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Minimally Invasive (MI) Knee Replacement: Is it right for you? Anatomy of the Knee Made up of three bones: Femur (thigh bone) Tibia (lower leg bone) Patella (kneecap) A Healthy Knee Joint Knee formed by ends of the femur, tibia and patella Cartilage provides padding between the bones and helps assure an effortless, smooth gliding movement of the joint Joint capsule provides fluid for smooth movement Causes of Knee Pain Osteoarthritis (wear and tear) Rheumatoid arthritis Post-traumatic arthritis caused by: Fractures Ligament injuries Meniscus cartilage tears What is Osteoarthritis? Degenerative condition that is not part of the normal aging process May result from overuse or injury Most common type of arthritis The Arthritic Knee Deterioration of cartilage Bone on bone Spurs, pitting, grinding Deformity Pain, impaired activity Knee Joint •Healthy knee joint •Arthritic knee joint How Can My Life Change with Treatment? A return to mobility Regaining a sense of your old lifestyle Reduce or eliminate pain Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Can reduce pain, swelling and redness Relief can take several months Examples: ibuprofen (Advil®, Motrin®) naproxen (Aleve®) Aspirin Reduce joint pain and inflammation Form of NSAIDs Common side effects of NSAIDs, aspirin, and acetaminophen are abdominal cramps or pain, abdominal discomfort, bloating and gas, constipation, diarrhea, dizziness, fluid retention and swelling, headache, heartburn, indigestion, itching, loss of appetite, nausea, nervousness, rash, ringing in ears, stomach pain, and vomiting. Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Medications Acetaminophen Reduces pain and lowers fever Does not decrease or reduce inflammation of arthritis Examples: Tylenol® Datril® Extra Strength Tempra® Common side effects of NSAIDs, aspirin, and acetaminophen are abdominal cramps or pain, abdominal discomfort, bloating and gas, constipation, diarrhea, dizziness, fluid retention and swelling, headache, heartburn, indigestion, itching, loss of appetite, nausea, nervousness, rash, ringing in ears, stomach pain, and vomiting. Non-Surgical Treatment Options for Knee Pain: Prescription Medications NSAIDS Most popular type for osteoarthritis treatment Analgesics Provide pain relief, but do not reduce inflammation Non-Surgical Treatment Options for Knee Pain: Prescription Medications Biological Response Modifiers Treat rheumatoid arthritis May postpone injury to the joints Glucocorticoids or Corticosteroids Treat rheumatoid arthritis Fight inflammation DMARDS Treat rheumatoid arthritis Slow joint destruction Every drug has possible side effects. Be sure to talk with your doctor about possible side effects before taking a new medication. If you notice a side effect, contact your doctor immediately to discuss whether or not you should continue to take that medication. Non-Surgical Treatment Options for Knee Pain: Injection Therapy Cortisone Injections Helps reduce swelling and discomfort from arthritis Temporary pain relief Risk of infection Following the injection, there may occasionally be increased pain or an inflammatory reaction to the injected medication Hyaluronic Acid (HA) Injections Restores lubrication and fluid in the joint Creates a shock absorber between the bones Risk of infection Following the injection, there may occasionally be increased pain or an inflammatory reaction to the injected medication. Non-Surgical Treatment Options for Knee Pain Lifestyle Changes Diet and exercise to control weight Orthotics Assistive devices (walker, cane, etc) Walking Bathrooms Climbing Dressing Surgical Options for Knee Arthritis Arthroscopy Debridement Meniscectomy Chondroplasty Osteotomy Bone cut and re-aligned onto remaining good cartilage Arthroplasty (Joint Replacement) Uni-compartmental knee replacement (partial knee replacement) Tri-compartmental knee replacement (total knee replacement) Arthroscopic Debridement “clean out” or “scrape bone” Somewhat unpredictable results 50 to 66 percent get relief for some period of time Pain relief may be temporary Best for patients with mechanical symptoms (catching, locking and giving out) Knee Osteotomy Re-align weight-bearing axis through “good” cartilage Most popular before success of contemporary knee replacement Useful for patients too young, heavy or active for knee implants Early results acceptable, questionable durability End-Stage Osteoarthritis Knee Replacement “Gold Standard of Care” Uni-compartmental Knee Replacement “Uni,” “partial replacement” or UKR Tri-compartmental Knee Replacement “Total replacement” or TKR “Minimally invasive” or MITKR Total Knee Replacement Total knee is affected by arthritis Reduce knee pain Improve the motion Continued advancements in technology, materials, and designs Total Knee Replacement Resurface joint with 3 components Implant materials include: Cobalt chrome Titanium alloy Ultra high molecular weight polyethylene (medical grade plastic) Preserve bone, ligaments, tendons Background on Minimally Invasive Knee Replacement Continued evolution to refine techniques to improve safety and cosmetics Smaller incisions Sparing key tendons and muscles Uses traditional implants Difference Between Traditional and Minimally Invasive Knee Replacement Traditional Minimally Invasive Proven clinical success for decades Full visualization of tissues Larger incision Clinical studies in evaluation Potentially less tissue dissection Smaller scar Minimally Invasive Knee Replacement Same implants as traditional knee replacements Components Femoral Tibial Patellar Reduced tissue trauma Ideal Candidate for Minimally Invasive Knee Replacement Suffering from arthritis and failure to respond to: Medication/injection Weight management Considerations Medical History Weight Severity of Arthritis Condition of skin Age Activity level Potential Benefits of Minimally Invasive Knee Replacement Less trauma to the knee Less bleeding Less pain Cosmetically appealing (smaller scar) Shorter hospital stay Quicker recovery than traditional total knee replacement Potential Complications and Risks Factors that effect risks: Skill of the surgeon Age, weight and health of the patient Patient compliance Surgical Procedure Incision is made. Damaged bone surfaces from the femur, tibia and patella, as well as worn-out cartilage are removed. Precision instruments and guides help surgeons make cuts at the correct angle. Surgical Procedure An implant is attached to each of the three bones (femur, tibia, and patella) Implants are designed to mimic a healthy knee. Incision is closed. The Future of Minimally Invasive Knee Replacement Evolving Clinical studies under way May be enhanced with computer assisted surgery