Arthritis of the knee is an increasingly common problem amongst active patients, typically from ages 35 through middle-aged and into the elderly population.
The inner/medial cartilage area of the knee is quite often much more arthritic than the patellofemoral (under the kneecap) or outer/lateral compartments. However, while some patients can indeed point with one finger to the most painful portion of the knee (often that inner/medial compartment), others just say that "its my whole knee doc." Despite the frequent perception of global knee pain, in reality, the percentage of individuals with primarily uni-compartmental/medial knee arthritis is much higher than is generally appreciated.
The importance of determining the primary location of a patient's arthritis knee pain cannot be overemphasized. Although MRI scans can be useful, the optimal knowledge comes from obtaining a thorough history, performing a physical examination and correlating the findings with standing knee x-rays. Weight-bearing x-rays, in conjunction with a complete history and physical examination, can often accurately localize the primary area of a patient's painful knee arthritis.
Patients with painful knee arthritis have many options to consider prior to surgery. These options include anti-inflammatory medications, cortisone or visco-supplementation ('liquid-cartilage') injections, topical solutions, canes and 'unloader' knee braces. However, when the preceding conservative treatments begin to fail to relieve a patient's arthritic pain, surgical options are available. Some surgical options are clearly less invasive than others.
At the Center for Sports Orthopaedics, SC, the Unispacer-'Uni-knee' implant has been shown to markedly decrease pain and to restore knee function, alignment and stability. This is achieved by replacing missing cartilage with a single metallic implant. The patient's own knee is preserved and a patient's body weight does not appear to be an issue. There is no dramatic bone resection or any metallic/cement fixation required, as a patient's own ligaments allow for implant and knee stability. The knee is not compromised with regard to possible future complete (or even partial) knee replacement operation(s).
This author has also determined that combining the UniSpacer with proprietary arthroscopic removal of the chronically inflamed deep synovial tissue of the knee further ensures dramatic relief from arthritic pain/swelling. Optimized surgical technique, including post-operative protocols, tends towards correspondingly improved patient results. At the Center for Sports Orthopaedics we have found that early non-braced range of motion and measured implant sizing has led to dramatically optimized results (as compared to the procedure when it was in its infancy).
Post-operative recovery appears to be relatively more rapid than with knee replacement, as the minimally invasive Uni-knee/UniSpacer incision is usually 2-3 inches in length and over the inner aspect of the knee. Non-braced weight bearing as tolerated is typically allowed immediately. A continuous passive motion (CPM) machine is utilized short-term to assist in rapid return of knee motion, as is specifically designed physiotherapy utilized to promote strength and functional motion.
Many of this author's patients had been followed for 2.5 years (as of Jan. 2005). The results have generally been a very dramatic reduction (or absence) of arthritic pain and improvement in knee function and stability. Many patients have requested and have now received an implant in their other arthritic knee. Although not all are so adventurous, one patient has climbed 'Diamond Head' mountain in Hawaii and another is able to engage in yoga.