Dr. Cabot is an orthopedic surgeon, specialized in knee pathologies. His doctoral thesis on arthroscopy and the anterior cruciate ligament (1992) was one of the first presented in Spain. He currently directs the Knee Unit of COTA at the Hospital Quirón in Barcelona and at the Centro Mare de Déu de la Salut. In the last 20 years he has organized numerous courses dedicated to knee pathology.
Dr. Cabot, when should we resort to the implantation of a knee prosthesis?
I am going to refer you to some evidence on the application of knee prostheses. In this regard, there are heads and tails of the same coin. The upside is that 85% of patients who undergo knee prosthesis implantation are satisfied, with good results in their daily activities. In addition, they notice an improvement in pain and functional capacity.
It is currently the treatment that offers the best results. You have also told us that there is a downside, what would it be?
Fifteen percent of patients are dissatisfied, and major complications occur in 1 to 3% of cases. Once they appear, it is a road of no return: when one prosthesis fails, another one comes along. The results are variable in sports activities such as walking, cycling, swimming, golf, etc. On the other hand, the surgical risk must be assessed, and it must be clear that there is a recovery period of approximately four months. In addition, it is required that the patient has a good general condition to optimize results; the attitude, the information, the expectations of the patient and his psychological state are very important.
Taking into account what you tell us, how do we decide?
The key lies in the indication of the prosthesis, which is based on clinical symptomatology, lack of improvement with other non-surgical treatments, joint deterioration, state of health, the patient’s disposition and age. What are the new developments in prostheses? There are new materials, such as ceramic and trabecular tantalum metal, more anatomical designs and mini-prostheses or partial prostheses. Navigation and robotic techniques that can improve precision. It should be noted that it always takes a minimum of 10 years to confirm whether something is better.
What other options are there?
Apart from other surgeries, such as osteotomy, there are usual health hygiene measures, such as diets, physical exercise, physiotherapy, etc. When the indication for surgery with arthroplasty is not clear, we advise regenerative treatments, ranging from growth factors to cell therapy.
Are they easy to apply?
Yes, but delicate. They require certain preparation conditions: suitable material, sterile rooms or laminar flow hood and, sometimes, collaboration with special centers authorized for the development of cell cultures.
And finally, could you give us one last piece of advice for those suffering from osteoarthritis of the knee?
I would give them a basic one: trust your doctor. Do not be hasty