Osteoarthritis of the knee

What is osteoarthritis?

Osteoarthritis of the knee

Osteoarthritis of the knee is a condition commonly referred to as "wear and tear" arthritis.

Causes

Although the degenerative process may accelerate in persons with a previous knee injury, many cases of osteoarthritis occur when the knee simply wears out. Some experts believe there may be a genetic predisposition in people who develop osteoarthritis of the knee. Osteoarthritis of the knee is the most common cause for total knee replacement surgery.

Symptoms

The primary symptoms of osteoarthritis are pain in the knee, swelling and stiffening of the knee joint. In the early stages of osteoarthritis the pain may be mainly associated with activity. As the cartilage wears away and the bones of the joint rub against each other, pain can become more severe and constant, interfering with regular daily activities and disrupting sleep.

Treatment

In the early stages of osteoarthritis, treatment may involve several techniques. Behavioral and lifestyle changes including losing weight and changing routines to avoid painful situations can be very effective in relieving pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium may also provide relief from pain. Cox-2 inhibitors are also effective in providing knee arthritis pain relief. Physical therapy may improve muscle strength and joint mobility, reducing the symptoms of osteoarthritis in the knee. Joint fluid therapy may lubricate the knee and reduce the pain and swelling of the joint. Partial or total knee replacement surgery may be necessary as the disease progresses and daily functioning becomes more impaired.


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References

*Journey II BCS.

  1. Hall, et al. Unicompartmental knee arthroplasty (alias uni-knee): an overview with nursing implications. Orthopaedic Nursing. 2004;23(3):163-171. Accessed April 25, 2019.
    • Based on pre-surgical pain levels in UKA patients.
  2. Mayman DJ, Patel AR, Carroll KM. Hospital related clinical and economic outcomes of a bicruciate knee system in total knee arthroplasty patients. Poster presented at: ISPOR Symposium; May 19-23, 2018; Baltimore, Maryland, USA.
  3. Nodzo SR, Carroll KM, Mayman DJ. The Bicruciate Substituting Knee Design and Initial Experience. Techniques in Orthopaedics. 2018;33(1):37-41
    • Compared to non-JOURNEY II knees; Based on BCS evidence
  4. 1Short-term Range of Motion is Increased after TKA with an asymmetric bicruciatestabilized implant.AcceptedPoster Presentation, AAOS 2018 New Orleans. Kaitlin M. Carroll, Peter K. Sculco, Brian CMichaels,RichardL. Murphy, Seth A, Jerabek, David J. Mayman
  5. 2J Orthop. 2017 Jan 7;14(1):201- 206. doi: 10.1016/j.jor.2016.12.005. eCollection 2017. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range
  6.  In Vivo Kinematic Comparison of a Bicruciate Stabilized Total Knee Arthroplasty and the Normal Knee Using Fluoroscopy Trevor F. Grieco, MS a, *, Adrija Sharma, PhD a, Garett M. Dessinger, BS a, Harold E. Cates, MD b, Richard D. Komistek, PhD. The Journal of Arthroplasty, September 2017
  7. Testing concluded at 45 million cycles, ISO 14242-1 and 14243-3 define test completion at 5 million cycles. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.
  8. Iriuchishima T, Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019. doi:10.4103/ortho.IJOrtho_392_18.
  9. Smith JR, Picard F, Lonner J, et al. The accuracy of a robotically-controlled freehand sculpting tool for unicondylar knee arthroplasty. Congress of the International Society of Biomechanics. August 4-9, 2013. Natal, Brazil.
  10. Zardiackas, Lyle D., Kraay, Matthew J., Freese, Howard L, editors. Titanium, Niobium, Zirconium, and Tantalum for Medical and Surgical Applications ASTM special technical publication; 1471. Ann Arbor, MI: ASTM, Dec. 2005

Additional claim statements and support regarding Smith+Nephew implants and Robotics-assisted surgery

