New Hip And Knee Replacement Data
A recent study examined how long knee or hip replacements last, and how their durability is affected by the persons age at the time of surgery. As published in the April 2017 edition of the medical journal The Lancet, researchers found that:
- Among more than 60,000 people who had a hip replacement, only 4.4% required revision surgery in the first 10 years after surgery, but by the 20-year mark, 15% required revision.
- Among nearly 55,000 people who had a knee replacement, only 3.9% required revision surgery within 10 years of surgery by 20 years, 10.3% required revision.
- Age did matter. Of those over 70 having hip or knee replacement, the lifetime risk of having a second operation on the replaced joint was about 5%. But this risk was much greater in younger individuals, especially for men. Up to 35% of men in their early 50s required a second operation.
Some orthopedic surgeons might scoff at these findings and say, “My patients do better than those in in this study.” And that may be true. But increasingly, hospitals and surgeons are being required to make public their results, so if youre considering hip or knee replacement and your surgeons results are truly better, or worse, than average, hopefully youll be able to find out.
More Than 80% Of Total Knee Replacements Can Last For 25 Years
Large data sets from national registries and case series show that about 82% of total knee replacements and 70% of partial knee replacements last for 25 years.
This NIHR-funded review of that data is the first to demonstrate longer-term effectiveness of these procedures. This means that the operation, which aims to relieve pain for osteoarthritis, may not need to be delayed to reduce the chance of a patient needing further surgery at a later date. It is an encouraging finding for an ageing population.
This study didnt include data from the UK, as the National Joint Register of England, Wales, Northern Ireland and the Isle of Man didnt go back far enough for this analysis. However, there is no reason to suspect that UK data, which is being collected, would be much different.
Who Gets Knee Replacement Surgery
You may consider knee replacement surgery if:
- Arthritis in the knee or a knee injury has severely damaged the mating surfaces of the joint.
- Pain and stiffness give you trouble doing everyday activities, such as walking up or down stairs or getting in and out of a car.
- Swelling and inflammation dont go away with rest and medication.Your knee is deformed, such as looking swollen or not shaped normally.
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Possible Complications Of Surgery
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.
Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.
Can Rehabilitation Be Done At Home
All patients are given a set of home exercises to do between supervised physical therapy sessions and the home exercises make up an important part of the recovery process. However, supervised therapy–which is best done in an outpatient physical therapy studio–is extremely helpful and those patients who are able to attend outpatient therapy are encouraged to do so.
For patients who are unable to attend outpatient physical therapy, home physical therapy is arranged.
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Who Might Need A Knee Replacement
Knee surgery may be suitable for patients who experience:
- Severe knee pain or stiffness that prevents them from carrying out everyday tasks and activities, such as walking, going upstairs, getting in and out of cars, getting up from a chair
- Moderate but continuous knee pain that continues while sleeping or resting
- Chronic knee inflammation and swelling that does not improve after taking medications or resting
- Knee deformity, where there is a noticeable arch on the inside or outside of the knee
- Depression, resulting from an inability to carry out daily or social activities
If the other available treatment options have not worked, surgery may be the best option.
Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
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What Is A Knee Replacement
A knee replacement, also known as knee arthroplasty is a surgical procedure where the actual knee joint is surgically cut out and replaced with an artificial joint. The artificial joint can also be called a prosthesis. There are many types and manufacturers of artificial knee joints. Examples include Zimmer, Biomet, Depuy, and Stryker. After the damaged knee joint is cut out a metal rod is inserted into both the thigh and shin bone that serves as an anchor for the new joint. This rod is then glued into position with special surgical cement. The prosthesis attaches to the rod. The procedure which takes approximately 1.5-2 hours can be performed in a hospital or outpatient surgical center. A general anesthetic or spinal block is required.
Factors Affecting The Longevity
Many studies have been done to determine how long a knee replacement will last. With hundreds of different types of knee replacements and countless different types of patients, there is no rule to how long a knee replacement will last in a particular individual.
Implant manufacturers are constantly striving to create a “better” implant that will last longer. Some of these implants have only been used for a handful of years, and determining whether or not they will last longer is a question only time can answer.
Some of the factors that seem to influence the longevity of knee replacement implants include:
How Long Will Total Knee Replacement Surgery Take
Urquhart: I like to put it in perspective for patients by using a flight analogy. While the actual operation may only take an hour or so, similar to a one-hour flight from Detroit to St. Louis, you should still budget plenty of time for the multiple steps before and after surgery just like the added time you budget to spend at the airport for security, checking your bags, etc.
General Risks Of Surgery
With any surgery, there are risks but they are extremely rare. These risks include:
Risks for anesthesia include breathing problems and reactions to the medications.
Your surgeon will discuss all of these with your prior to your surgery. If you have any questions, always ask your doctor until you are happy that you understand what exactly is involved.
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What Is A Robotic Knee Replacement
Images from the computer during Mako robotic-assisted knee replacementThe quick answer is that the surgeon can use a computerized robotic device to help guide the surgical instruments during the surgery. This can improve accuracy and allow for pre-planning of the knee replacement surgery based on the specific anatomy of your individual knee.
JOI also is the leader in providing robotic-assisted knee and hip replacements use the Mako robot. JOI orthopaedic surgeons have the most experience using the Mako robot in the Northeast Florida region. Robotic-assisted knee replacement surgery is currently available for a partial knee replacement, a total knee replacement and a total hip replacement.
