FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

"ARTHRITIC KNEE" CAN OFTEN BE REPAIRED BY ARTHROSCOPIC SURGERY

Question: I'm 61-year-old man, and I've been having trouble with my knees for the past year or so. My family doctor says I have arthritis and wants me to see a specialist for an arthroscopic surgery. She told me that she thought I might be a good candidate for this type of surgery. Can you explain to me what arthroscopic surgery is?

Answer: Thirty years ago arthroscopy was developed as a tool to diagnose joint problems -- particularly those in the knee. Today it can be used to diagnose and repair injuries in virtually any of the bodyÕs major joints.

An arthroscope is a slender tube-shaped surgical instrument that uses fiber optics to capture a TV image. The surgeon passes it through a small skin incision then deeper into the joint itself to actually look for the cause of the joint problem. Then other specially designed instruments are inserted through additional small incisions to complete the operation.

An advantage of arthroscopic surgery is that the small incisions usually heal very quickly, often allowing daily activities to be resumed within a few days or weeks. This is beneficial for those with arthritis, like you, but also for people suffering sports injuries.

Arthritis, as in your case, most commonly affects the knee joint. This degenerative disorder involves damage to the bones and also changes in the protective layer of cartilage that covers the joint surfaces. While 100 percent of those over age 60 have damage to the knee cartilage, you are in the unlucky 2 percent that actually have clinical problems with their knees. For these folks, arthroscopy is often very helpful in both diagnosing and treating their sore joints.

Arthroscopic surgery for knee problems caused by injury to cartilage can involve removing loose fragments of bone or cartilage from the joint as well as trimming away or reshaping damaged areas of cartilage. This can help reduce the pain and decreased range of motion that are typical of arthritis. Unfortunately, it does not permanently cure the underlying arthritic condition.

A more curative approach is possible in some cases where the damage is not too severe -- but usually only in those under 30. In this procedure the surgeon transplants cells into the joint that grow new cartilage. These cells -- called chondrocytes -- can then set about the task of repairing the damaged areas.

Unfortunately, arthroscopic surgery isn't appropriate for all types of arthritic joint damage. Occasionally benefit can be provided by the more traditional joint surgery involving bigger incisions and larger surgical tools. Hopefully, your family doctor is correct, and you are a good candidate for arthroscopic surgery.

One final word about knee surgery. Though it doesn't sound likely in your case, many people with arthritic knees have to eventually undergo knee replacement surgery, in which the damaged joint is replaced with an artificial one. Bone, metal, ceramic and plastic parts have all been used. Metal parts for knee replacement are currently the most popular. Though this surgery is quite dramatic in its approach, it is also usually quite successful.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.