[Medical Q&A] Do I need to undergo knee replacement surgery immediately if I suffer from knee osteoarthritis?

Author: Qi Pan China Rehabilitation Research Center

Reviewer: Ma Lifeng, deputy chief physician, Beijing Friendship Hospital, Capital Medical University

The answer is of course no! Only a very small number of patients with knee osteoarthritis require surgical treatment, and the vast majority can be relieved through non-surgical treatment. For the treatment of knee osteoarthritis, we must follow the principle of step-by-step treatment.

1. Basic treatment Basic treatment is the first choice, including patient education, exercise therapy, physical therapy, action support therapy, etc. Patients should control their weight, reduce actions that damage the knee joint (going up and down stairs, squatting, climbing, etc.), and strengthen quadriceps strength training (straight leg raising training and wall squatting, etc.). Doctors usually use physical therapy such as interferential current stimulation therapy and pulsed ultrasound therapy to relieve patients' pain symptoms.

2. Drug treatment For obese elderly people, the knee joints have obvious pain symptoms, and it is difficult to lose weight through exercise. It is recommended that these patients go to the weight loss clinic of the endocrinology department to achieve the goal of weight loss through a reasonable diet and necessary medication. In addition, Chinese patent medicines and acupuncture can also be used to treat knee osteoarthritis.

3. Restorative treatment Restorative treatment includes arthroscopic surgery, cartilage repair surgery, force alignment surgery, etc. Arthroscopic surgery is effective in the short term for knee osteoarthritis with only pain symptoms, and there is no significant difference in the medium and long-term efficacy compared with conservative treatment. Patients with unicompartmental osteoarthritis of the tibiofemoral joint with poor knee force alignment, especially young and middle-aged patients with a high level of activity, can choose high tibial osteotomy, supracondylar femoral osteotomy or proximal fibula osteotomy.

4. Reconstructive treatment For patients with severe knee osteoarthritis who are not effective in any intervention, knee resurfacing surgery (reconstructive treatment) can be chosen. Of course, the physician will fully consider the patient's specific situation, subjective wishes and expectations when deciding whether to perform knee resurfacing surgery. Only when the surgical indications are accurately selected can a good surgical effect be guaranteed.