The fitting of a knee joint prosthesis is the ultimate phase in the treatment of knee osteoarthritis. There are therefore several possible treatments before this end.

a) Medical treatment.

In the beginning these are simple rules, but they are the basis for the treatment of arthrosis, and therefore of wear and tear.

The first rule is weight loss if you are overweight and losing a few kilograms often has a miraculous result on pain.

A reduction in sports activity is advised in the case of a painful attack, and then the patient is advised to switch to less aggressive sports such as walking, cycling and swimming.

Of course, carrying heavy loads is strongly discouraged.

Depending on the morphology of the lower limbs, orthopaedic inserts can be prescribed and should be changed every 1 to 1,5 years.

Medicines can also be prescribed and, in order to protect the cartilage, they are called chondroprotectors. However, their action will diminish over time.

Non-steroidal anti-inflammatory drugs (NSAIDs) can also be prescribed, either to get over an attack, or for longer term use in a 3 to 4 week course of treatment, provided there is no allergy or contraindication (anticoagulant treatment for example). Very often a medication protecting the stomach is combined.

Infiltrations can also be carried out, it can be an intra-articular infiltration of cortisone, especially when the knee presents a synovial effusion.

Intra-articular infiltration(s) of hyaluronic acid or viscosupplementation may be offered in the absence of swelling. This treatment, which must be followed by a relative rest for a few days, gives excellent results with often a lull of more than a year. The treatment can then be repeated until the hyaluronic acid no longer has any effect. The time for surgery may then have arrived.

The use of intra-articular injection of cartilage stem cells or PRP has not yet provided any scientific proof of their value.

b) Arthroscopy and osteoarthritis.

Arthroscopy may sometimes be offered if medical treatment fails. Indications are rare and this intervention may be proposed in young subjects in order to try to delay a heavier surgical solution.

This involves joint lavage often associated with the removal of unstable and symptomatic meniscus lesions. This procedure is performed on an outpatient basis, requires two stitches and takes 10 to 20 minutes. If walking is possible immediately, rest for at least 3 to 4 weeks is strongly recommended.
The results of these joint washings are nevertheless much discussed today and the patient must be well warned of the significant risk of failure that can lead to surgical graduation.

c) Valgisation tibial osteotomy.

The tibial valgus osteotomy (OTV) is another non-prosthetic surgical solution.

It is suitable for patients up to the age of 65 who have internal knee problems with varus deformity of the lower limb. These patients have bowed legs, and when walking, all the weight passes entirely inside the knees and explains the internal wear and tear.

The aim of the operation is to act on the deformity and not to simply put the leg back straight but rather in an X shape in order to pass all the weight on the external compartment.

To do this, the surgeon must cut part of the tibia while keeping an external hinge, put a more or less large internal wedge associated with a plate and screws.

This requires 1 hour of surgery, an outpatient hospitalisation and support under cover of two English canes is allowed.

An average work stoppage of 6 weeks is necessary.