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Find the Best Treatment Option for Your Knee Pain

Delivering Top Quality Treatment for Knee Pain

Accurately Diagnosing the Knee Pain Cause
An accurate diagnosis allows physicians to deliver the most appropriate treatment for your knee pain condition. The Total Joint Center team specializes in evaluating, diagnosing and treating a wide variety of knee conditions. As part of your initial evaluation the orthopedic specialist reviews your medical history, performs a physical examination, tests your range of motion, and muscle strength. If necessary, further diagnostic imaging studies, X-ray, MRI, arthrogram, or galdolinium scan, may be ordered.

Non-surgical Treatment Options for Knee Pain
Many soft-tissue knee injuries can be treated using non-surgical techniques. However, a tear or rupture usually will not heal without surgical intervention to alleviate chronic pain. Some common physical therapy techniques for knee pain can control inflammation and help control pain. But if pain persists more than a week or is disabling, individuals should seek medical assistance and evaluation.

Non-surgical Treatments
• Bracing
• Compression
• Cortisone injection
• Elevation and rest
• Fluid removal
• Heat therapy/Cold therapy
• Over-the-counter pain medicine
• Physical therapy
• Weight loss

Procedures for Knee Replacement
When non-surgical treatments do not work or your injury is disabling, your surgeon will work with you to select the best least invasive treatment option for an optimal outcome. Orthopedic surgeons at the Saint Francis Total Joint Center offer many effective treatment modalities.

Knee Athroscopy: Using an arthroscope, a fiber optic telescope, inserted into knee joint, surgeons are able to see knee damage and may also be able to repair damage or remove irritating particles. Arthroscopy requires 3 or 4 entry incisions which can be closed with little or no scaring.

Robotic Assisted Partial Knee Replacement: Using a robotic arm, the surgeon resurfaces the diseased portion of the knee, sparing your healthy bone, ligaments, tendons, and surrounding tissue. An implant is then secured in the joint to allow the knee to move smoothly again.

Minimally Invasive Total Knee Replacement: When the knee joint is beyond repair, sometimes a total knee replacement is the only alternative. 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 surgery (MIS) techniques are used with clinically proven implants and can shorten recovery times, reduce the length of time 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.

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, or other conditions. By placing the components in the right position, prosthesis wear is decreased.

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.

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.

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