Nonoperative Treatment Options
Oftenpatients decide to have their non-operative treatment with Dr. Boettner. The benefit is that he will be able to monitor the progress of the arthritis and will help you understand at what a point surgical intervention might be beneficial for you. Dr. Boettner performs a variety of non-operative treatment options prior to considering total knee replacement. These include exercise protocols, NSAID medications that are aimed at decreasing inflammation inside the joint, reduce pain, or supplements that will supply nutrients towards the cartilage. Dr. Boettner also performs intra-articular injections to improve the joint lubrication and to decrease inflammation and pain.
Sometimes patients, in their 30s and 40s, that continue to be physically active will start to develop minor intra-articular injuries that will start to interfere with their desired activity level. Conditions like meniscus tears, loose bodies or early degenerative cartilage changes might sometimes require non-operative treatment in that age group and, ultimately, once non-operative treatments fail, might require arthroscopic surgery. Knee arthroscopy is a minimally invasive way to inspect the inside of the joint with a camera and using minimally invasive tools, Dr. Boettner can then address meniscus tears or cartilage defects and reconstruct them to help you return to your desired activity level without requiring major open surgery. The rehabilitation of knee arthroscopy is usually relatively fast and patients often return to work within a few days and to their desired level of sport within three to six weeks.
Partial Knee Replacement
Once arthritis progresses to where full-thickness cartilage defects, affect larger portions of the joint, usually arthroscopic surgery is no longer indicated. In patients with this condition that fail non-operative treatment we in selected patients have the option to perform a partial knee replacement. Partial knee replacement is a treatment technique that is used if only one part of the joint shows advanced arthritis. The knee has three compartments, the medial, lateral, and patellofemoral compartment. Each compartment can develop end stage arthritis without the other ones being affected. For patients with unicompartmental arthritis partial knee replacement might offer a relatively fast rehabilitation with better range of motion and better overall activity levels. Studies have also shown that patients who have a partial knee replacement have a faster return to sport and a higher overall percentage of sport participation. The main disadvantage of partial knee replacement is that, over the years, arthritis in the other compartments can present and, ultimately, further surgery might be needed. We do, today, assume that patients who undergo partial knee replacement will have a higher risk of requiring a second procedure than patients with a total knee replacement. If you are an ideal candidate, Dr. Boettner will review the indication for a partial knee replacement and will explain to you whether you are a candidate. Today he performs most of his partial knee replacements using robotic-assisted surgery.
The following images show different types of partial and total knee replacement:
Robotic Surgery and Navigation
Over the last decade, new surgical tools, including computer navigation and robotic surgery, have gained access to the operating room. For a lot of procedures these high precision tools are not required for experiences surgeons. However, Dr. Boettner utilizes both procedures if indicated. He has gained experience with computer navigation for primary total hip replacement as well as total knee replacement and currently uses robotic surgery for almost all of his partial knee replacements. Computer-assisted surgery is not a guarantee of a perfect surgery and often patients have the feeling that the computer will ultimately make things better. Our philosophy is that the combination of an experienced surgeon, with the guidance of a computer, can improve your outcome and that is why we implement thistechnology. Especially in partial knee replacements, they allow us to better simulate how the new artificial joint will function in your body and that will ensure good outcome of your surgery.
Total Knee Replacement
Once the arthritis affects two or three compartments inside the knee and nonoperative treatment options have failed, Dr. Boettner will discuss with you minimally invasive total knee replacement. Dr. Boettner usually utilizes a minimally invasive approach, trying to minimize any injury to the quadriceps muscle. We do use posterior stabilized implants, which, in the past, have shown to have better range of motion than cruciate-retaining total knee replacements. Dr. Boettner has extensive experience in total knee replacement surgeries, especially, knee replacementsfor severe deformities.
Usually if you undergo total knee replacement you will have spinal epidural anesthesia with epidural pain management after the procedure. You will stay in the hospital for three days and start working on range of motion and be mobilized out of bed on the day after the surgery. Patients usually regain range of motion within four to six weeks of the procedure and regain their independence, including stair climbing, within 6 to 12 weeks. Most of our patients are able to return to work within six to eight weeks. For young patients, we do offer a ceramic-coated total knee replacement, which has been shown to decrease wear rate and ultimately might have a positive effect on the implant’s long term survival.