and sometimes persists for up to 8 months or 1 year.  

It is normally reserved for people with moderate osteoarthritis of the knee in which the cartilage is not yet seriously affected or people with serious osteoarthritis who refuse to undergo surgery.  

Studies are underway to demonstrate a potential slowdown in progression of osteoarthritic lesions with this product.  

 

WHAT PRECAUTIONS NEED TO BE TAKEN?

The procedure is generally well tolerated. In the hours following the injection heat, redness and pain may occur in the injected joint. But these signs disappear within a few hours. However, if such signs occur 48 hours after the injection, you should go and see your doctor immediately to rule out the possibility of an infection.

Knee: Joint lavage

 
WHAT ARE THEY USED FOR?

This technique can rid the painful joint of the enzymes responsible for the breakdown of cartilage as well as microcrystals or cartilage fragments that, imprisoned in the joint, maintain irritation. Currently it is performed on the knee joint.

HOW DO THEY WORK?

Joint lavage involves injecting into the joint a large dose of physiological saline solution and extracting it again loaded with impurities. This procedure is carried out in a hospital or clinic environment, either in the operating room or in a biopsy room, as an outpatient or with a short hospital stay. It is performed under local (or local-regional) anaesthesia , and in strict aseptic conditions to ensure the sterility of the procedure. It can sometimes be combined with a corticosteroid injection which produces a result that is both fast (thanks to the corticosteroid injection) and sustainable (thanks to the joint lavage). Your doctor may prescribe it during a flare-up of osteoarthritis of the knee, and when the knee remains swollen despite treatment.

WHAT PRECAUTIONS NEED TO BE TAKEN?

It is procedure that is generally well tolerated and whose effectiveness can last for 6 months to 1 year. You should tell your doctor if you have heart disease and/or any allergies, as there may be an intolerance to the local anaesthetics used.

Knee: Arthroscopy

 
WHAT ARE THEY USED FOR?

Arthroscopy has very few indications in osteoarthritis. However, it can be proposed in osteoarthritis of the knee when a mobile and unstable piece of cartilage or meniscus is suspected in the joint.

HOW DO THEY WORK?

The procedure is performed in an operating room and requires a short hospitalisation (24 to 48 hours). This procedure is carried out under local, general or epidural anaesthesia in an operating room. It involves introducing a small camera into the centre of the affected joint to assess the lesions caused by osteoarthritis.



It also enables performing joint "cleansing" to rid the joint of cartilage or meniscal fragments either by performing a JOINT LAVAGE or directly using a clamp. The practitioner can, in fact, introduce the necessary instruments thanks to two incisions.  



He or she can also regularise the joint surfaces.


WHAT PRECAUTIONS NEED TO BE TAKEN?

A variable rest period is recommended for the joint after this treatment.


Complications that may arise are those related to any surgical procedure (complications of anaesthesia, risk of phlebitis, pulmonary embolism) and those related to surgery on a joint (infections, reflex sympathetic dystrophy).

Knee: Corrective surgery

 
WHAT ARE THEY USED FOR?

By corrective surgery we mean, an operation intended to correct certain defects of the bones that are responsible for the abnormal morphology of a joint. Thus one can occasionally be required to correct the axis of a knee or a malformation of the hip.

HOW DO THEY WORK?

The morphological defects result in abnormal pressure on certain parts of the cartilage of the joint in question, and therefore increased wear and tear. By correcting the existing defect, the pressure will be spread better over the entire surface of the cartilage which will thus wear less.  

It is therefore understandable that when such defects exist, there is interest in carrying out these procedures as early as possible. That is to say, during the early symptoms of osteoarthritis. Indeed, if the cartilage is too damaged, the procedures will not be effective.

 

WHAT PRECAUTIONS NEED TO BE TAKEN?

Osteoarthritis of the knees and hips can sometimes benefit from this type of surgery.  

This is major surgery: it requires hospitalisation for about ten days and prohibits putting weight on the operated leg for 6 weeks.  

The risks are those of any surgical procedure (phlebitis, pulmonary embolism, risk of anaesthesia) and also the risk of infection.

 

Knee: Fitting of prostheses

 
WHAT ARE THEY USED FOR?

This is to replace a joint badly damaged by osteoarthritis by a joint in synthetic material. The indication is never urgent because it is primarily to improve comfort. The surgical decision is the result of discussions between yourself, your doctor and the surgeon.

The results are generally good with a reduction of pain associated with osteoarthritis and a satisfactory restoration of mobility. However, you should keep in mind that a prosthetic joint rarely functions as well as a normal joint. The techniques with the safest and best results are currently those used for hips and knees.

 

 

HOW DO THEY WORK?

This mainly involves knee and hip joints. The prostheses are made of different materials and attached to the bone with a special cement or "biological glues".

The procedure is done under general or local-regional anaesthesia. It also includes a self-transfusion (sample of your own blood before surgery for you if a transfusion is required during surgery). This technique removes all the risks of a transfusion.

Hospitalisation lasts about a week, but a stay of 4 to 6 weeks straight afterwards in a rehabilitation centre is desirable. 

 

WHAT PRECAUTIONS NEED TO BE TAKEN?

In all cases these procedures are necessary only when all other medical treatments have failed. The materials used have the disadvantage of wearing out after 15 to 20 years and even faster in young and active people. This is why a prosthesis is not generally proposed to people under the age of 55 to 60 years (except in special cases).  

Preparation is necessary:  

  • strength training for the muscles that will surround the future prosthesis,
  • weight loss in cases of obesity,
  • eliminating any source of infection (teeth, sinuses, etc.).

Some surgeons recommend a period of one to several months after the last injection of corticosteroids and the operation in order to be safe from any potential infection with the corticosteroids. The risks are those of any surgical procedure but there can be specific complications with prostheses:  

  • the prosthesis may become detached from the bone to which it had been fixed: it sometimes loosens due to infection (1-2%),
  • poor positioning of the prosthesis and lastly much less serious,
  • painful muscle or tendon problems that disappear with proper rehabilitation.