Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Anesthetic
Length of total knee replacement surgery
Pain and pain management
Prefer To Listen To This Article
We always encourage positive visualisation and documentation of the future here at The Physio Co , but, dont expect to be hopping out of bed and running home the day after a full knee replacement.
Thats not to say the tennis career is over! Merely to say youll likely be watching the next major tennis tournament on TV rather than attending or participating at your local club this year, anyway!
In addition to the six to eight prep for the operation, weve also put together an 8 to 12-week step-by-step guide as to how a professional TPC physio will support a full knee replacement patient in reaching a goal after the operation.
My Decision With Surgery And Age
I opted to have TKR at age 67 for a couple of reasons.
- One I wanted to have a pain free knee that allowed me to remain active an improve my quality of life. I lived with the pain as long as I could.
- Two, I wanted the new knee to last my lifetime, hoping that a second knee replacement would not be necessary.
I felt that this age was the sweet-spot for me. I was tired of living with pain in my knee and I was still young enough to be mobile and remain active .
If I would have waited longer, I may have resigned myself to a more sedentary lifestyle, and I believe the recovery timeline may have increased .
Also Check: Is Nano Knee Covered By Medicare
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.
What Is The Alternative To Knee Replacement Surgery
Regenerative Stem Cell Therapy
Stem cell knee therapy is becoming a popular alternative to knee replacement surgery. Through a method known as autologous transplantation, the cells are extracted from the patients bone marrow or fatty tissue, processed, and immediately injected into the damaged knee.
You May Like: Inversion Table After Hip Replacement
How Old Is Too Old For Hip Or Knee Replacement
More people are reaching their 80s and 90s, and many of them lead active lives, says Dr. Piuzzi. So were seeing more people in these age groups who want relief from hip or knee pain.
Total joint replacement is major surgery and requires several weeks of recovery at home. But despite this, youre never too old to have your hip or knee replaced.
There is no age cutoff for joint replacement, says Dr. Piuzzi. Studies have found that people in their 80s and 90s benefit from hip or knee replacement as much as younger people.
Caring Medicals Published Research Starts With A Young Man Of 63 And Continues On With A Young Woman Of 76 Years Of Age
In our own research that we published in the Clinical Medicine Insights Arthritis and Musculoskeletal Disorders, we documented 7 patient outcomes using bone marrow Prolotherapy / stem cell therapy.
- The patients included a 69-year old male with knee pain,
- a 69-year old female with knee pain,
- a 76-year old female with pain in both hips, and
- a 63-year old man with pain in the hips you can read about their case histories in our article Bone Marrow Stem Cell Prolotherapy.
While we are always hesitant to define anyone as elderly especially patients in their 60s and 70s, the research we spoke about earlier in this article set the line of knee replacement at age 70. Once you get to 70, it should only be knee replacement according to that research. But as we have found, 70 is too young NOT to explore stem cell therapy.
The determination of the effectiveness of stem cell therapy in the elderly needs to be made during a consultation. As mentioned above if determined that success will be good, stem cell therapy may be utilized on its own or within the comprehensive prolotherapy program.
Recommended Reading: Inversion Table Knees
What About Exercise Following A Knee Replacement
Exercise and sport are recommended after knee replacement, apart from contact sports, which may weaken the cement and lead to loosening of the joint components. Recreational sports including golf, tennis and skiing will gradually become possible depending on how fit and sporty you were before the operation. Cycling is a very good way of building up strength and mobility after knee surgery.
Exercising the main muscle groups around your knee is very important both before and after having a knee replacement. You can download a selection of exercises that are designed to stretch, strengthen and stabilise the structures that support your knee. Try to perform these exercises regularly, for instance for 10 minutes six to eight times a day. However, its important to find a balance between rest and exercise so you dont overwork your knee. Its a good idea to get advice from your doctor or physiotherapist about specific exercises before you begin.
When Do You Have A Total Knee Replacement
Patients usually elect to have this procedure after nonoperative treatment options or knee replacement alternative surgeries fail to maintain knee function and pain levels. For those patients that do decide to have total knee surgery, keep reading to learn more about the total knee replacement recovery process.
