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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.

Key Points

  • Osteoarthritis (OA) of the knee should first be treated nonsurgically; however, if this approach fails, several surgical options are available

  • Arthroscopic lavage and debridement should not be used as a routine treatment in knee OA, as only selected patients might benefit; neither procedure alters disease progression

  • Evidence for the use of bone marrow stimulation techniques for knee OA is unclear; the primary indication for this procedure remains focal cartilage defects

  • Osteotomy is recommended for young, active patients with knee OA who are not suitable candidates for arthroplasty

  • Total knee arthroplasty is a safe and cost-effective treatment for severe knee OA, although the relative risks and benefits should be thoroughly considered

  • Unicompartmental knee arthroplasty or patellofemoral replacement can be an option for selected patients with isolated medial or patellofemoral OA, respectively

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Figure 1: Characteristic appearance of advanced osteoarthritis of the knee, occurring mainly in the medial compartment.
Figure 2: Microfracture is a bone marrow stimulation technique that creates small holes in the bone with the aim of stimulating growth of fibrocartilaginous tissue.
Figure 3: High tibial osteotomy, often used to treat medial unicompartmental knee osteoarthritis.
Figure 4: Total knee arthroplasty replaces the femoral and tibial contact areas.
Figure 5: Unicompartmental knee arthroplasty in isolated medial osteoarthritis replaces only the medial femoral and tibial contact areas.

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Correspondence to Klaus-Peter Günther.

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J. Lützner has received speakers' honoraria and grant/research support from Aesculap and Stryker. S. Kirschner has received speakers' honoraria and grant/research support from Aesculap, Stryker and Zimmer. K. -P. Günther has received speakers' honoraria and grant/research support from Stryker and Zimmer. P. Kasten has received speakers' honoraria from Biosafe and Tornier, and grant/research support from Biosafe.

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Lützner, J., Kasten, P., Günther, KP. et al. Surgical options for patients with osteoarthritis of the knee. Nat Rev Rheumatol 5, 309–316 (2009). https://doi.org/10.1038/nrrheum.2009.88

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