From the Guidelines
Total knee arthroplasty (knee replacement surgery) is the definitive treatment for severe end-stage osteoarthritis (OA) of the left knee that has not responded to conservative measures. This recommendation is based on the most recent and highest quality evidence available, which suggests that knee replacement surgery is a safe and effective treatment for improving quality of life, reducing pain, and improving function in patients with severe OA 1.
Treatment Options
When considering treatment options for severe end-stage OA of the left knee, the following should be taken into account:
- Pain management: acetaminophen (up to 3000mg daily in divided doses) and NSAIDs like naproxen (500mg twice daily) or celecoxib (200mg daily) if tolerated, as well as topical NSAIDs such as diclofenac gel 1% applied to the knee four times daily 1.
- Intra-articular corticosteroid injections (such as methylprednisolone 40-80mg or triamcinolone 40mg) may provide temporary relief for 1-3 months 1.
- Physical therapy focusing on quadriceps strengthening, low-impact exercises, and gait training is essential to maintain function 1.
- Weight loss of even 5-10% can significantly reduce knee pain if the patient is overweight 1.
- Assistive devices like a cane (used in the opposite hand) or knee brace can improve mobility and reduce pain 1.
Considerations
It is essential to consider the individual patient's factors, such as age, comorbidity, and the presence of inflammation, when tailoring treatment for knee OA 1. Optimal management of knee OA requires a combination of pharmacological and non-pharmacological treatment modalities 1.
Surgical Intervention
Joint replacement should be considered for refractory pain associated with disability and radiological deterioration 1. The effectiveness of total knee replacement (TKR) in knee OA has a well-established place in those severely incapacitated, with good or excellent outcomes for pain and function reported in 89% of people up to five years after surgery 1.
From the Research
Treatment Options for Severe End-Stage Osteoarthritis (OA) of the Left Knee
- Surgical treatments for knee OA include:
- Arthroscopy
- Osteotomy
- Knee arthroplasty 2
- The goal of osteotomy for unicompartmental knee OA is to transfer the weight load from the damaged compartment to undamaged areas, delaying the need for joint replacement 2
- Total knee arthroplasty can be a safe, rewarding and cost-effective treatment for patients with severe OA 2, 3, 4
- Unicompartmental knee arthroplasty and patellofemoral replacement can be successful in selected patients with isolated medial or patellofemoral OA 2
- Total joint arthroplasty represents the only valuable, established surgical option for severe, end stage OA, providing considerable pain relief, functional restoration, and improved quality of life 4
- Surgical referral for knee joint replacement can be considered for patients with end-stage OA after using all appropriate conservative options 5
Considerations for Treatment
- Determining the most appropriate surgical procedure depends on several factors, including the location and severity of OA damage, patient characteristics and risk factors 2, 6
- Arthroscopic lavage and debridement do not alter disease progression, and should not be used as a routine treatment for the osteoarthritic knee 2, 6
- Bone marrow stimulation techniques such as microfracture are primarily used to treat focal chondral defects, but the evidence for their use in knee OA remains unclear 2
- Osteotomies and different cartilage repair procedures can be used to postpone OA, but the scientific clinical evidence in favour of this type of surgery is considerably reduced 4