What is knee arthritis?
What is arthritis of the knee?Arthritis of the knee is a disease which wears away the cartilage between the femur (thigh bone) and the tibia (shin bone) causing the two bones to scrape against each other, raw bone on raw bone. When this happens, the joint becomes pitted, eroded and uneven. The result is pain, stiffness and instability. In some cases, motion of the leg may be greatly restricted.
OsteoarthritisOsteoarthritis, which is the most common form of arthritis in the United States, is degenerative and, although it most often occurs in patients over the age of 50, it can occur at any age, especially if the joint is in some way damaged.
It is usually confined to the large weight-bearing joints of the lower extremities, including the hips and knees, but may affect the spine and upper extremity joints, too. Patients with osteoarthritis often develop large bone spurs, or osteophytes, around the joint, further limiting motion.
Unlike osteoarthritis, which is a "wear and tear" phenomenon, rheumatoid arthritis is a chronic inflammatory disease that results in joint pain, stiffness and swelling. The disease process leads to severe, and at times rapid, deterioration of multiple joints, resulting in severe pain and loss of function.
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Knee Arthritis Treatment
Knee arthritis (Osteoarthritis) is one of the leading causes of disability in the United States. Knee arthritis develops slowly and the pain it causes worsens over time. Although there is no cure, there are numerous treatments to help. Injections called viscosupplementation may be helpful.
Viscosupplementation is typically recommended for patients whose pain continues to limit their activities after nonsurgical treatments have been exhausted. In this injection, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring lubricant found in the fluid surrounding joints. Hyaluronic acid enables your bones to move smoothly over each other and it acts like a shock absorber for your joints.
Adding hyaluronic acid to your arthritic knee joint will facilitate movement and reduce pain. You may be given one to five shots over a period of several weeks. If the injections are effective they may be repeated after a period of time, usually 6 months.
Knee arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside your knee. In an arthroscopic knee examination, an orthopaedic surgeon makes small incisions in the patient’s skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the knee joint.
By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the knee joint through this very small incision rather than a large incision needed to open the knee. Arthroscopy of the knee can diagnose and repair Meniscal (cartilage) tears, worn or injured areas of your cartilage cushion, and ligament tears.
One of the most common knee injuries is an ACL (anterior cruciate ligament) sprain or tear. Athletes who participate in sports like soccer, football, and basketball are more likely to injure their ACL. ACL tears are frequently caused by:
- Changing direction rapidly.
- Stopping suddenly.
- Slowing down while running.
- Landing from a jump incorrectly.
- Direct contact or collision.
When you injure your ACL, you might hear a “popping” noise and you may feel your knee give out from under you. This injury can also be associated with significant swelling within the knee joint. Other common symptoms of an ACL tear include:
- Loss of full range of motion of your knee.
- Tenderness along the knee joint line.
- Discomfort or pain while walking.
- Pain combined with swelling. When you tear your ACL your knee will typically begin swelling within 24 hours.
NOTE: It is possible for the swelling and pain may subside on its own, but if you attempt to return to sports activities:
- Your knee will probably be unstable.
- Your risk causing further damage to the cartilage (meniscus) of your knee.
Knee Ligament Injuries
Knee ligament injuries are also very common sports injuries and can range from sprains to tears. The knee is the largest joint in your body and one of the most complex. It is also vital to movement. Three bones meet to form your knee joint: your thighbone, shinbone, and kneecap.
Your knee ligaments connect your thighbone to your lower leg bones. Because the knee joint relies on these ligaments and surrounding muscles for stability, it is easily injured. Common causes of knee ligament injuries include:
- Direct contact to the knee.
- Hard muscle contraction.
- Changing direction rapidly while running.
It is possible to injure two or more knee ligaments at the same time. Multiple ligament injuries can be severe and have serious complications.
Partial knee replacement
Bone and ligament sparing partial knee replacement
Partial knee replacement
Partial knee replacement has been around as a surgical option since the 1970s. Today, partial knee replacement with the JOURNEY◊ UNI knee implant is a minimally invasive surgical procedure that may provide several key benefits to patients whose arthritis is confined to a single compartment of their knee, have a moderately active lifestyle and are within normal weight ranges.
First, let's discuss what is meant by the term minimally invasive surgery or MIS. To be clear, MIS is still a surgical procedure and therefore carries the same risks associated with other surgeries.
