In most cases of joint degeneration, surgical intervention will be the appropriate means to long-term relief and mobility. There are several different surgeries which you and your surgeon may consider, depending on the specifics of your condition. Total knee arthroplasty (total knee replacement surgery) is the most severe knee surgery and is performed when the joint has degenerated beyond a tolerable point.
For knees that have not yet reached that point or for patients with meniscal tears or other non-bony orthopedic knee issues, arthroscopy or osteotomy might be more appropriate than a total knee arthroplasty.
In a knee arthroscopy, a surgeon will look inside the knee joint, repair torn ligaments and remove damaged parts. Two or three very small incisions are made on the front of the knee. A fiber optic camera is inserted through one incision. A surgical instrument is inserted through the other incision.
The surgeon can then examine and repair the knee. Knee scopes are most often performed for meniscal tears (torn cartilage). A degenerative tear can be debrided (cleaned up) during the arthroscopy. A traumatic sports-related tear can be debrided or repaired via arthroplasty.
Because of the minimal soft tissue damage resulting from from an arthroscopy, recovery is relatively quick. It is a relatively easy surgery and most patients go home immediately after the scope. Patients will typically be able to resume normal activity and return to work within two or three weeks. The knee will be swollen for less than a week.
Knee osteotomy is a surgical procedure in which the surgeon removes or adds a wedge of bone to the top of your tibia (shinbone) or the bottom of your femur (thighbone). This provides a less worn area of articular cartilage to the weight bearing part of the joint.
Osteotomy is typically recommended for those with arthritis damage in just one area of the knee. Arthritis on just one side of the knee can cause the knee to bow inward (valgus deformity) or outward (varus deformity). This can be corrected by the removal or addition of a wedge of bone. (Traumatic injury or even birth defects can also cause misalignment for which osteotomy is an appropriate surgical intervention.)
Many patients who undergo knee osteotomy will eventually need a total knee replacement. The osteotomy will buy them a varying amount of time before the need for total joint replacement becomes necessary.
One of our forum members produced these informative videos about HTO (high tibial osteotomy):
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