Knee Replacement Alternatives
Knee Osteotomy
Osteotomy simply means cutting bone. In the case of knee arthritis, it refers to cutting either the tibia or femur bone in order to change the alignment of the knee. When a young person has advanced arthritis and pain, osteotomy is considered an treatment option.
The problem with this treatment is that it is technically very challenging and even when done well by an experienced surgeon the results are not always good. It is considered a "bridge" treatment to "buy time" before an eventual knee replacement.
Dr. Jana does not do osteotomy surgery. However, if his patient is a candidate for osteotomy, Dr. Jana would refer him or her to the appropriate orthopedic sub-specialist.
Knee Arthroscopy
Knee arthroscopy uses a fiber-optic camera to look around the knee. It is an out-patient procedure and it involves only 2-3 small incisions. Most frequently, it is used to treat pain resulting from a torn meniscus.
The meniscus is a C-shaped cartilage pad that acts a shock-absorber between the femur and the tibia. When there is a tear, the surgeon removes the torn part of the meniscus and tries to leave behind as much of the intact meniscus as possible. In rare cases, meniscus can be repaired with sutures.
Arthroscopic surgery is also used for ACL reconstruction, patella realignment and treatment of focal cartilage damage.
While arthroscopy is very successful in treating meniscus tears, it is not very useful in treating arthritis. This is because arthritis involves the loss of the normal cartilage. When someone has large areas of cartilage that are worn down and roughened, there isn't much that can be done with an arthroscope. Studies show that patients with 2 mm or less of joint space, based on their X-ray, should not have arthroscopic surgery because it is not helpful.