My mother is 86 and in great health. She has to have her right knee replaced. She is in extreme pain because she is bone on bone. It kills me to see her suffer so. The surgery will help her be out of pain at least after the healing process. Her quality of life will be so much better. If no surgery she would be in a wheelchair within 6 months.
You May Like: Rebuilding Knee Cartilage Naturally
Total Knee Replacement In The Very Elderly
Osteoarthritis is one of the most prevalent chronic, disabling diseases and affects two-thirds of individuals > 65 years of age. More than 10 million Americans have osteoarthritis. Joint replacement is the preferred treatment for alleviating pain and improving function in patients with advanced osteoarthritis.1-3 The following case illustrates a number of issues faced by a frail elderly patient pursuing total knee replacement .
Case Presentation
Mr. X, a 92-year-old man with a history of severe arthritis of the left knee, was hospitalized for a mechanical fall and severe pain in his left knee. His medical history included congestive heart failure , degenerative joint disease of both knees, hypertension, cirrhosis, pseudogout, atrial fibrillation, interstitial lung disease, s/p pacemaker, and chronic obstructive pulmonary disease necessitating home oxygen. He had had recurrent hospitalizations for mechanical falls and severe knee pain.
At the time of presentation, the patient, who had never married and was childless, lived alone in a trailer and acknowledged being an alcoholic and a smoker. During his hospitalization, he was given an intra-articular injection of cortisone into his knees and lidoderm patches for pain relief. The surgical option of knee replacement was not offered to the patient because he was considered to be at high risk for an operative intervention. He was transferred to a skilled nursing facility for physical rehabilitation.
Discussion
References
Why Did My Mother Have A Knee Replacement
My mother is 86 and in great health. She has to have her right knee replaced. She is in extreme pain because she is bone on bone. It kills me to see her suffer so. The surgery will help her be out of pain at least after the healing process. Her quality of life will be so much better. If no surgery she would be in a wheelchair within 6 months.
Also Check: How To Whiten Knee
Factors That May Exclude You
While age alone won’t exclude you from surgery, other factorsincluding some aging-related factorsmay. Among some of the more common red flags surgeons watch out for:
- Severe osteoporosis may make it impossible to perform the surgery because the bones may be too brittle to support the new joint prosthetic. While mild to moderate osteoporosis is not a contraindication, it may affect how a surgeon performs the surgery.
- An existing infection can also exclude you from surgery, at least until such time as the infection is fully healed and confirmed to be resolved.
- Cigarettes won’t outright exclude you, but may factor in if you are on the borderline for eligibility. Research suggests, among other things, that smokers are 10 times more likely to need a revision surgery than a non-smoker.
- Obesity is also not a direct contraindication, but may factor into your assessment. If your weight makes it impossible for you to lift yourself, for example, you may not have the means to participate in physical therapy.
- Alcoholism, substance abuse, or mental illness can also make it difficult for a surgeon to sign off unless there is some form of established treatment to ensure you’ll adhere to rehabilitation and avoid falls in order to optimize your outcome after surgery.
Types Of Arthritis That Affect The Knee
Inflammatory arthritis
This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.
Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.
Osteoarthritis
Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.
OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .
Recommended Reading: Fluid On The Knee Remedies
How To Handle Waiting For Surgery
Whether a patient is choosing to delay surgery, or theyre trying to reschedule and encountering delays, the wait for relief can be challenging.
I was due to have my knees replaced at the start of in March, Tracey E. shared with CreakyJoints via Facebook. It has so far been cancelled four times, and I now dont even have a date for it. In the meantime, my hip now needs replacing.
She is one of many people trying to navigate pain and mobility issues while waiting out surgery delays. And shes not alone. Among patients who had postponed their joint replacement surgery, 71 percent reported that they experienced increased pain, 58 percent said they experienced mobility changes, and 36 percent said they experienced worsening sleep while waiting, according to the Zimmer Biomet survey.