  • Implants that are built to last
  • LEGION◊CR Knee with VERILAST◊ technology was lab-tested for 45 million cycles (estimating 30 years of wear performance) and showed 81% less wear than similar 5-million cycle cobalt chrome implant.
    • Learn More
      • ISO 14243-3
      • VERILAST knee wear testing and results apply only to the VERILAST LEGION CR Primary Knee System only. Extended lab-testing for other VERILAST knee systems have not been performed. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.
  • Smith+Nephew implants may offer a more normal feeling knee
    • Based on JOURNEY◊ II BCS knee implant
    • Learn More
      • Verstaete MA, Van Onsem S, Zambianchi F, et al. Multi-centre evaluation of knee kinematics during different activities for anatomic total knee design. Poster presented at: 2nd World Arthroplasty Congress; 19-21 April, 2018; Rome, Italy.
      • Sharma A, Dessinger G, Cates H, Komistesk R. In vivo kinematic comparison for subjects having a bi-cruciate substituting TKA vs the normal knee. Poster presented at: 2nd World Arthroplasty Congress; 19-21 April, 2018; Rome, Italy.
      • Kosse NM, Heesterbeek PJC, Defoort KC, Wymenga AB, van Hellemondt GG. Improved maximal flexion after minor adaptations in implant design bicruciate-substituted total knee arthroplasty. Poster presented at 19th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT); May 30 – June 1 2018; Barcelona, Spain.
  • 89% of patients were able to take the stairs again after surgery.
    • Based on JOURNEY◊ II BCS knee implant patients
      • Iriuchishima T and Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019. DOI:10.4103/ortho.IJOrtho_392_18
  • A robotics-assisted knee replacement with Smith+Nephew implants may get you back in the game six months sooner than traditional knee replacement surgery
    • Based on UKA patients
      • 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
  • Over 90% of patients who had a Smith+Nephew knee replacement surgery returned to work within 6 months.
      • Harris AI, Luo TD, Lang JE, Kopjar B. Short-term safety and effectiveness of a second-generation motion-guided total knee system. Arthroplast Today. 2018;4:240–243. 1
  • Robotics-assisted surgery with Smith+Nephew implants may lead to a faster rehabilitation and shorter recovery time than traditional knee surgery when following your doctor’s recovery plan and physical therapy recommendations.
    • Claim 19 & 20 (PCS REC.015)
  • Due to its improved accuracy, Smith+Nephew robotics-assisted UKA has lower revision rates* compared to conventional techniques
    • Shown in clinical studies with follow-up of up to 5.5 years
      • Batailler C, White N, Ranaldi FM, Neyret P, Servien E, Lustig S. Improved implant position and lower revision rate with robotic-assisted unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2019;27(4):1232-1240.
      • Battenberg AK, Netravali NA, Lonner JH. A novel handheld robotic-assisted system for unicompartmental knee arthroplasty: surgical technique and early survivorship. J Robot Surg. 2019;14(1):55-60.
      • Gregori A. 5 Yr Experience Semi Active Robotic Partial Knee Replacement: The Financial Impact. Poster presented at: SICOT;October, 2018; Montreal, Canada.
  • A study has shown Smith+Nephew robotic technology has demonstrated faster return to sport (4.2 vs 10.5 months) when compared to conventional techniques*
        • *n= 28 (n=11 robotic procedures), p<0.01
          • 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
  • Robotics-assisted surgery with Smith+Nephew implants may help patient get discharged sooner
    • Study of UKA patients
      • Sephton BM, et al. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain.
      • Shearman AD, et al. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain.
  • Robotics-assisted surgery with Smith+Nephew implants may provide patients with a smoother recovery
    • Based on JOURNEY II family of implants
      • Mayman DJ, Patel AR, Carroll KM. Hospital Related Clinical and Economic Outcomes of a Bicruciate Knee System in Total Knee Arthroplasty Patients. Poster presented at: ISPOR Symposium; May 19-23, 2018; Baltimore, Maryland, USA.
  • Robotics-assisted surgery with Smith+Nephew implants may help patients regain function faster
      • Shearman AD, et al. EKS Arthroplasty Conference. May 2-3, 2019; Valencia, Spain.

Additional statements and support regarding Knee Replacement

  • More than 90% of people who have knee replacement surgery experience dramatic relief in knee pain and are better able to perform common activities.
    • Based on pre-surgical pain levels
      • American Academy of Orthopaedic Surgeon website, http://orthoinfo.aaos.org/topic.cfm
  • The majority of patients experience profound improvements in their physical activity after having knee replacement surgery.
    • Based on pre-surgical activity levels
      • Brandes M, et. al., “Changes in physical activity and health-related quality of life during the first year after total knee arthroplasty.” Clin Orthop Relat Res. 1991 Dec;(273):151-6. https://www.ncbi.nlm.nih.gov/pubmed/20981812 Accessed Wednesday, April 17, 2019