However, because it uses specially designed surgical instruments, MIS wth the JOURNEY UNI implant is able to prepare the bones of your knee and then properly place your new implant using a smaller incision than traditional knee replacement. Also, because the implant only replaces one compartment of your knee, there is less bone removed and typically less disturbance to the tissue surrounding the knee than in traditional knee replacement surgery.
According to the American Academy of Orthopaedic Surgeons, partial knee replacement patients usually spend less time in the hospital, have less blood loss, and return to normal activities sooner than do total knee replacement patients. Partial knee replacement patients may also experience better early flexion, less pain after surgery and more natural feeling outcome.
Potential benefits of JOURNEY UNI knee replacement compared with total knee replacement
- No disruption of the knee cap
- Less blood loss
- Possibility for less post-operative pain
- Faster rehab/recovery time
- Better early range of motion
Important: Individual results may vary.
Important safety notes
Individual results of joint replacement vary. Implants are intended to relieve knee pain and improve function, but may not produce the same feel or function as your original knee. There are potential risks with knee replacement surgery such as loosening, wear and infection that may result in the need for additional surgery. Patients should not perform high impact activities such as running and jumping unless their surgeon tells them that the bone has healed and these activities are acceptable. Early device failure, breakage or loosening may occur if a surgeon's limitations on activity level are not followed.
Talk to your doctor to determine what treatment may be best for you.
- Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res. 1991; (273):151-156
- Based on the JOURNEY UNI surgical technique
All materials copyright © 2023 Smith & Nephew, All Rights Reserved.
Partial Knee Replacement
Thanks to technological advances, more people with knee arthritis are now able to benefit from partial knee replacement instead of total knee replacement. In addition to older Treasure Coast residents, partial knee replacement has grown in popularity among baby boomers. Their active lifestyles can result in wearing out their knees earlier than previous generations.
During knee replacement surgery, damaged bone and cartilage is resurfaced with metal and plastic components. In partial knee replacement only a portion of the knee is resurfaced. Partial replacements are becoming more appealing to patients due to:
- Higher patient satisfaction rates.
- Preserving more normal knee motion.
- Less blood loss during surgery.
- Quicker recovery time.
Since partial knee replacement is done through a smaller incision, patients usually spend less time in the hospital and return to normal activities sooner than total knee replacement patients. Also, because the bone, cartilage, and ligaments in the healthy parts of the knee are kept, many patients report that a partial knee replacement feels more natural than a total knee replacement.
Total Knee Replacement
- Does ongoing knee pain make it hard for you to perform simple daily activities like walking, or climbing stairs
- Do you experience knee pain while you are sitting or lying down?
- Do nonsurgical treatments like medication and using walking support devices no longer help?
- Does your knee pain affect your quality of life?
You may be a candidate for total knee replacement surgery. Knee replacement surgery is a safe and effective procedure to relieve pain, and help you resume normal activities. Improvements in surgical techniques and materials have increased the effectiveness of knee replacement surgery, in fact it is one of the most successful surgical procedures performed today.
Total knee replacement is a popular option among Treasure Coast residents and by over half a million people nationwide. There are three types of arthritis that are the most common cause of chronic knee pain.
- Osteoarthritis – which is typically age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older.
- Rheumatoid Arthritis – which is an inflammatory arthritis. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness.
- Post-Traumatic Arthritis – which can follow a serious knee injury such as a fracture.
Total knee replacement does not actually replace your entire knee joint. Only the surface of the bones are actually replaced. There are four basic steps to a total knee replacement:
- Prepare the bone, the damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal implants to recreate the surface of the joint.
- Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button.
- Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface for comfortable mobility.
You may be a candidate for total knee replacement surgery if:
- Your knee has become bowed or knock-kneed due to severe arthritis.
- Your daily activities are limited due to severe knee pain or stiffness.
- You find it hard to walk more than a few blocks without significant pain.
- You need to use a cane or walker.
- You experience moderate or severe knee pain while resting or sleeping.
- You experience chronic knee inflammation and swelling that does not improve with rest or medications.
- Your knee pain and mobility have not improved after trying cortisone injections, physical therapy, anti-inflammatory medications or lubricating injections.
