Vernon Franklin Sechriest II, MD is an orthopedic surgeon and knee specialist with over two decades of experience in treating patients with knee pain and problems. According to Dr. Sechriest for many patients, knee pain does not have to equal total joint replacement. In the following article, Dr. Sechriestt describes several joint-sparing surgical alternatives to total knee replacement. Sechriest refers to these options as the “4 Rs” of joint sparing surgery.
“The 4Rs is a simple concept I use to explain the wide variety of joint sparing surgical options for any knee problem,” says Dr. Sechriest. “No matter how much medicine and technology advance, there remain four basic surgical tactics to treat a knee problem.” Could you benefit from one of these procedures?
Table of Contents
Remove: Arthroscopy
This type of procedure is the least invasive. Using a small camera (i.e. arthroscope) allows doctors to evaluate the cause of a patient’s knee pain and to remove any damaged tissue. This technique also allows the surgeon to determine what further treatment a patient may need. Patients with knee pain related to a torn meniscus or cartilage injury may greatly benefit from the remove technique. Total recovery time after arthroscopic surgery ranges from two to six weeks.
Realign: Osteotomy
Some patients experience knee pain because their joint is not properly aligned. Improper alignment may contribute to poor joint function and pain. In these cases, realignment may be the best treatment option. Physical examination and X- rays are used to diagnose the problem. To restore proper alignment, a surgeon may manipulate the bone, or they may release or tighten soft tissues. “This surgical option may have a longer recovery time because it takes a while for the tissue to heal,” says Dr. Sechriest. “Patients typically require aggressive and prolonged physical therapy after this type of procedure. However, the benefit may be great.” Realignment of the knee can decrease pain and prevent further damage to the joint.
Repair: Preservation &/or Restoration of Cartilage
Some patients with knee pain may benefit from repair of diseased or damaged cartilage. Cartilage transplant can improve and/or restore normal joint function. With this procedure, cartilage defects are repaired using tissue borrowed from other areas of the patient’s own knee, or from a donor. Dr. Sechriest emphasizes that cartilage repair may be ideal for younger patients who aren’t yet ready for a total knee replacement. The recovery time varies based on what area of the knee that you are having repaired.
Resurface: Partial knee Replacement
The resurface option refers to partial knee replacement surgery. The knee has three parts: the femur, the patella, and the tibia. In a total knee replacement, all three parts are replaced and knee ligament(s) are removed. With a partial knee replacement, only one or two of the parts are resurfaced and ligaments are spared. Dr. Sechriest explains, “Compared to total knee replacement, partial resurfacing of the knee typically means less surgery, less risk, less pain, a shorter recovery time, and a more natural-feeling knee.” Patients are able to use their newly resurfaced knee right after surgery.
According to Dr. Sechriest, this procedure can have excellent clinical results and durability. The ideal patient for the resurface option is an active younger person with arthritis who isn’t yet ready for a total knee replacement, or an elderly patient who may not be able to tolerate the major stress of a total knee replacement.
When patients are considering knee surgery, it is important to remember that there are few absolute rules to dictate which of the 4 Rs might be best. For this reason, Dr. Sechriest works with each patient to diagnose their knee problem, learn about their lifestyle, and to understand their expectations before recommending a surgery. “Some patients may benefit from one, two, or even three of the 4 Rs. It’s very individualized care— every patient deserves that,” he says. “Patients are empowered by a better understanding that allows them to effectively participate in shared decision-making about their care.”
As an orthopedic surgeon and knee specialist with a wealth of knowledge and leadership experience, Vernon Franklin Sechriest II, MD, currently serves as the Chief of Staff for the VA Loma Linda Healthcare System.