Differences Between Total And Partial Knee Replacement
Knee replacement surgery is recommended when conservative treatments such as physical therapy, braces, steroid injections and anti-inflammatory medication fail to alleviate pain.
If a patient requires surgery on both knees, its called a bilateral knee replacement. The two procedures can be done simultaneously or doctors may choose to use a staged bilateral approach that schedules the second surgery several days, weeks or months later.
The decision to have a total versus a partial knee replacement is based on a doctors recommendation after a full patient evaluation is performed.
Why Is A Knee Osteotomy Done
All joints, including the knees, have cushioning tissue called cartilage where bones meet. Some people develop osteoarthritis when cartilage wears away in a joint, which can cause the tibia and femur to rub uncomfortably. This pressure can cause pain and stiffness in your knee.
Doctors perform knee osteotomy to shift pressure from the damaged part of the knee to an area with healthy cartilage and cushioning. This shift can reduce pain and improve mobility in the knee. A doctor may also use a knee osteotomy to repair a broken knee that did not heal properly.
What To Expect After Knee Surgery
Since there are many types of knee replacements, your post-op experience can vary. However, you can generally expect to experience some pain following knee surgery, swelling or warmth at the incision site, and difficulty sleeping at times. These are all typical post-operative experiences you can mentally prepare for, and they should improve weekly.
Immediately after surgery, your pain will be minimal. This is because, in the first 2448 hours, your body will still have an effective nerve block, anesthesia, and medication administered inside your knee during the operation.
Your doctor will keep you comfortable with additional pain medication prescriptions over the next few weeks, weaning you off narcotic medications when deemed appropriate.
You should expect to ice your knee and walk every hour for at least 10 minutes to help with recovery. In fact, your physician will have you move the same day of the operation.
We will start physical therapy immediately and get you up and walking the same day of your surgery, Dr. Shah says.
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Risks Of The Procedure
As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:
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Blood clots in the legs or lungs
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Loosening or wearing out of the prosthesis
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Continued pain or stiffness
The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.
Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
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.
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Your Recovery At Home
You may need some help at home for several days to several weeks after discharge. Before your surgery, arrange for a friend, family member or caregiver to provide help at home. You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance.
Not All Hospitals Achieve The Same Results
Knee replacement is a surgery focused on reducing pain and getting you back to the activities you love. But not all hospitals achieve the same results. Some are more reliable than others. With the help of the HSS Hospital Reliability Scorecard, you can make sure you’re asking the critical questions to find the hospital that’s right for you. Understanding the data points will help you make the best decision for your care.
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Can I Avoid Or Postpone A Knee Replacement
The choice on whether to have surgery to address arthritis of the knee joint depends on multiple factors, including:
- the condition of the knee joint
- the patientâs age and activity level
In cases where the damage from arthritis is minimal, and/or if the patient does not have a very active lifestyle, nonsurgical treatments by be tried, including:
- physical therapy
- , such as ibuprofen
- weight loss to reduce pressure on the knee
Do You Need A Physiotherapist
Book a private appointment with a local physio today
Dr Sarah Jarvis, 20th May 2022
Quality standards for knee replacementThe National Institute for Health and Care Excellence has issued new guidance on knee replacements. If your specialist recommends knee replacement, they advise that:
- You should be given advice on ‘prehab’ – how you can get into the best shape to recover well from your operation – when you go on the waiting list for surgery.
- If you have osteoarthritis in one half of your knee joint , you should be given the choice of partial or total replacement.
- You should be given tranexamic acid, to reduce blood loss, during surgery.
- Before you go home after surgery, you should be given advice on rehabilitation to improve your recovery.
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Risks Of Knee Surgery
There are risks with any surgical intervention.
The most common complication could be skin numbness, says Dr. Shah.
Other risks could be infection, stiffness, component malpositioning, or loosening of the implant. In general, if patients participate in physical therapy, the vast majority will have good to excellent outcomes.
What Happens After Total Knee Replacement
Talk with your healthcare provider about what you can expect after your surgery. You may have significant pain around your incision after your procedure, but pain medicines may help to relieve your pain. You should be able to get back to a normal diet fairly quickly.
You may get imaging, like an X-ray, to see the results of the surgery. You might be able to go home within a day or two.