Good news! Total knee replacement surgery successfully reduces knee pain and improves mobility in over 90% of patients. After total knee replacement surgery we typically recommend that you not participate in high-impact activities such as running, jogging, jumping, or other high-impact sports. After total knee replacement surgery you should be able to enjoy unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.
Discover more. Fear less.
Robotics-assisted knee surgery with Smith+Nephew implants can deliver the ultimate knee replacement experience - a quicker, smoother recovery*1,2†using a naturally shaped knee made from materials designed to last.
Knee replacement has changed-for the better
The earliest knee replacement procedures were performed in 1968 and relied on manual guides and procedures to remove damaged bone and place the implant within the joint.
Over time, more advanced implant techniques were introduced that used long metal alignment rods inserted into the center of the thigh bone (femur). These rods, which help determine the correct anatomic alignment between the knee and hip, provide an attachment point for positioning the surgical cutting guides. Once the bone cuts are made, the surgeon must remove these rods before the new implant can be positioned. More recently, pre-surgery improvements like computerized tomography (CT) scans and magnetic resonance images (MRIs) are now used to help create computer-generated surgical plans for each patient.
However, even with these advances, drawbacks still remain. For example, the use of alignment rods may lead to a risk of surgical complications such as fat embolisms3, CT scans can result in potentially harmful radiation exposure, and pre-surgical MRIs may increase overall costs or add time from consultation to procedure.
The ultimate knee replacement experience
Enter robotics-assisted surgery: combining the advantages of traditional methods with innovations while minimizing the drawbacks to patients. This advanced technology is designed to help your surgeon plan and perform your knee replacement surgery with a greater degree of accuracy than is possible with traditional methods,4-8 and without the need for metal rods, CT scans or pre-surgical MRIs. Smith+Nephew, the only company offering handheld robotics assisted technology for partial and total knee replacements, believes this enhanced level of accuracy can give you a better long-term outcome.4-6,9
A unique plan
Your knee replacement surgery is as unique as you are because it's the only one that combines your knee's anatomy with the specific implant your surgeon chooses for you. As a result, your surgery requires an individualized surgical plan to help ensure your implant is positioned and aligned correctly for your anatomy. With robotics-assisted surgery, your surgeon uses the CORI◊ Surgical System to create a customized 3D digital model of your knee. This three-dimensional view helps your surgeon finalize and verify the right size implant for you and create a detailed surgical plan for how your replacement will be placed in order to optimize movement and function. As an added benefit, the 3D digital model eliminates the need to get a CT scan of your knee before your surgery, which reduces your exposure to harmful radiation.
A natural fit
Of course, robotics-assisted surgery is about more than a detailed 3D view of your knee. The CORI Surgical System also helps your surgeon perform the procedure as he/she planned it, giving you the combined benefits of the accuracy of robotics assistance and the skill and training of your experienced surgeon.5,6,10,11
When it comes to knee replacement surgery, accuracy is important because if an implant is positioned incorrectly, it may not function as well as it should nor last as long as possible. In addition to its added accuracy, when robotics-assisted surgical procedures are combined with the wide variety of Smith+Nephew implants available, your surgeon is able to choose the implant which best meets your needs, including options that allow you to keep more of your natural bone and ligaments, including the ACL.12 That means your body can maintain more of its natural rhythm and step.12,13 You may also regain function faster and get discharged from the hospital sooner as compared to conventional technique surgeries.* 13‡
A wide selection
Knee replacement shouldn't be a one-size-fits-all. With the CORI robotics-assisted surgical system, your surgeon is able to choose your implant from the widest selection available.14 Moving beyond the variety of options available, only Smith+Nephew knee implants can be made with a highly durable material called OXINIUM◊ Oxidized Zirconium. This unique, innovative material has been lab tested to last significantly longer than conventional knee implant materials.14,15
Why does my knee hurt?
One of the most common reasons for knee pain is osteoarthritis, also known as "wear and tear" arthritis. This disease often requires treatment using either full or partial knee replacement surgery. Generally speaking, as osteoarthritis progresses it causes the smooth cushion between bones (cartilage) to break down. This loss of cartilage can cause your joints to become swollen, hard to move and painful.17 While there,s no cure for osteoarthritis, there are lots of treatment options, including both surgical and nonsurgical options you should discuss with your surgeon. These include:
- Lifestyle changes that can include weight loss and reducing activities that are stressful on your knee
- Physician-prescribed low-impact exercises and physical therapy
- Medications to decrease swelling and provide temporary pain relief
- Surgical options, such as arthroscopic surgery, and partial and total knee replacement
Which type of replacement is right for me?