For most patients its been manageable, but for some its been pretty hard, says Dr. Haas, who has been managing his patients with anti-inflammatory medications and non-narcotic pain medications, as well as heating and cooling therapies. Hes also been focusing on patients activity levels. People werent getting out of the house very much, and its been shown that arthritis gets worse without activity. We tried to encourage mobility and set them up with physical teletherapy.
The American Academy of Orthopaedic Surgeons offers some recommendations to help patients who are awaiting surgery, including:
And whats happening with the underlying joint condition during this waiting period?
Characteristics Of Severe Arthritis Of The Knee
Pain
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Stiffness
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
Location
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
Recommended Reading: What Do You Do For Water On The Knee
Knee Replacement Can Be Reasonable Option Even For Older Adults
Dear Mayo Clinic:
I am 72 years old and need a knee replacement. Is this safe at my age? Will I be able to do the same activities after I have recovered from surgery?
Answer:
If you are otherwise in good health, knee replacement surgery can be a reasonable option for someone your age. It should only be used if other nonsurgical treatment approaches have not worked for your knee problems, though. As with any surgery, knee replacement does involve some risks. But for many people, this surgery offers a good opportunity to return to an active lifestyle.
Knee replacement surgery is most often used to repair joint damage caused by osteoarthritis and rheumatoid arthritis that causes knee pain and makes it hard to do daily activities. During knee replacement, a surgeon cuts away the damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with an artificial joint.
The number of knee replacements being done for people 65 and older in the United States has risen sharply, with the rate of these surgeries almost doubling in the past several decades. There are a variety of reasons for the increase.
Of course many of these people, like you, want to stay active into their later years, too. It’s not uncommon to see 80-year-olds and even 90-year-olds with symptomatic knee arthritis that they want treated, so they can return to their usual activities.
Robert Trousdale, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.
Understanding Why Some Joint Replacements Fail
We’re also supporting research to improve the outcome of knee replacement surgeries, such as a project aimed at increasing the understanding of why joint replacements sometimes fail by investigating whether there are genetic risk factors that influence surgery outcome. This research has the potential to improve patient experience and increase the life of the joint replacement.
Don’t Miss: How To Lighten Your Knees Overnight
How Your New Knee Is Different
After the procedure, you may experience numbness around the incision and stiffness when bending your knee. It is unlikely that you will regain full motion, but you should find that you have more motion than you did before surgery once you are healed. Though kneeling will likely be uncomfortable, it should not harm your new knee. You should also not be alarmed if you notice clicking while bending your knee or walking. Be aware that the new knee trips metal detectors such as those at airports and secure buildings.
Looking For Alternatives To Total Knee Replacements
We’re also funding research which is investigating alternative approaches to total knee replacement. For example, total knee replacement is not recommended for many young people. This study aims to develop a new method called ToKa®, which uses images of the patient’s joint and specially designed software to design a patient specific implant that will be made via 3D printing. If successful, this technique could prevent osteoarthritis patients from needing total joint replacement.
Don’t Miss: How To Get Rid Of Fat Around Knees
Evaluating Harms And Benefits Of Surgery For Frail Older Adults
For a healthy 80-year old that has arthritis in their knee that affects their everyday activities, knee replacement surgery could improve their quality of life. But what about an 80-year old person with a cardiac condition and cognitive decline?
In the latest edition of the Right Care Series in the journal American Family Physician, Dr. Ann Lindsay from the Stanford University School of Medicine, and patient partners Helen Haskell and John James tackle the subject of evaluating older adults for frailty before recommending elective surgery.
Patients will often come to their primary care clinician to ask about surgeries they are considering. Thus, primary care clinicians play a key role in helping patient and families understand the risks of surgeries and figure out whether that surgery is appropriate for them. An important part of this process is evaluating patients for signs of frailty, a condition that greatly increases the risks of surgery.
Frailty is a term that describes patients, regardless of age, who have reduced physiologic reserve and are at increased risk of dying within five years. For frail patients, even procedures described as low-stress can lead to significant declines in function and cognitive decline. However, as Haskell and James write, patients and their families may not be aware that disability, impairment, and worsened function are among the risks of surgery.