Click here to view next page of this article



Surgical treatment of knee arthritis may be appropriate if conservative measures fail to control symptoms of pain or instability. Selection of the appropriate intervention depends upon the age, activity status, and life expectancy.


Arthritis of the knee (as with other joints) can be categorized as being noninflammatory or inflammatory in etiology. Noninflammatory arthritis is by far the most common presentation of arthritis in the knee, and typically will present as involvement of one or two of the three compartments of the knee. Osteoarthritis in the knee typically presents with medial hemijoint involvement, although concurrent involvement of the patellofemoral joint.

Noninflammatory arthritic conditions of the knee may be appropriate for surgical interventions such as arthroscopic debridement, cartilage auto- or allograft procedures, osteotomy, unicompartmental arthroplasty, total arthroplasty, or, in rare cases, arthrodesis. In contrast, inflammatory arthritic syndromes are more amenable to surgical interventions such as synovectomy, total arthroplasty, or, very rarely, arthrodesis.


The technique of arthroscopic surgery in the knee has advanced rapidly over the last 15 years. The procedure is now routinely performed as an outpatient, and rehabilitation is relatively rapid compared with previous open arthrotomy.

The power of the arthroscope lies in its ability to provide an accurate diagnosis of the intra-articular structures within the knee joint.

The role of arthroscopy in management of arthritic syndromes.

Arthroscopy for Osteoarthritis of the Knee

Judicious selection of patients is critical to successful outcome of arthroscopic treatment of patients with noninflammatory arthritis of the knee.


Synovectomy of the knee in early inflammatory arthrosis appears to be successful in decreasing swelling and pain, when the underlying disorders are unresponsive to aggressive medical therapy. Indications for synovectomy may


Osteotomy of the knee is an option when noninflammatory osteoarthrosis involves a single weight-bearing compartment of the knee . Alternatives to osteotomy include unicompartmental replacement, total knee arthroplasty.

Valgus Deformities of the Knee

Loss of the lateral articular space of the knee leads to progressive increase in valgus angulation of the femoral-tibial angle. Correction of this deformity by


It is intuitively appealing, when unilateral osteoarthritis exists in the knee, to artificially resurface only the involved portion of the joint. The unicondylar arthroplasty seeks to accomplish this.


Total knee arthroplasty is the current treatment of choice for bi- or tricompartmental osteoarthrosis of the knee and inflammatory arthritis of the knee. Indications for prosthetic knee replacement include pain refractory to medical management, or, more rarely, instability due to bone erosion and malalignment. However, the current limitations of the biomaterials.


Other alternatives in the surgical management of knee arthritis such as fusion, homologous cartilage implantation, and allograft resurfacing are occasionally appropriate to highly selected patients.

Knee Fusion

Fusion of the knee joint may be the treatment of choice for the young, active or heavy patient with end-stage knee arthritis, or in those patients for whom there is a relative or absolute contraindication to prosthetic arthroplasty . Knee fusion is reserved for those patients with unilateral disease, and is also

Cartilage Implantation

The elusive goal of biologic resurfacing of injured articular cartilage has lead to intensive efforts to stimulate and repair both isolated and generalized articular

Allograft Resurfacing of the Arthritic Knee

Gross and his associates have reported the use of fresh, small fragment osteochondral allograft resurfacing of the knee, primarily following traumatic injuries resulting in secondary osteoarthritis . In their series of 91 patients, 75% "success" at 5 years, 64% at 10 years, and 63% success at up to 14 years followup was observed.