Surgical options for patients with osteoarthritis of the knee

Abstract

Osteoarthritis (OA) of the knee is a progressive disease that ultimately damages the entire joint. Knee OA should initially be treated conservatively, but surgery should be considered if symptoms persist. Surgical treatments for knee OA include arthroscopy, osteotomy and knee arthroplasty; determining which of these procedures is most appropriate will depend on several factors, including the location and severity of OA damage, patient characteristics and risk factors. Arthroscopic lavage and debridement do not alter disease progression, and should not be used as a routine treatment for the osteoarthritic knee. Bone marrow stimulation techniques such as microfracture are primarily used to treat focal chondral defects; the evidence for the use of these techniques for knee OA remains unclear. The goal of osteotomy for unicompartmental knee OA is to transfer the weight load from the damaged compartment to undamaged areas, delaying the need for joint replacement. This procedure should be considered in young and active patients who are not suitable candidates for knee arthroplasty. For patients with severe OA, total knee arthroplasty can be a safe, rewarding and cost-effective treatment. In selected patients with isolated medial or patellofemoral OA, unicompartmental knee arthroplasty and patellofemoral replacement, respectively, can be successful.

Fibrous Scaffolds with Varied Fiber Chemistry and Growth Factor Delivery Promote Repair in a Porcine Cartilage Defect Model

“…Current clinical treatments to repair cartilage damage are not without limitation-most approaches rely on damaging the patient's own cartilage to obtain tissue or cells for transplantation into the defect. [3][4][5][6] For example, autologous chondrocyte implantation involves isolation of cells from cartilage biopsies, expansion ex vivo, and then injection back into the defect site. 3,4,7 Alternatively, microfracture, which involves the introduction of holes into the underlying subchondral bone, releases marrow elements (including endogenous stem cells) into the defect that clot in place and provide a template upon which some regeneration can occur.…”

Osteoarthritis and Mesenchymal Stem Cell Therapy: An Overview

“…The range of the sites that can be treated is expanding in many other joints including the elbow, ankle, and at multiple locations in the hand. Despite these advanced techniques, some disadvantages still exist including the incompatibility of prosthetic joints with the functionality of a native joint, high cost for each procedure, and their invasive nature [8,18,[25][26][27].…”

Efficacy of arthroscopic loose body removal for knee osteoarthritis

“…Alternatively, patients with severe KOA may be treated by surgeries, including arthroscopic removal of loose body, joint debridement, osteotomy, arthrodesis and arthroplasty (artificial joint replacement) (12). Intra-articular loose bodies, which are formed due to articular cartilage atrophy, degeneration and necrosis after cartilage malnutrition or developmental disorders, are chondral, osseous or osteochondral fragments located in the articular cavity (13).…”

“…Intra-articular loose bodies, which are formed due to articular cartilage atrophy, degeneration and necrosis after cartilage malnutrition or developmental disorders, are chondral, osseous or osteochondral fragments located in the articular cavity (13). Loose bodies that move freely in the joint cavity may lead to joint pain, locking and swelling (12). According to their structure, intra-articular loose bodies may be divided into fibrous, cartilaginous bony, cartilaginous, bony and crystalline loose bodies or exogenous articular foreign matter (14).…”