Degenerative Arthritis of the Knee

An increased life expectancy and heightened awareness of the importance of maintaining physical fitness throughout adulthood equal more miles on knees.1-5 There are variations in the patient population with articular surface changes: age, physical demands, goals, and expectations. In the active individual, how do we keep these knees natural, painless, and moving? The wand of the arthroscope does not magically remove the pain from an arthritic, malaligned knee. The decision to intervene arthroscopically should be based on symptoms of mechanical locking, effusion, and localized painful popping. The light for the future of arthroscopy burns brightly; however, make sure the choice of procedure and equipment is indicated for the patient's problem. Multiple clinical examinations and histories to document symptoms are necessary. Biomechanical assessment of gait, radiographs of the weight-bearing patient, and technetium-99m bone scan are performed.6-8 In this era of "outcomes review" and close scrutiny of health-care expenditures, the arthroscopist should proceed with caution.9 Many patients with arthritic knees may not benefit dramatically from arthroscopic intervention. 10 Complications from arthroscopy do occur.11-13 The superiority of arthroscopy to plain radiography of chondral changes is well recognized. 1316 The focus of this chapter is degenerative arthritis: its nature and pathophysiology, analysis of the published literature regarding arthroscopic treatment, and areas that warrant further investigation.