Knee | Orthopaedics and Sports Medicine | Dartmouth-Hitchcock
Skip to main content
x
Dartmouth-Hitchcock logo
Summer Flowers In This Section

Knee

Non-Surgical options

Medications:
over-the-counter non-steroidal anti-inflammatory medicines or more potent prescribed medicationsKnee graphic

Corticosteroid injections:
direct anti-inflammatory effects when injected into a degenerative joint

Viscosupplementation:
injection of synthetic forms of synovial fluid (a lubricant for the joint) into the knee joint to treat the symptoms of arthritis

Physical therapy:
you can see a physical therapist in your local community or one of our specialists in the Rehabilitation Medicine Department

Walking aids:
use of a cane or walker to improve your gait and functional mobility

Braces/orthotics:
knee symptoms can often be relieved by proper orthotics or braces that maintain appropriate limb alignment

Weight management:
diet and exercise regimens for healthy living can also help to treat your hip and knee pain; we offer dietitian services to assist you

Exercise program:
directed exercises can improve your stamina and reduce the symptoms of arthritis; your physical therapist can help design a customized program for you

Surgical options

Autologous chondrocyte implantation (ACI):
An arthroscopic surgery needs to be performed as a first step to see if this technique is the right approach. During this first procedure the cartilage cells are taken. The cells are then sent to a laboratory and grown for four to six weeks to generate millions of new cells. A second surgery is required, with a larger incision to implant the newly grown cells. A second incision is made during that surgery over the shin bone and an area of tissue called periosteum is taken to create a "patch" to cover the area of cartilage damage. Once the patch is in place, the new cartilage cells are injected under it. This surgery is done as an outpatient procedure so you will return home on the same day of your surgery. Physical therapy is an important part of the rehabilitation after surgery. Your weightbearing will be restricted for a period of time after the procedure in order to allow the cartilage to heal.

Knee arthroscopy:
After making small cuts, using a pencil-sized instrument called an arthroscope, the surgeon can see an image of your knee that is transmitted through a small camera, via optic fibers, to a television monitor. The TV image allows the surgeon to thoroughly examine the interior of your knee and determine the source of your problem. During the procedure, the surgeon can also insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues. Most often, this procedure is used to diagnose or treat:

  • A torn meniscus
  • Loose fragments of bone or cartilage
  • Damaged joint surfaces or softening of the articular cartilage, known as chondromalacia
  • Inflammation of the synovial membrane, such as rheumatoid or gouty arthritis
  • Abnormal alignment or instability of the knee cap
  • Torn ligaments including the anterior and posterior cruciate ligaments

This surgery is done as an outpatient procedure so you will return home on the same day of your surgery. Physical therapy is an important part of the rehabilitation after surgery. Usually you can go back to physical activity within about three weeks after your procedure.

Knee osteotomy:
Osteoarthritis in the knee can often cause people to become bow-legged or knock-kneed. This happens because the cartilage of the joint wears thin. If the damage is more on one side of the joint than the other, the knee can have a deformed appearance. An osteotomy can be done to shift the weight-bearing forces off from the worn side of the joint and put more force on the healthier part of the joint. The surgeon cuts the bone and then reorients it by either removing a wedge of bone to change the alignment or a large part of the bone on one side for adjustment. Once it is realigned, a metal plate and screws hold the bones in the new position. This surgery is only right for certain patients. Most people are better suited for a total knee replacement. The best candidates are usually young, active people who have arthritis only on one side of the knee joint. Physical therapy is an important part of the rehabilitation after surgery. Usually the results of this surgery will last about 10 years and then you may need to have a knee replacement. This procedure requires a short hospital stay and your weightbearing may be restricted while the bone is healing. Physical therapy is an important part of the rehabilitation after surgery.

Total knee replacement surgery:
Patients who are best suited for this type of surgery include those with:

  • Knee pain that has failed to respond to conservative therapy (including medication, injections, and physical therapy for six months or more)
  • Knee pain that limits or prevents your level of activity
  • Arthritis of the knee
  • Decreased knee function caused by arthritis
  • Inability to sleep through the night because of knee pain
  • Some tumors involving the knee

The procedure itself takes about two hours. Some patients choose to have both knees done at once (bi-lateral) if there is significant pain in both joints. Your surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee. Many different types of designs and materials are currently used in total knee replacement surgery. Nearly all of them consist of three components: the femoral component (made of a highly polished metal), the tibial component (made of a durable plastic often held in a metal tray), and the patellar component (also plastic). Patients are typically in the hospital for two to three days after surgery and then either go home or to a skilled nursing facility. The patient can bear full weight immediately after surgery and will begin walking with a walker or crutches the evening after surgery. Physical therapy is critical to the success of your new joint and speed of healing after surgery. Recovery is different for each patient, but most of the healing occurs in the first three months after surgery. Prosthetic joints typically last 10 to 15 years, some as long as 20 years, before they loosen. Once the prosthetic joint becomes loose, revision surgery is required.

Total Knee Replacement Components

Total Knee Replacement Components

Unicompartmental knee replacement (partial knee replacement):
Partial knee replacement is usually recommended in patients who have severe arthritis of the knee and who have not benefited from conservative treatments such as medications, injections, strengthening exercises, and weight loss. In addition, it is recommended in patients who have arthritis that is confined to a limited area of the knee and have intact ligaments (specifically the ACL). If these qualifications are not met, then the minimally invasive partial knee surgery may not be as successful. The surgery takes about one and a half hours. An incision is made over the knee and the worn-out cartilage is exposed. The rough edges of the end of the femur (a bone that goes from the hip to the knee) and top of the tibia (a bone that goes from the knee to the ankle) are cut flat, cleaned, and then the unicompartmental device is cemented in place. Patients start rehabilitation exercises right away. You will be in the hospital for one to two nights. Those who are eligible for this option have a smaller scar, less pain, usually a shorter hospital stay, faster rehab and recovery time, and sometimes a greater range of motion when compared to those getting a total knee replacement.

Partial (Unicompartmental) Knee Replacement Components

Partial Knee Replacement Components

Revision surgery:
Please note that if you have had a previous knee replacement, our team has years of experience in doing revision knee replacement surgery – it is our specialty. Our surgeons work together as a team in surgical planning and operative care for complex cases involving failed or infected total joint replacements. 

Contact Us

0