Tricompartmental osteoarthritis is a condition affecting the knee, where the smooth cartilage covering the ends of bones gradually wears away, leading to bones rubbing together. This form of osteoarthritis impacts all three areas of the knee joint. The decision to undergo surgery for tricompartmental osteoarthritis depends on various individual factors, including the severity of symptoms, the extent of cartilage damage, and the patient’s overall health and lifestyle.
What is Tricompartmental Osteoarthritis?
The knee is composed of three distinct compartments: the medial compartment (inner side, where the thigh bone meets the shin bone); the lateral compartment (outer side, where the femur and tibia connect); and the patellofemoral compartment (behind the kneecap, where it articulates with the femur). Tricompartmental osteoarthritis affects all three of these areas.
This condition results in pain that worsens over time, often accompanied by stiffness, especially in the morning or after periods of rest. Patients may experience swelling, a reduced ability to bend or straighten the knee, and a grinding or crunching sensation known as crepitus. Other common symptoms include difficulty with stairs, increased pain after activity or in certain weather conditions, and a feeling of the knee buckling or giving way. Diagnosis involves a physical examination to assess range of motion, tenderness, and any bony lumps, along with imaging techniques such as X-rays or MRI.
Non-Surgical Treatment Approaches
Non-surgical strategies aim to reduce pain and improve function. Lifestyle modifications are a foundational step, including weight management to lessen the load on knee joints and engaging in low-impact exercises like swimming or cycling. These activities help strengthen muscles around the knee and improve overall fitness without excessive joint stress.
Physical therapy plays a significant role in conservative management, with a therapist guiding patients through exercises designed to strengthen muscles, enhance flexibility, and improve balance. Pain management techniques include over-the-counter options such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Topical NSAID gels or creams can also provide localized relief.
When oral medications are insufficient, injections into the knee joint may be considered. Corticosteroid injections provide temporary pain relief by reducing inflammation. Hyaluronic acid injections aim to restore lubrication within the joint, potentially reducing friction and pain. Platelet-rich plasma (PRP) injections are another option to promote healing and reduce inflammation.
Surgical Considerations and Procedures
Surgery becomes a consideration for tricompartmental osteoarthritis when non-surgical treatments no longer adequately control severe pain or when significant functional impairment negatively impacts a patient’s quality of life. The decision for surgical intervention is highly individualized, made in consultation with an orthopedic surgeon, taking into account factors like the extent of cartilage damage, the patient’s age, and overall health.
One surgical option is a partial knee replacement, also known as unicompartmental arthroplasty (UKA). This procedure replaces only the damaged portion of the knee, aiming to preserve more of the natural joint. While typically used for arthritis affecting only one compartment, UKA may be considered in select cases of tricompartmental disease.
Total knee replacement (Total Knee Arthroplasty or TKA) is the most common surgical treatment for advanced tricompartmental osteoarthritis. During this procedure, the damaged cartilage and bone from all three compartments of the knee are removed and replaced with artificial components made of metal and plastic. The surgeon prepares the ends of the thigh bone and shin bone to fit the artificial parts. A plastic piece is often placed between them for smooth movement, with a plastic component also attached to the back of the kneecap.
Another less common surgical approach is an osteotomy, which involves cutting and realigning the bones around the knee to shift weight from the damaged areas to healthier cartilage. This procedure is considered for younger patients with arthritis predominantly affecting one side of the knee and is less frequently applied for widespread tricompartmental disease due to its limited ability to address damage across all three compartments. Following surgical procedures, rehabilitation with a physical therapist is a part of recovery, focusing on strengthening the leg and restoring knee movement.