The worn knee in middle age...time for a prosthesis

In case of severe osteoarthritis with bone on bone on weight bearing X-rays and after failure of non-operative treatments, it is time for knee arthroplasty for patients with a mean age of 65 years. Patient’s expectations have changed over time with a rising importance of physical activity following knee arthroplasty. Physical and sportive activities can have also detrimental consequences regarding prosthetic wear and orthopedic surgeon advices will be important. Material quality has improved as well as perioperative management with blood loss managment, multimodal pain control, and fast-track surgery. Indications of surgery include analysis of deformity, and evaluation of osteoarthritis in each compartment of the knee. In case of arthritis or avascular necrosis limited to one compartment, unicompartental knee arthroplasty may be indicated. Design and surgical technique combined with anterior cruciate preservation may lead to nearly forgotten knees.
In case of arthritis in more than one compartment total knee arthroplasty finds all the place, with also improvements over the last decade including more personalized designs and robotic assisted surgery. The follow-up of patients did also benefit from modern technologies with numerical analysis of patient reported outcomes.