6850 W. Centennial Drive, Tinley Park, IL 60477
Phone (708) 429-3455 /  Fax (708) 429-3422

Specialties: Knee Osteoarthritis

How does arthritis destroy the knee?

The bottom of the femur (thighbone) and the tibia form the knee joint. They are covered with a thin, smooth, glistening material called hyaline cartilage. It is the knee hyaline and meniscal cartilage that cushion the joint and absorb shock. Normally, this cartilage is lubricated by a few drops of specialized joint fluid. The arthritic knee may produce increased amounts of fluid ("water on the knee"). Cartilage has poor healing capabilities and once it is damaged it no longer provides cushioning. As it wears away, bone becomes exposed. Bone surfaces rubbing against each other can cause significant pain.

How do we treat arthritis without surgery?

Unfortunately, there is no cure for arthritis. Procedures such as cartilage transplant are not indicated for the person with a degenerative knee. They are generally used on the young athlete that has a small injury to their articular cartilage. Our initial approach is the alleviation of symptoms with conservative measures (oral medications, injections, activity modifications). Anti-inflammatory medications (NSAIDS, Advil, Aleve, Celebrex, Vioxx) have all about the same effectiveness and only improve symptoms- they do not change the progression of the arthritis. Occasionally we will recommend an injection of an anti-inflammatory steroid into the knee joint. These injections are generally safe and well tolerated and may be repeated every three months if found effective (3-4 times a year). Another type of injection is Synvisc (hyaluronic acid). This material is a normal material found in the knee joint fluid although in abnormal amounts in the arthritic knee. By injecting this medicine, the knee begins to produce more normal joint fluid. This is an expensive series of three injections that we have found to work approximately 50% of the time (less than 40 % of the time in patients with advanced arthritis).

One may also control arthritis with activity modification. You can think that a degenerative knee is like having a tire with 50,000 miles of tread on it. One should continue to maintain a fit lifestyle, but an effort should be made to perform more unweighted activities. The best activity for your knee is to perform pool aerobics. The next best activities are a stationary bike, recumbent bike and elliptical trainer. Walking and treadmill machines are better than running. One should save the higher impact activities for things one really enjoys doing.

When should I have surgery?

There are surgical procedures for a degenerative knee other than a replacement. Occasionally, we will perform a knee scope to "clean out" the debris and thereby decreases the soreness and swelling in the knee. This has variable results and the benefit is rarely sustained past one year. Other surgeries include a unicompartmental knee replacement (replacing only the inner or outer portion of the knee) or an osteotomy (realigning the knee by cutting the femur or tibia). These procedures are indicated in select patients.

The main indication for total knee replacement is arthritis of the knee accompanied by considerable pain and loss of function that does not respond to conservative treatment. The decision to proceed with surgery is ultimately up to the patient. Arthritis of the knee is not a malignant condition and is not life threatening. Quality of life is the main consideration. When you feel that you are living your life around your knee and your symptoms prevent you from living your life the way you wish, consideration to a knee replacement should be given.

What is a total knee replacement?

A total knee replacement consists of three pieces. These are made of rugged polyethylene (high density plastic) and alloy metals. These pieces resurface the three bones that comprise the knee joint (the femur, tibia, and patella). The femoral component (the end of the thighbone) is made of alloy metal (cobalt chrome). The tibial component (the top of the shin bone) has a metal tray with a snap-in plastic insert that mates with the femoral components. The patella component (the kneecap) is plastic, and mates with a groove in the femoral components. These components are usually held in place with cement. This cement is actually a polymer that serves as a grout and is not an adhesive. Occasionally we will press-fit the components. This relies on the ingrowth of the patient’s own bone for fixation and is used based upon the patients age and quality of bone.

How long do they last?

Design changes have occurred in recent years and current prostheses have been improved in an effort to yield better function and longevity. Since the prostheses now being used are of newer designs we do not exactly know how long they will last. Most studies have found that at 10 years 90% of all knee replacements are functioning well. Another study has found that, at 18 years, 94% of knee replacements are still functioning.

A well-implanted prosthesis, in a compliant patient, usually lasts for many years. Strenuous use and obesity have the potential to shorten the life of the implant. It should be emphasized that total knee replacements are not done to allow the patients to return to unlimited activities. Fitness may be maintained by "low impact" sports such as swimming or bicycling. Golfing and bowling are usually possible, and even moderate skiing in some individuals. Jogging is not recommended. Doubles tennis is preferred to singles.

What is the hospital stay like?

You will be admitted the day of surgery and remain hospitalized for approximately 3 days. Immediately after your knee replacement you may place your full weight on your new knee. We will begin your therapy the day of your surgery and emphasize walking, regaining your range of motion and strengthening exercises. The quicker we can get you home, the better off you will be.

Transfusions are occasionally needed during or after surgery and we often encourage our patients to donate their own blood a few weeks before surgery. If you do require blood from the blood bank we reassure you that it is safe. There is less than a 1 in 1.7 million chance that you would receive a blood product with the HIV virus.

Your pain is controlled with injections and later by pain pills. Your discomfort should significantly decrease by the third day and only require pain pills before performing therapy. After all major orthopedic surgeries, the patient is at risk of developing a blood clot. Occasionally, a blood clot can break free from their location in the leg veins and travel via the blood stream to the lungs, causing serious complications and even death. We can significantly decrease this risk by placing you on a blood thinner for approximately 6 weeks. This will require regular blood checks to determine the proper dosage of the medication.

What are potential complications?

The most common complications after a knee replacement are infection and blood clots. We can lower the risk of infection to less than 1% by using special operative suites, meticulous operative technique, and antibiotics before surgery and for 48 hours after surgery. If an infection does occur, another surgery may be required to "wash out" the infection from the knee. Occasionally the knee prostheses must be removed to allow eradication of infection. Usually a new prosthesis can be implanted after the infection is cleared.

We significantly lower the risk of blood clots by placing you on a blood thinner for approximately 6 weeks. If you develop significant leg swelling or shortness of breath, you need to seek immediate medical attention to evaluate for a blood clot or embolus.

Other complications include: dislocation of the components, premature loosening, fractures around the components, damage to nerves or arteries during surgery, and anesthesia risks.

We emphasize that these risks are rare and feel that the potential benefits from a knee replacement far outweigh the potential risks. We take significant precautions to lower these risks.

What should I expect after surgery?

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Last Modified: June 24, 2014