Professor Phil Turner
President of the British Orthopaedic Association and specialist knee surgeon
Once arthritis has developed and non-operative measures have failed, what can be done for younger patients? Professor Phil Turner explains how outcomes have improved for young sportsmen and women suffering with knee arthritis.
Patients are being diagnosed with knee arthritis at an increasingly younger age. This seems to be largely due to sports-related knee injuries where the cartilage – properly called the meniscus – has been torn or removed. These cartilage structures are important for the health of the knee and we now make every attempt, if possible, to repair them rather than remove them. Once arthritis has developed and non-operative measures have failed, what can be done?
Once damaged, joint surfaces cannot be returned to normality
Despite interesting and promising advances in attempts to regenerate worn or damaged joint surfaces, they cannot be returned to normality. The future may lie with the injection of “growth factors” or stem cells along with replacement or transplants, but we are not there yet. For now, the focus is on overcoming symptoms and improving function for as long as possible while taking the least risk.
Usually the damaged cartilage is on the inner side of the knee and so subsequent arthritis produces a bow-leg deformity. This will overload the worn part of the knee even more and the situation simply gets worse.
Increasingly, an operation called an osteotomy is used to correct the alignment in the young and active patients where a joint replacement can leave the patient dissatisfied and at risk of early failure. These patients are typically in their forties and fifties who want to continue to play sport and lead a very active life. Using modern technology, we hope that we can buy 10-to-15 years before they will need a knee replacement.
Partial or total knee replacement?
With more advanced arthritis or in older age groups, a decision needs to be made between a partial or total knee replacement. Only a percentage of people will be suitable for a partial replacement and for them there may be advantages of better function and a reduced risk of complications such as infection.
However, partial replacements need to be re-done more often than total knee replacements either because of failure or progression of arthritis in the rest of the joint. New advances, such as robotics, may eventually lead to better results and less risk of failure.
Making the right decision about when to have surgery and what sort of operation should be done depends on the underlying problem and the patient’s expectations. A surgeon will take time to explain the options and the risks and benefits for each individual.
The results of knee surgery for arthritis have improved immeasurably over the last 30 years and the vast majority of patients will achieve a high level of activity for the rest of their lives. We all look forward to the progress to be made over the next 30 years.