Don't limit your options - the CORI Surgical System works with both partial and total knee replacements.
Partial knee replacement
Most often, this procedure is an option for early to mid-stage knee pain and damage. With this type of knee implant your surgeon replaces the area of your knee that is damaged while keeping the supporting tissue and ligaments that help stabilize your knee.
Accurate implant placement is especially important with a partial knee replacement since it requires that your new implant be correctly balanced with your remaining bone and cartilage in your joint. Smith+Nephew offers the only hand-held robotics-assisted system that helps design a surgical plan that allows you to keep as much of your healthy bone and cartilage as possible.
Traditional surgical techniques use mechanical cutting guides, instead of tailoring a surgical plan that's unique to you.
Total knee replacement
Most often, this procedure is an option for advanced knee pain and damage. With this type of knee implant your surgeon replaces the entire knee joint. It's one of the most common procedures performed in all of medicine.
Since no two knee joints are the same, aligning your new knee implant requires your surgeon to match the position with your knee's existing range of motion. The CORI System uses a robotics-assisted, handheld device - adding an additional layer of planning and accuracy directly in the skilled hands of the trained surgeon you trust.
Traditional surgical techniques still use rods and older methodology.
CORI Surgical System
When a highly skilled surgeon is equipped with the latest in robotics-assisted and knee implant technology, you can rest easy knowing you're getting the ultimate knee replacement experience.
The CORI Surgical System uses handheld robotics-assisted technology that helps your surgeon plan and perform your unique procedure. This robotics-assisted approach is efficient and more accurate than traditional knee surgery.5,6,8
At the beginning of your surgery, your surgeon uses the CORI system to create a customized 3D digital model of your knee. This three-dimensional view helps your surgeon finalize and verify the selection of your knee implant and create a plan for your surgery without the need for either a CT scan or MRI.
During the procedure, the CORI system works in conjunction with your surgeon's skilled hands to achieve accurate positioning of the knee implant based on your unique anatomy. 7,10,11,18,20,21 The system sends precise information about your knee to the robotics-assisted handpiece more than 300 times per second, allowing your surgeon to remove damaged surfaces, balance your joint and position the implant with accuracy. 7,10,11,18,20,21
The result is a naturally shaped knee, made from materials designed to last longer, that is positioned with an added level of accuracy to allow for a quicker, smoother recovery*1,2†
Important Safety Notes
Not all patients are candidates for the Smith+Nephew knee products. Knee replacement surgery is intended to relieve knee pain and improve knee functions. Implants may not produce the same feel or function as your original knee, and individual results will vary. Potential risks include loosening, wear and infection that may result in the need for additional surgery. There are risks associated with any surgical procedure including CORI-enabled Knee Replacement. The CORI Surgical System is not for everyone. Discuss your condition and implant options with your surgeon to determine if the CORI Surgical System is right for you. Children, pregnant women, patients who have mental or neuromuscular disorders that do not allow control of the knee joint, and morbidly obese patients should not undergo a CORI-enabled procedure. The information listed in this brochure is for informational purposes and is not meant as medical advice. For more information, please talk to your surgeon.
* Partial knee replacement vs conventional techniques
- Sephton BM, Bakhshayesh P, Edwards TC, Ali A, Kumar Singh V, Nathwani D. Predictors of extended length of stay after unicompartmental knee arthroplasty. J Clin Orthop Trauma. 2019. 11(Suppl 2):S239-45
- Canetti R, Batailler C, Bankhead C, Neyret P, Servien E, Lustig S. Faster return to sport after robotic-assisted lateral unicompartmental knee arthroplasty: a comparative study. Arch Orthop Trauma Surg. 2018;138(12):1765-1771
† n=28 (n=11 robotic procedures)
- Al-Shaer DS, Ayoub O, Ahamed NA, Al-Hibshi AM, Baeesa SS. Cerebral fat embolism syndrome following total knee replacement causing a devastating neurocognitive sequelae 2016 Jul; 21(3): 271-274
- Battenberg AK, Netravali NA, Lonner JH. A novel handheld robotic-assisted system for unicompartmental knee arthroplasty: surgical technique and early survivorship.J Robot Surg.
