Surgery for Knee Pain

Advances in knee surgery mean recovery is quicker.

If your knee pain doesn’t go away following other prescribed treatments, your doctor may recommend surgery. Which type of surgery you have will depend on your particular injury or condition.

Surgery is often used to treat knee pain due to a mechanical problem, such as a torn cartilage or ligament, or to treat knees that are ravaged by osteoarthritis.

Surgery for Knee Pain Due to Injury

Arthroscopy is a procedure in which your orthopedic surgeon uses a small camera to both diagnose and treat knee pain.

“Arthroscopy is usually used for a mechanical problem, such as a torn meniscus or ligaments,” says William Bargar, MD, director of the Joint Replacement Center at Sutter General Hospital in Sacramento, Calif., and a spokesperson for the American Academy of Orthopaedic Surgeons. “When you have these kinds of problems, there are typically loose pieces of cartilage in your knee joint, and taking them out is helpful. There’s also a role for arthroscopy for other conditions, such as ligament reconstructions.”

Arthroscopic knee surgery is typically done as an outpatient procedure and lasts less than an hour. After going home, most people are able to walk unassisted, but it can take up to eight weeks until your knee is completely back to normal.

Knee Pain: Surgery for ACL Tears

Anterior cruciate ligament (ACL) tears are quite common and are treated by replacing the torn ligament with a graft made of tendon, which comes from a hamstring tendon autograft, a patellar tendon autograft, or a quadriceps tendon autograft. An autograft means the tissue is taken from a part of your body and used elsewhere in your body. An alternative method is called an allograft, in which the graft comes from a cadaver.

Knee Pain: Joint Replacement Surgery

For knee pain due to arthritis, joint replacement surgery has become more common in recent years.

“Anytime you talk about replacing a joint, people get nervous because they think you are going to take out the whole joint,” says Dr. Bargar. “We actually just resurface the joint because the cartilage has worn away. The goal is to resurface that joint so the bearing surface is metal against plastic. We only take away a tiny bit.”

After removing the damaged bone and cartilage, your surgeon will position the new metal and plastic joint surfaces to restore your knee alignment and function.

If your knee pain is caused by a single compartment in your knee, you may be a candidate for unicompartmental, or partial, knee replacement surgery. Not too long ago, this type of surgery was used only for thin, older people who were not very active.

“Some really exciting things are going on with partial knee replacements,” Bargar says. “We’re changing our indications. If you compare partial and total knee replacements, total generally has worked better. But over the last six to eight years, there’s big emphasis on doing less invasive surgeries. Doctors have changed their thinking. If most of the wear is in one compartment, we can think about doing a partial replacement. Now, if you do a partial in a younger patient, we think of it as a staging procedure. It will last 10 to 15 years and then we’ll have to do a total knee replacement. Patients like the idea of a staging procedure, and that’s why we’re seeing more partial knee replacements.”

Ultimately, the decision to have a partial vs. total knee replacement for knee pain caused by osteoarthritis depends on the level of damage to your knee. If there is more than one compartment involved, you’ll need a total knee replacement.

Bargar advises that if you have knee pain and are considering any kind of surgery, it’s important to ask your surgeon how many procedures of your particular kind he has performed. “Joint replacement is technically challenging, and you should go to someone who has done at least 50 per year,” he says.

Other Types of Knee Pain Surgery

• Autologous chondrocyte implantation (ACI): This is a procedure in which new cartilage is grown and implanted in your knee. “It involves harvesting cartilage cells, growing them, and then reinjecting them under a flap in the area of concern,” Bargar says. “It’s certainly not highly successful, but it’s worth trying in a younger patient when you don’t want to get into a joint replacement.”
• Abrasion arthroplasty osteotomy: This procedure is usually done to realign the joint if you have bow legs or knock-knees. “If you have a deformity, you wear away part of the joint resulting in osteoarthritis,” Bargar says. “We cut the bone above or below the joint and realign the leg. It’s designed to realign the extremity and to shift the weight load.” But, as knee replacement surgery has improved, you don’t see as many osteotomies,” says Bargar. More people — young and old — tend to have joint replacement surgery, since success rates of osteotomy are about 80 percent and success rates for a joint replacement are 95 percent, says Bargar.
• Abrasion arthroplasty: A type of arthroscopic surgery, abrasion arthroplasty is sometimes used to treat knee pain associated with arthritis. “We would abrade the area where the cartilage is lost, trying to break through the bone to get some fibrocartilage growing and regenerating. It’s not very helpful, but some people still use it. It was commonly used when people used to do arthroscopy for arthritis, but nowadays you don’t see as much of it,” says Bargar.

Regardless of the type of surgery used to treat your knee pain, pain management with medication, specific exercise, and therapy will have you on the road to a relatively quick recovery. “We can get patients through surgery a lot more easily today,” Bargar says. And that is good news for the millions of people living with knee pain.