Your provider will let you know when you can put weight on your leg. You may have specific instructions about limiting your movements. You might need to use a cane, walker, or crutches for a few days or weeks. A physical therapist can help you maintain your range of motion and strength. You should be able to go back to most light activities within a few weeks. During this time, you may find it helpful to have some extra help at home.
You might have some fluid draining at the incision site. This is normal. Let your provider know right away if you have an increase in redness, swelling, or draining at the incision site. You should also let your provider know if you have a high fever, chills, or severe pain that does not improve.
Make sure to keep all of your follow-up appointments with your surgeon. You may need to have your stitches or staples removed a week or so after your surgery.
Most people note a significant decrease in their pain following a total knee replacement. You may have some remaining stiffness in the joint, as well as more limited range of motion.
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Continuous Passive Motion Machine
The PT will also help you use a continuous passive motion machine. This device moves the joint slowly and gently after surgery. It helps prevent a buildup of scar tissue and joint stiffness.
Youll probably use the CPM machine in the hospital and possibly at home, too. Some people leave the operating room with their leg already in the device.
Some pain, swelling, and bruising are expected after TKR surgery. Try to use your knee as soon as possible, but avoid pushing yourself too far too soon. Your healthcare team will help you set realistic goals.
What can you do at this stage?
Get plenty of rest. Your PT will help you get out of bed and walk a short distance. Work on bending and straightening your knee, and use a CPM machine if you need one.
On the second day, you might walk for brief periods using an assistive device. As you recover from surgery, your activity level will increase gradually.
What Are Knee Replacement Implants Made Of
The selection of knee replacement prosthesis design and materials depends on each individual patient. The main implant components are made of metal â usually titanium or chrome-cobalt alloys. The implants are fixated in place either with a cement bonding agent or by osseointegration, in which a porous metal stem extends into the tibia and the patient’s natural bone grows into it. A plastic platform or spacer will be inserted between the tibial and femoral implant surfaces. The spacer is made of polyethylene.
Most femoral components are made of metal alloys or metal-ceramic alloys . The patellar component is plastic . The tibial insert component is also plastic . The tibial tray component can be made of the following materials:
- cobalt chromium
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How Do I Determine If I Need A Knee Replacement
If youre considering knee replacement surgery, talk to an orthopedic surgeon. Orthopedic surgeons specialize in operations to fix joints and muscles.
Your orthopedic surgeon will:
- Ask about your symptoms, including how severe they are and how long youve had them. The surgeon may also ask whether anything makes symptoms better or worse, or whether symptoms interfere with your daily life.
- Take your medical history to learn about your overall health.
- Examine you to check knee motion, strength and stability.
- Order X-rays of your knee. The images can help the surgeon understand how much damage is in your knee. Advanced imaging is rarely helpful in the arthritic knee.
The orthopedic surgeon will then make a recommendation for surgery or another treatment option.
Knee Replacement Surgery Technologies
There are various ways surgeons can approach knee replacement surgery. Modern technologies are constantly advancing to improve patient outcomes.
To understand how a knee replacement is done, consider some of the following types of surgeries.
- Manual knee replacement uses specialized alignment guides
- Computer navigation-guided knee replacement surgery uses many digital points registered on the bone to give external feedback from a computer to help with sizing and alignment
- Patient-specific implants, or PSIs, in knee replacements require a CT or MRI ahead of the surgery, and there are custom cutting guides ordered ahead of time to exactly match the patients knee anatomy
- Robotic-assisted knee replacement surgery involves a saw attached to a robotic arm to guide the operation
With robotic-assisted knee surgery, Dr. Tauchen explains, at the time of surgery, you register the knee, and you use a probe and tell the computer where the knee is located in space in the room. Once you adjust the cut thickness and angles, it does not allow you to deviate from this plan when making your cuts. Its more accurate with more precise cuts.
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Why Do People Need A Total Knee Replacement
Doctors may recommend a total knee replacement to treat various knee conditions. They may only consider this procedure if other treatment options have not worked.
Your doctor may recommend a total knee replacement to treat severe knee joint damage caused by:
- Knee joint injuries: Fractures, torn ligaments, and torn cartilage can lead to severe joint damage.
- Osteoarthritis: This degenerative joint disease causes the breakdown of cartilage and bones within the joint, resulting in pain, stiffness, and swelling. It is the for a total knee replacement.
- Osteonecrosis: This is a rare condition where blood flow to the bones is restricted, resulting in bone tissue death and collapse of the joint.