- Batailler C, White N, Ranaldi FP, et al. Improved implant position and lower revision rate with robotic assisted unicompartmental knee arthroplasty.Knee Surg Sports Traumatol Arthrosc.2019;27:1232.
- Herry Y BC, Lording T, Servien E, Neyret P, Lustig S. Improved joint-line restitution in unicompartmental knee arthroplasty using a robotic-assisted surgical technique.Int Orthop.2017;41:2265-2271.
- Gregori A, Smith JR, Picard F, Lonner JH, Jaramaz B. Accuracy of imageless robotically assisted unicondylar knee arthroplasty. Paper presented at: International Society for Computer Assisted Orthopaedic Surgery (CAOS) 15th Annual Meeting; 2015; Vancover, Canada.
- Bollars P, Boeckxstaens A, Mievis J, Kalaai S, Schotanus MGM, Janssen D. Preliminary experience with an image‑free handheld robot for total knee arthroplasty: 77 cases compared with a matched control group. Eur. J. Orthop Surg Traumatol. 2020;30(4):723-9
- Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why Are Total knee Arthroplasties Failing Today?Clinical Orthopaedics and Related Research.2002;404:7-13
- Bollars P, Boeckxstaens A, Mievis J, Janssen D. The Learning Curve and Alignment Assessment of an Image-Free Handheld Robot in TKA: The First Patient Series in Europe. Poster presented at: 19th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery. 2019; New York, USA.
- Kopjar B, Schwarzkopf R, Chow J, et al. NAVIO Robotic Assisted Surgical System for Total Knee Arthroplasty Using JOURNEY II Guided-Motion Total Knee System. Poster presented at: ISTA 2-5 October, 2019; Toronto, Canada.
- 00225 V3 JOURNEY II Design Rationale 11.17.
- Shearman AD, et al. Robotic-assisted unicondylar knee arthroplasty is associated with earlier discharge from physiotherapy and reduced length of stay compared to conventional navigated techniques. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain
‡ n=62 (31 robotics)
- Smith+Nephew 2020. Comparison of the number of available implants for robotic-assisted knee arthroplasty systems. Internal Report. EO.REC.PCS015.001.v1
- Heyse TJ, Chen DX, Kelly N, et al. Matched-pair total knee arthroplasty retrieval analysis:Oxidized zirconium vs. CoCrMo. The Knee. 2011;18:448-452.
- Papannagari R, Hines G, Sprague J and Morrison M. Long-term wear performance of an advanced bearing knee technology. ISTA, Dubai, UAE, Oct 6-9, 2010
- https://www.arthritis.org/diseases/osteoarthritis. Accessed 22 Oct 2020
- Gregori A, Picard F, Bellemans J, Smith JR, Simone A. Handheld Precision Sculpting Tool for Unicondylar Knee Arthroplasty. A Clinical Review. Poster presented at: 15th EFORT Congress;4-6 June, 2014; London, UK
- Geller JA, Rossington A, Mitra R, Jaramaz B, Khare R, Netravali NA. Rate of learning curve and alignment accuracy of an image-free handheld robot for total Knee Arthroplasty. European Knee Society Arthroplasty Conference;2019; Valencia, Spain.
- Mitra R, Jaramaz B, Nikou C, Kung C. Accuracy Assessment of a Novel Image-Free Handheld Robot for Knee Arthroplasty in Bi-Cruciate retaining knee and total knee replacement - A Cadaveric Study. World Arthroplasty Congress;2018; Rome, Italy.
- Kaper BP, Villa A. Accuracy and Precision of a Handheld Robotic-guided Distal Femoral Osteotomy in Robotic-assisted Total Knee Arthroplasty. European Knee Society Arthroplasty Conference;2019; Valencia, Spain
All materials copyright © 2023 Smith & Nephew, All Rights Reserved.
All materials copyright © 2023 Smith & Nephew, All Rights Reserved.
If you are experiencing chronic knee pain call the Orthopaedic Center of Vero Beach at 772-778-2009 to schedule an appointment. We’ll conduct a thorough examination and determine if total knee replacement might be the best option for you.