Will a knee replacement help the full-thickness cartilage defect in my right knee?

Q: I've had two surgeries so far for a full-thickness cartilage defect in my right knee. The results have been disappointing as I can't do any of the fun sport activities I like. Someone suggested a knee replacement. Would something like that work?

A: Cartilage lesions of the knee joint can be difficult to repair in order to restore painfree function. Full-thickness (clear through the cartilage to the bone) can be especially problematic. Patients are often unable to cope with the pain.

In fact, a recent study from Norway comparing patients with chondrocyte (cartilage cell) damage to other knee problems was published. Patient complaints were measured and reported for three groups of patients with different knee problems.

One group had a ruptured anterior cruciate ligament (ACL), another group had knee osteoarthritis, and the third group had full-thicknes cartilage defects. Complaints were categorized as pain, other symptoms, daily activities, ability to participate in sports and recreational activities, and health-related quality of life.

The patients with ACL tears were the ones most distressed by their inability to participate in physical activities. Their quality of life was more influenced by that factor than the older adults who couldn't get around because of pain from knee arthritis. Patients with cartilage defects reported that their quality of life was affected equally by pain, inability to get around to do their daily activities, and the inability to participate in sports and recreational activities. This was true no matter what type of surgery they had to repair the cartilage.

Some experts have wondered if patients with cartilage lesions that severe should just go ahead and have the knee joint replaced. But the problem with that is that these patients are usually much younger than patients in need of a knee replacement for arthritis. Joint replacements don't last a lifetime -- they are usually good for 10 to 15 years. So that treatment option isn't really realistic for younger adults.

You really need to go back to your surgeon and report what's going on. It may be time to step back and re-evaluate your situation before going on. There may be a simple step that can be taken to help you feel better and regain some of the function you've lost before considering a total knee replacement.

Reference: Stig Heir, MD, et al. Focal Cartilage Defects in the Knee Impair Quality of Life as Much as Severe Osteoarthritis. In The American Journal of Sports Medicine. February 2010. Vol. 38. No. 2. Pp. 231-237.

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