- Rheumatoid arthritis: This is an autoimmune disease that causes severe inflammation and damage, mainly in the joints.
Total knee replacement is a common procedure. that doctors worldwide will perform 3.48 million procedures annually by 2030.
How Do I Get Ready For Total Knee Replacement
Ask your provider how you should plan to get ready for your surgery.
Tell your provider about any medicines you are taking, including:
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All prescription medicines
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Over-the-counter medicines such as aspirin or ibuprofen
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Herbs, vitamins, and other supplements
Ask if there are any medicines you should stop taking ahead of time, like blood thinners.
If you smoke, try to quit before your surgery.
If you are overweight, your provider may advise you to try to lose weight before your surgery.
Donât eat or drink after midnight the night before your procedure.
You may want to make some changes to your house, to make your recovery smoother. This includes things like adding a handrail in your shower.
In some cases, your provider might want additional tests before you have your surgery. These might include:
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X-rays, to get information about your hip
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MRI, to get more detailed information about your hip
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Electrocardiogram , to make sure your heart rhythm is normal
Follow any other instructions from your healthcare provider.
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Types Of Knee Replacement Approaches
Your doctor will also choose a surgical approach thats best suited to your needs. You and the medical team will engage in pre-operative planning that covers the type of procedure you receive and associated medical requirements.
In order to ensure a smooth procedure, a skilled orthopedic surgeon will map out your knee anatomy in advance so that they may plan their surgical approach and anticipate special instruments or devices. This is an essential part of the process. Possible procedures are discussed below.
Reasons For The Procedure
Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.
Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.
Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.
If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:
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Anti-inflammatory medications
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Cortisone injections into the knee joint
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Viscosupplementation injections
There may be other reasons for your doctor to recommend a knee replacementsurgery.
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What Are The Risks Of Total Knee Replacement
Most people do very well with their minimally invasive total knee replacement. But as with any surgery, the procedure does carry some fairly rare risks. Possible complications of the surgery include:
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Loosening of the components of the knee
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Limited motion of the knee
There is also a very slight risk that the procedure might not relieve your pain. Your own risk of complications may vary according to your age and your other medical conditions. Ask your provider about the risks that most apply to you.
Who Can Benefit From Knee Replacement
Each person is different, but your orthopedic care team will likely talk with you about a total knee replacement if:
- X-rays show advanced arthritis or significant deformity of your knee
- You have severe stiffness and swelling of your knee
- You have knee pain every day, even at rest
- You have significant instability, and your knee gives out/gives way
- You have made significant lifestyle changes and activity limits related to your knee
- You have a failed previous knee replacement
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Knee Replacement Recovery Time And Recuperation
Total knee replacement surgery generally takes about 60 to 90 minutes, but you should expect to be in the operating room for over two hours. Rehabilitation will begin within 24 hours of surgery.
After your surgery, the nursing staff will position you in bed and help you turn until you are able to move on your own. You may have a pillow between your legs if ordered by your surgeon.
Very soon after surgery, a physical therapist will come to your room to teach you appropriate exercises and review your progress. Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles.
Your rehabilitation program will begin as soon as you are medically stable and there are orders from your doctor to begin postoperative mobility. All patients begin rehabilitation within 24 hours of their surgery. Your motivation and participation in your physical therapy program is key to the success of your surgery and recovery. The physical therapist will assist you in the following activities:
- sitting at bedside with your feet on the floor
- transferring in and out of bed safely
- walking with the aid of a device
- climbing stairs with aid of a device
What Are The Different Methods Of Performing A Total Knee Replacement
When planning your TKR, your surgeon will recommend either traditional surgery or minimally invasive surgery. Over 85% of all knee replacements are performed traditionally, meaning that the surgeon operates through a single large incision. Typically, this incision will cut into the quadriceps tendon on the front of the knee.
During open knee replacement surgery, the surgeon has a clear view of the joint while they operate. This unobstructed view of the bones in your knee makes it easier for the surgeon to get correct placement and alignment for the artificial knee joint. However, traditional surgery tends to come with longer healing and recovery times than minimally invasive surgeries.
In a minimally invasive knee replacement surgery, the surgeon only makes a small cut in a quadriceps muscle instead of cutting through the tendon. This procedure is more technically challenging than open surgery, and it often requires special tools and training. Minimally invasive knee replacement surgery may not be recommended if you:
- Are obese or overweight
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