Minimally Invasive (MI) Knee Replacement: Is it

right for you?

Anatomy of the Knee

Made up of three bones: Femur (thigh bone) Tibia (lower leg bone) Patella (kneecap)

A Healthy Knee Joint Knee formed by ends of the

femur, tibia and patella Cartilage provides padding

between the bones and helps assure an effortless, smooth gliding movement of the joint

Joint capsule provides fluid for smooth movement

Causes of Knee Pain

Osteoarthritis (wear and tear)

Rheumatoid arthritis Post-traumatic arthritis

caused by: Fractures Ligament injuries Meniscus cartilage tears

What is Osteoarthritis?

Degenerative condition that is not part of the normal aging process

May result from overuse or injury Most common type of arthritis

The Arthritic Knee

Deterioration of cartilage Bone on bone Spurs, pitting, grinding Deformity Pain, impaired activity

Knee Joint

•Healthy knee joint •Arthritic knee joint

How Can My Life Change with Treatment?

A return to mobility Regaining a sense

of your old lifestyle Reduce or

eliminate pain

Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Can reduce pain, swelling and redness Relief can take several months Examples:

ibuprofen (Advil®, Motrin®) naproxen (Aleve®)

Aspirin Reduce joint pain and inflammation Form of NSAIDs

Common side effects of NSAIDs, aspirin, and acetaminophen are abdominal cramps or

pain, abdominal discomfort, bloating and gas, constipation, diarrhea, dizziness, fluid retention and swelling, headache, heartburn, indigestion, itching, loss of appetite, nausea, nervousness, rash, ringing in ears, stomach pain, and vomiting.

Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Medications

Acetaminophen Reduces pain and lowers fever Does not decrease or reduce inflammation of arthritis Examples:

Tylenol® Datril® Extra Strength Tempra®

Common side effects of NSAIDs, aspirin, and acetaminophen are abdominal cramps or pain, abdominal discomfort, bloating and gas, constipation, diarrhea, dizziness, fluid retention and swelling, headache, heartburn, indigestion, itching, loss of appetite, nausea, nervousness, rash, ringing in ears, stomach pain, and vomiting.

Non-Surgical Treatment Options for Knee Pain: Prescription Medications

NSAIDS Most popular type for osteoarthritis treatment

Analgesics

Provide pain relief, but do not reduce inflammation

Non-Surgical Treatment Options for Knee Pain: Prescription Medications

Biological Response Modifiers Treat rheumatoid arthritis May postpone injury to the joints

Glucocorticoids or Corticosteroids Treat rheumatoid arthritis Fight inflammation

DMARDS Treat rheumatoid arthritis Slow joint destruction

Every drug has possible side effects. Be sure to talk with your doctor about possible side effects before taking a new medication. If you notice a side effect, contact your doctor immediately to discuss whether or not you should continue to take that medication.

Non-Surgical Treatment Options for Knee Pain: Injection Therapy

Cortisone Injections Helps reduce swelling and discomfort from arthritis Temporary pain relief Risk of infection Following the injection, there may occasionally be increased pain or an

inflammatory reaction to the injected medication

Hyaluronic Acid (HA) Injections Restores lubrication and fluid in the joint Creates a shock absorber between the bones Risk of infection Following the injection, there may occasionally be increased pain or an

inflammatory reaction to the injected medication.

Non-Surgical Treatment Options for Knee Pain

Lifestyle Changes Diet and exercise to control weight

Orthotics Assistive devices (walker, cane, etc)

Walking Bathrooms Climbing Dressing

Surgical Options for Knee Arthritis Arthroscopy

Debridement Meniscectomy Chondroplasty

Osteotomy Bone cut and re-aligned onto remaining good cartilage

Arthroplasty (Joint Replacement) Uni-compartmental knee replacement (partial knee

replacement) Tri-compartmental knee replacement (total knee

replacement)

Arthroscopic Debridement“clean out” or “scrape bone”

Somewhat unpredictable results

50 to 66 percent get relief for some period of time

Pain relief may be temporary Best for patients with

mechanical symptoms (catching, locking and giving out)

Knee OsteotomyRe-align weight-bearing axis through “good” cartilage

Most popular before success of contemporary knee replacement

Useful for patients too young, heavy or active for knee implants

Early results acceptable, questionable durability

End-Stage Osteoarthritis Knee Replacement“Gold Standard of Care”

Uni-compartmental Knee Replacement “Uni,” “partial replacement” or

UKR

Tri-compartmental Knee Replacement “Total replacement” or TKR “Minimally invasive” or MITKR

Total Knee Replacement

Total knee is affected by arthritis

Reduce knee pain Improve the motion Continued

advancements in technology, materials, and designs

Total Knee Replacement

Resurface joint with 3 components Implant materials include:

Cobalt chrome Titanium alloy Ultra high molecular weight polyethylene (medical

grade plastic)

Preserve bone, ligaments, tendons

Background on Minimally Invasive Knee Replacement

Continued evolution to refine techniques to improve safety and cosmetics

Smaller incisions Sparing key tendons and muscles Uses traditional implants

Difference Between Traditional and Minimally Invasive Knee Replacement

Traditional Proven clinical success

for decades Full visualization of

tissues Larger incision

Minimally Invasive Clinical studies in

evaluation Potentially less tissue

dissection Smaller scar

Minimally Invasive Knee Replacement

Same implants as traditional knee replacements

Components Femoral Tibial Patellar

Reduced tissue trauma

Ideal Candidate for Minimally Invasive Knee Replacement

Suffering from arthritis and failure to respond to: Medication/injection Weight management

Considerations Medical History Weight Severity of Arthritis Condition of skin Age Activity level

Potential Benefits of Minimally Invasive Knee Replacement

Less trauma to the knee Less bleeding Less pain Cosmetically appealing (smaller scar) Shorter hospital stay Quicker recovery than traditional total knee

replacement

Potential Complications and Risks

Factors that effect risks: Skill of the surgeon Age, weight and health of the patient Patient compliance

Surgical Procedure

Incision is made. Damaged bone surfaces from the femur, tibia

and patella, as well as worn-out cartilage are removed.

Precision instruments and guides help surgeons make cuts at the correct angle.

Surgical Procedure

An implant is attached to each of the three bones (femur, tibia, and patella)

Implants are designed to mimic a healthy knee.

Incision is closed.

The Future of Minimally Invasive Knee Replacement

Evolving Clinical studies under way May be enhanced with computer assisted

surgery