TREATMENTS
Knee osteoarthritis
Knee osteoarthritis, also known as gonarthrosis, is a degenerative disease or due to previous injuries.
KNEE OSTEOARTHRITIS IN FIGURES
%
affects 10% of people over 60 years of age
%
affects 20% of people over 70 years of age
of the main causes of disability and absenteeism.
%
of people with osteoarthritis have functional and occupational limitations.
knee prostheses per year in Spain (almost 3 million in the world)
Knee osteoarthritis
It is characterized by progressive wear and tear of the articular cartilage that causes pain, stiffness and decreased mobility.
DESCRIPTION
What is osteoarthritis of the knee?
Osteoarthritis is one of the leading causes of disability in older adults.
It can also affect younger people due to factors such as previous injuries, old surgeries, obesity or genetic predisposition. It is the result of a cascade of injuries that involve the meniscus, ligaments, cartilage until it causes bone deformity.
SYMPTOMS and diagnosis
Symptoms that may appear
Localized pain
Especially during physical activity or weight bearing.
Crepitation
Noise or sensation of friction, when moving the joint.
Limitation of movement
Both in flexion and extension.
Swelling
Or signs of inflammation, although these are usually less marked than in inflammatory diseases such as rheumatoid arthritis.
Joint deformities
Such as varus (bowlegged) or valgus (X-legged) deviations.
Lameness
Due to multiple causes (pain, deformity, instability, among others).
Imaging and laboratory tests help to confirm the diagnosis and assess the degree of involvement:
X-rays
They are the main tool to observe joint space loss, osteophyte formation and bone sclerosis.
Magnetic Resonance Imaging (MRI)
Indicated in selected cases, it allows the evaluation of cartilage, meniscus or associated ligament injuries.
Ultrasound
Useful for assessing joint effusions or periarticular structures.
Synovial fluid analysis
In cases of diagnostic doubt, it helps to rule out other causes such as infections or inflammatory arthritis.
DEGREES OF KNEE OSTEOARTHRITIS
Kellgren and Lawrence classification
Grade 0 (Normal)
It extends along the meniscus, parallel to its curvature.
Grade 1 (Doubtful)
Minimal osteophytes, without clear symptoms.
Grade 2 (Mild)
Obvious osteophytes, slight narrowing of joint space, mild pain
Longitudinal breakage
It extends along the meniscus, parallel to its curvature.
Grade 3 (Moderate)
Erash, large osteophytes, moderate pain and stiffness.
Grade 4 (Severe)
Complete loss of joint space, deformity, constant pain and severe functional limitation.
*Osteophyte: Is an abnormal bone formation (bone spur) that appears at the edges of a joint due to joint wear and tear, as in osteoarthritis. It may cause pain, stiffness or limit movement.
treatments
Conservative treatment
Initial treatment of osteoarthritis of the knee focuses on relieving symptoms and improving joint function without resorting to surgery. It includes:
Patient education
Information about the disease and modification of activities to avoid joint overuse.
Weight loss
Reducing body weight significantly reduces the load on the knee and relieves pain.
Physical exercise
Muscle strengthening programs, especially of the quadriceps, and low-impact exercises such as swimming, cycling, elliptical or yoga.
Physiotherapy
Modalities such as manual therapy, ultrasound or local heat may be helpful.
Drugs
Analgesics (paracetamol) or non-steroidal anti-inflammatory drugs (NSAIDs)
Infiltrations
Hyaluronic acid, PRP or intra-articular corticoids.
Surgical treatment
When conservative treatment is not sufficient and the patient’s quality of life is severely affected, surgical options are considered:
Arthroscopy
Indicated in very specific cases with mild pain and only meniscus or cartilage injury.
Osteotomies
Recommended in young patients with varus or valgus deformities, in order to redistribute joint load.
Knee prosthesis
Total or partial arthroplasty is the definitive option for advanced cases, achieving significant pain relief and functional improvement.
TYPES OF PROSTHESES
Total knee prosthesis
It is a surgical procedure in which all the damaged articular surfaces of the knee (femur, tibia and, sometimes, patella) are replaced. It is indicated in cases of advanced osteoarthritis affecting the entire joint.
Advantages
- Relieves severe pain.
- Improves functionality and corrects deformities.
Inconveniences
- Slower recovery (3-6 months).
- Risk of complications such as infection or loosening of the implant.
Partial knee prosthesis
Replaces only the damaged compartment of the knee (medial, lateral or patellofemoral). Indicated in cases of localized osteoarthritis.
Advantages
- Less invasive surgery.
- Faster recovery.
Inconveniences
- Not suitable for advanced generalized osteoarthritis.
- Risk of progression of osteoarthritis in other areas.
Types of implants
The choice of treatment should be individualized, considering the patient’s needs and expectations, as well as the degree of joint involvement. Comprehensive and multidisciplinary management is key to optimize results and improve quality of life.
HTH patellar tendon plasty
It is one of the most common grafts and consists of taking a segment of the patient’s own patellar tendon (central portion of the tendon, including bone at both ends).
Advantages:
- Good integration and healing
- High success rate and knee stabilization.
Disadvantages:
- Pain in the donor site
- Long longitudinal incision
Prosthesis with cruciate ligament retaining (CR - Cruciate Retaining)
- Preserves the posterior cruciate ligament (PCL), providing natural stability.
- Indicated in patients with functional ligaments and good stability.
Medial pivoting prosthesis (MP - medial pivoting)
- Reproduces the native kinematics of the knee preserving the pivot movement.
- Possibility of implanting the femoral component without cement.
- Indicated for young and active patients.
Prosthesis with cruciate ligament replacement (PS - Posterior Stabilized)
- Replaces the PCL with a design that includes a post and box on the femoral and tibial components.
- Indicated in patients with instability or absence of PCL.
Longitudinal breakage
It extends along the meniscus, parallel to its curvature.
Semi-constrained prosthesis (CCK -Constrained Condilar Knee)
- This configuration allows us a certain rotational stability and a discreet medio-lateral stability.
- When the ligament complex is not fully competent or there are difficulties to compensate the spaces in extension and flexion, such as severe bone deformities.
High constriction or hinged prostheses
- The femoral and tibial components are joined by a hinge mechanism and are also indicated in elderly patients with severe varus or valgus deformities where adequate ligamentous balance is difficult to achieve.
RESULTS OF KNEE PROSTHESIS IMPLANTATION
Implant survival
The survival of a knee prosthesis refers to the time it remains functional without the need for surgical revision:
- At 10 years: 90-95% survival rate.
- 20 years: Approximately 85%.
- Factors affecting longevity:
- Age of the patient (implants in young patients have a higher risk of wear).
- Level of physical activity (increased use may shorten the service life).
- Surgical technique and implant quality.
Patient satisfaction
- Overall rate: Between 80-90% of patients are satisfied after surgery.
- Positive factors:
- Significant pain relief.
- Improved mobility and quality of life.
- Factors associated with dissatisfaction (10-20%):
- Persistence of residual pain.
- Unfulfilled expectations (limited movements in specific activities).
- Postoperative complications such as infection or joint stiffness.
Video rights Dr. Cory Calendine MD
In general, knee prostheses are highly effective in relieving pain and restoring function. Proper patient selection and expectation management are key to optimizing outcomes.
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