The knee has three individual areas, called compartments, that can be impacted by arthritis or osteoarthritis. One of those areas is the knee cap. Known technically as patellofemoral arthritis, it occurs when the cartilage becomes worn away beneath the kneecap. This creates pain with activity, along with instability. Many of the individuals seen with kneecap arthritis are young – between 30 – 45. Too young to ideally consider a total knee replacement. Often, their arthritic knee and worn cartilage is the result of an earlier traumatic knee injury.
Arthritis in the kneecap has long been a challenge for doctors to effectively treat. First, because it often tends to occur in patients who are too young for a total knee replacement and second, because previous implants and techniques did not lead to ideal outcomes. Today, there are new options and Dr. John Arvesen, an orthopedic surgeon and sports medicine specialist at OrthoTexas, recently had his work published in a national Orthopedic Journal outlining the new techniques available to help these patients.
Individuals with severe or bone-on-bone arthritis in the kneecap usually have alignment issues which cause instability in addition to the pain. In treating these patients, we start with conservative treatments, including: physical therapy, bracing, injections or activity modifications. Sometimes weight loss may be recommended if it is thought that may help relieve extra pressure on the knee.These treatments can often buy some time for the patient before they need to look at other more invasive options.
When these non-operative methods fail to relieve the pain of arthritis, doctors next look at surgical options that can be employed to relieve the pain and keep their patient active. Often, arthroscopic surgery can be considered to “clean out” the knee, and cartilage restoration procedures have also become a popular option, as well as, realigning the kneecap using a procedure referred to as a tibial tubercle osteotomy. Ultimately, however, in patients with bone-on-bone or end stage osteoarthritis, a total knee replacement has been the gold standard to relieve the pain, instability and get people back to all the activities they enjoy. A total knee replacement offers good long-term results.
Because it’s not ideal to have a knee replacement at a young age, doctors continue to look for other better options for treatment. Today, we are able to offer a partial knee replacement for those patients who have arthritis isolated to only the kneecap. The benefit here is that it is a bone-preserving surgery where only a small part of the knee is replaced. A kneecap replacement, along with a bone re-alignment corrects the instability, kneecappain, and osteoarthritis, and at the same time helps the knee feel and function in a more natural way.
Recovery – what can you expect
If you are looking at surgery on your kneecap, the first thing people want to know is -what is the recovery? Following surgery, the patient will wear a hinged knee brace for the first 6 weeks after surgery. The first 2 weeks you can expect to be partially weight bearingbut will progress to full weight-bearing at the end of 6 weeks. For most patients a continuous passive motion device is fitted by a therapist and used to increase range of motion over the next 6 weeks. After 6 weeks you can expect to work with a physical therapist to increase your range of motion and begin strengthening exercises. You may be encouraged to begin the stationary bike or pool therapy and you will begin to walk normally, once again. Over the following 6 weeks, the focus will be to continue to increase activity and intensity and move into the final stage of rehabilitation which focuses mainly on strengthening. At week 20, individuals mayeven begin a gentle jog or running program, if desired. While afull return to sport or activities is different for each person, depending on their goals or level of activity,but it is typically expected at 6 months.
If you are young and have knee pain that is starting to restrict you or your activities because of pain or instability, take the time to see a sports medicine doctor and have it evaluated. Before you know it, you’ll be on the road to recovery and back to doing all the things you love. Dr Arvesen(link: https://www.orthotexas.com/drarvesen/ ) is an orthopedic surgeon at OrthoTexas. He sees patients in the Carrollton office. Dr Arvesen is fellowship-trained in sports medicine and a specialist in treating knee pain.