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Total Joint Center


For Knee Pain


Our Diagnostic Services
It is important to get an accurate diagnosis of the cause of your knee pain so that you can receive the correct treatment. At the Total Joint Center, we specialize in evaluating and diagnosing knee problems.

As part of your evaluation and diagnosis, the doctor will review your history; why are you coming to see the doctor? When and how did your knee pain start? In addition, the doctor will perform a physical exam. To perform the physical exam the doctor needs to move your knee through its range of motion and test the strength of your muscles.

As a result of the exam the doctor may ask you to have an x-ray, an MRI (Magnetic Resonance Imaging), an arthrogram or an aspiration arthrogram, or a gadolinium scan. These tests will help the doctor make a differential diagnosis (If you already have x-rays, please bring them with you).



Procedures for Knee Replacement
The Total Joint Center is dedicated to the care and treatment of knee pain. Our orthopedic surgeons offer many effective treatment modalities and always utilize the least invasive measures to treat your knee pain.

Total Knee Replacement
Knee replacement surgery has improved markedly over the last 10 years. A total knee replacement is really replacing the cartilage with an artificial surface similar to capping a tooth. The knee itself is not replaced, as is commonly thought, but rather an artificial substitute for the cartilage is inserted on the end of the bones. This is done with a metal alloy on the femur and tibia, placement of a plastic spacer in between and resurfacing of the kneecap. This creates a new, smooth cushion and a functioning joint that does not hurt. Another way to describe the surgery is a knee resurfacing.

A total knee replacement is recommended when a patient has at least two of the following indications:

  • at least two of the three compartments of the knee have moderate to advanced arthritis
  • the pain from arthritis is adversely affecting the quality of the patient's life
  • all conservative measures have failed
  • the patient has osteonecrosis

Minimally Invasive Knee Replacement
MIS techniques are used with clinically proven implants and can shorten recovery times, reduce length of stay in the hospital and result in much smaller scars (3-4 inches versus the standard incision of 6-12 inches).

The instruments used in MIS have been improved and modified to enable surgeons the ability to properly align and place the implants though a much smaller incision. This smaller incision also helps to minimize blood loss and post-surgery pain. All of the surgeons at the TJC utilize the MIS surgery for knee replacement.

Computer Navigated Knee Replacement
Computer navigation uses a GPS system that helps the surgeon align and orient knee implants with the patient’s anatomy. This enables the surgeon to place the prosthesis in a position to give the new knee the best strength, stability and range of motion. Another benefit is less risk of post-op problems due to tendonitis, bursitis, etc.; by placing the components in the right position, wear of the parts is decreased.

UniSpacer
The UniSpacer is a small, metallic, kidney-shaped insert that is intended to restore normal alignment of the knee with medial (inside) compartment arthritis. It restores stability and provides a smooth surface for the bones to glide over when cartilage has been worn away by arthritis or the meniscus is no longer intact.

The UniSpacer is a mobile bearing source that conforms to the bone's structure and stays in place without cement or screws. The surgeon first performs an arthroscopy, cleaning away any unnecessary torn cartilage. Next the surgeon makes a two to three inch incision and removes any bone spurs. The UniSpacer is then slipped into the knee joint between the femur and the tibia.

Unicompartmental knee replacement
Unicompartmental tibio-femoral arthroplasty is the replacement of only the medial or lateral compartments of the knee. This surgery is successful in the younger patient who has arthritic changes in only one compartment of the knee. The surgery is performed through a smaller incision and leads to a rapid recovery, less pain and shorter hospitalization. Many surgeons now prefer this procedure to the osteotomy as an intermediate option in younger, more active patients. 85% to 90% of the unicompartmental knee replacements last 10 years or more. Failures occur from wear of the plastic insert to increased symptomatic arthritis in the other compartments of the knee.

Osteotomy
A proximal tibial or distal femoral osteotomy may be considered for patients with arthritis symptoms limited to the medial or lateral compartments. This procedure attempts to even the load distribution through the knee. The ideal patient for the osteotomy is a young, active patient with mild to moderate mal-alignment and osteoarthritis limited to one compartment. All ligaments must be intact. The pain relief from an osteotomy is incomplete and longevity is limited so that 50% of the patients receiving on osteotomy need a knee replacement after 10 years.

Minimally Invasive Knee Arthroscopy
Knee arthroscopy is a minimally invasive procedure similar to hip or shoulder arthroscopy. A small camera lens, inserted into the knee joint, displays imaging on a television monitor, while surgical instruments are manipulated via a second small incision. The procedure takes less than one hour. Patients go home on crutches that are usually discarded within a few days. Arthroscopy works well with symptomatic meniscal tears, but has mixed results with arthritis. Arthroscopic debridement may provide relief of the early symptoms of arthritis.

Injections
Interarticular corticosteroids are powerful anti-inflammatories. They have been shown to provide relief of painful osteoarthritis of the knee. There is a small risk that the injections can increase the risk of infection should you need to proceed with a knee replacement. This must be weighed against the pain relief that the cortisone shot affords. Cortisone injections should be viewed as conservative treatment for knee pain.

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Saint Francis Memorial Hospital
900 Hyde St
San Francisco, CA 94109
(415) 353-6000