Nerve And Other Tissue Damage
There’s a small risk that the ligaments, arteries or nerves will be damaged during surgery.
- Fewer than 1 in 100 patients have nerve damage and this usually improves gradually in time.
- About 1 in 100 have some ligament damage this is either repaired during the operation or protected by a brace while it heals.
- About 1 in 1,000 suffer damage to arteries that usually needs further surgery to repair.
- In about 1 in 5,000 cases blood flow in the muscles around the new joint is reduced . This usually also needs surgery to correct the problem.
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The Risks Of Early Knee Replacement Surgery
Learn more about the risks of having total knee replacement surgery too soon and what researchers have learned from the rise in revision surgeries.
As more and more Americans choose to have total knee replacement surgery at increasingly younger ages, the number of revision surgeries procedures to correct a failed joint replacement is also soaring.
According to a study of more than 2 million knee replacement patients presented at the 2014 American Academy of Orthopaedic Surgeons meeting, there was a:
- 120% increase in knee replacements over a 10-year period.
- 89% increase in knee replacements among those aged 65 to 84.
- 188% increase in knee replacements for 45- to 64-year-olds.
Some revision surgeries are relatively minor for instance, when one component of the implant is exchanged for another. But many entail removing and replacing the entire implant device, the ends of which are affixed to the thigh and shin bones. Revisions are long and complex, require special surgical skills and are rarely as successful as the first operation at restoring function and range of motion.
Studies have found that 85% of knees last 20 years, and the AAOS estimates 10% of patients will need a revision at some point. The younger you are when you have the surgery and the longer you live, the more likely it is you will need revision surgery.
Why Have Revision Rates Risen?
Risks More Likely Among Men
The Right Time for a Knee Replacement
Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
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The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
Knee Replacement Surgery By The Numbers
Knee replacement can help relieve knee pain and enable you to live a fuller, more active life. If you and your orthopedic surgeon have decided that you are a good candidate for a full joint replacement, you are in good company. Almost one million hip and knee replacement surgeries are performed in the United States annually, making it one of the most common orthopedic procedures performed today.
- By 2030, total knee replacement surgeries are projected to grow 673% to 3.5 million procedures per year.
- About 60% of all knee replacement operations are performed on women.
- Approximately 85% of knee replacements will last for 20 years.
- Nearly 1/2 of American adults will develop knee osteoarthritis in at least one knee in their lifetime.
- 80% of osteoarthritis patients have some degree of movement limitation.
- More than 90% of people who have knee replacement surgery experience a dramatic reduction in knee pain.
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Do You Have To Come To The Hospital For Total Knee Replacement Surgery
Urquhart: Knee replacements in healthy patients do not require a hospital stay. In fact, we now offer the surgery at the Brighton Center for Specialty Care, one of our outpatient specialty clinics.
Patients have the surgery performed in one of the operating rooms at the facility and then are moved into a recovery area where they are monitored and work with physical therapy to be safe to go home. The center has the ability and staffing to monitor patients overnight, if needed. Then the patient is able to finish their recovery at home.
How Much Pain Will I Have After Surgery
There will definitely be some pain after your operation but your surgery team will do everything possible to keep it manageable and minimal.
You may receive a nerve block prior to your operation and your surgeon may also use a long-acting local anesthetic during the procedure to help with pain relief after the procedure.
Your doctor will prescribe medication to help you manage the pain. You may receive this intravenously immediately after surgery.
When you leave the hospital, the doctor will give you pain relief medication as pills or tablets.
After you recover from surgery, your knee should be significantly less painful than it was before. However, there is no way to predict the exact results and some people continue to have knee pain for many months after their operation.
Following your doctors instructions after surgery is the best way to manage pain, comply with physical therapy and achieve the best result possible.
If you have had a general anesthetic, you may wake up feeling a bit confused and drowsy.
You will probably wake up with your knee raised to help with swelling.
Your knee may also be cradled in a continuous passive motion machine that gently extends and flexes your leg while you are lying down.
There will be a bandage over your knee, and you may have a drain to remove fluid from the joint.
If a urinary catheter was placed, a healthcare professional will usually remove it later on the day of your operation or the next day.
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What Should You Expect After Knee Revision Surgery
Most patients who undergo revision procedures can expect to have good to excellent results. Although expected outcomes include pain relief with increased stability and function, complete pain relief and restoration of function is not always possible.
Up to 20% of patients may still experience some pain following revision knee surgery. This can persist for several years after the procedure. Additionally recovery after revision total knee surgery is heavily dependent on the state and function of the knee prior to the revision surgery.
What Can I Do To Help My Recovery After Knee Replacement
Soon after surgery, you will be able to walk with a cane or a walker. But you will need help with everyday activities, such as:
Plan ahead to have a friend or loved one help you after surgery, or tell your healthcare provider if youll need help.
Your recovery will also be easier and safer if you adjust your home ahead of time. Things to consider include:
- Bench or chair in the shower, as well as secure safety bars.
- No tripping hazards, like cords and loose carpets.
- Secure handrails along any stairs if you use stairs.
- Stable chair with a back, two arms and a firm seat cushion, along with a footstool to elevate your leg.
- AVOID reclining chairs as they DO NOT allow for proper elevation of your post surgical leg.
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