What Are The Risks Of Knee Replacement Surgery

What Are The Advantages Of Knee Replacement

Long-term, you may still feel some discomfort and have to limit high-impact activity to protect the replacement joint. But knee replacement can relieve a lot of the pain and help you move much better. More than 90% of people who have a total knee replacement still function well 15 years after surgery.

Ial Knee Replacement Overview

A is also known as unicompartmental knee arthroplasty or unicondylar knee arthroplasty. In this surgery, damaged cartilage and bone are removed and replaced only in one diseased compartment of the knee. This differs from a total knee replacement, in which bone and cartilage from the entire joint are replaced.

Partial knee replacement is suitable for people who experience arthritis only in one compartment of the knee joint, rather than throughout the joint. It can also provide relief from pain and stiffness in some people who have medical conditions that make them poor candidates for total knee replacement surgery.

No Surgery Complications For Patients In Kaiser Study

A large 2013 study published inThe Journal of Bone & Joint Surgeryfailed to find any association between diabetes and negative surgical outcomes. In that study, researchers retrospectively reviewed the electronic health records of more than 40,000 Kaiser Permanente patients who had a knee replacement. However, patients with diabetes in the Kaiser study were generally healthier, tended to have well-controlled diabetes, and had better outcomes overall. The rarity of negative outcomes and uncontrolled diabetes in the study made it harder for the researchers to draw statistically significant conclusions.

Although the study suggests that you dont have to postpone elective surgery for total knee replacement if diabetes is uncontrolled, its important to remember that this is a retrospective study that is missing very crucial information, such as the type of diabetes treatment, duration of diabetes, and the status of diabetes control during hospitalization when can rapidly improve blood glucose levels,says Osama Hamdy, MD, PhD,medical director of the Obesity Clinical Program at the Joslin Diabetes Center in Boston and associate professor at Harvard Medical School.

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Persistent Pain And Dissatisfaction

Although outcomes after total knee replacement are good, many patients continue to report pain and dissatisfaction.

Clinically significant persistent pain and dissatisfaction has been reported in 20% of patients.5 Night pain is quite common after knee replacement. Possible explanations for such pain include unrealistic expectations, technical flaws of the procedure and pain from other sites. If the pain is persistent without a known cause then referral to the pain management team should be made.

• Mr Waheed is senior knee fellow and Mr Dowd is consultant orthopaedic surgeon at The Royal Free and The Wellington Hospitals, London

References

1. SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am 2006 88: 480-5.

2. Claus A et al. Risk profiling of postoperative complications in 17, 644 total knee replacements. Unfallchirurg 2006 109: 5-12.

3. Blom AW, Brown J, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Infection after total knee arthroplasty. J Bone Joint Surg Br 2004 86: 688-91.

4. Januel JM, Chen G, Ruffieux C, et al. Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review. JAMA 2012 307:294

What Are The Risks Of Knee Surgery

14 May, 2021

In some cases, knee surgery is the only option when it comes to treating or resolving issues with this joint. This procedure can carry some risks and its generally only considered if theres no other alternative. So, what are the risks of knee surgery?

Knee problems tend to show up in young people because of sports or as a consequence of work-related activities. In older people, knee pain is usually the result of degeneration caused by aging.

Pain in this joint can seriously affect mobility and our quality of life. In these cases, its common to get knee surgery in order to solve the problem. Also, if the knee is significantly injured, theres no other option but to operate on it.

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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.

Revision Risks

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

Joint Surgery

Risks Of Total Or Partial Replacement

In most cases, partial or total joint replacement is very effective in solving knee problems. Like any surgical intervention, there are some risks. The following are the most common:

• Thrombus formation: This is the most common complication. The surgeon always takes precautionary measures which generally include blood-thinning medication, leg elevations, exercises, and compression stockings.

• Infection: About 2% of patients contract an infection in the two years following this knee surgery. You can prevent these infections during or after surgery.
• Osteolitis: This is the breakdown of the bone next to the implant and usually requires surgical intervention.
• Implant fracture: This is a rare complication that can be prevented by avoiding excessive or inappropriate physical activity.
• Others: In very rare cases, you may have an allergic reaction to the implants metal. Improper implant placement can cause dislocations or an outside force could cause parts to loosen or shift.

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Taking Care Of Yourself At Home

Be guided by your doctor or surgeon, but general suggestions include:

• The pain and stiffness take time to ease, so be patient. It may take around three months before you feel fully recovered.
• Keep your wound site clean and dry.
• Avoid smoking cigarette smoke can increase your risk of lung infections.
• Avoid any sporting activities for at least two months.
• Follow the suggestions given to you by medical staff on how to walk, climb stairs, and get in and out of chairs safely.
• Avoid jumping, jolting the knee joint or kneeling down.
• Use aids to help you around the home for example, handrails at the bath and toilet, footstools, raised toilet seats, crutches and walking sticks.
• Check your knee carefully for any signs of infection. These can include redness, swelling, warmth or seepage.
• See your doctor or surgeon if you experience anything unusual, such as clicking or popping sounds coming from the knee joint, or a sudden loss of joint control or movement.

Knee Replacement Surgery Risks

Risks and Complications of Knee Replacement Surgery

What are the risks of undergoing a knee replacement surgery?

Risks of knee replacement surgery include:

. Blood clots in the legs or lungs

. Pulmonary embolism, which can cause shortness of breath, chest pain, and even shock.

. A fracture during or after surgery

. Urinary tract infection

. Chronic knee pain and stiffness

. Bleeding in the knee joint

. Blood vessel injury

. Infection of the knee which can require reoperation.

. The risks of anesthesia include potential heart, lung, kidney, and liver damage

Other common complications include:

. An allergic reaction to the prosthesis or bone cement can occur. In these cases, the bone cement and prosthesis must be removed.

. Excess bone forming around the artificial knee joint, leading to restricted movement in the knee.

. Excess scar tissue restricts movement of the knee

. Instability of the kneecap, resulting in painful dislocation to the outer side of the knee.

. Ligament, artery, or nerve damage around the knee joint

. Dislocated kneecap

. A prosthesis component can become loose or dislocate if it does not seal to the bone well or is misaligned.

. Legs may be slightly different lengths after surgery. In some cases, a shoe insert can remedy this problem.

. Damage can occur to the knees patella and/or the soft tissue that support the joint between the patella and the femur.

How common are complications?

. About 1 percent of people develop an infection after surgery.

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Dangers And Risks Of Putting Off Knee Replacement Surgery

Patients often delay knee replacement surgery because of fear of the procedure or concerns about the recovery process. Interestingly, while many people worry about what could possibly happen if they undergo knee replacement surgery, fewer stop to think about what will likely happen if they wait:

• Increased knee pain
• Further damage to the joint
• Reduced mobility and ability to use the knee

Continuing to delay knee replacement surgery can bring about serious consequences, such as the inability to walk, work and perform normal daily tasks.

Knee Replacement Surgery May Be More Complex the Longer You Wait

The longer a patient waits to have knee surgery, the more complicated the surgery can become. Here are some ways the procedure can become more complex when a person delays knee replacement surgery:

• The knee may become deformed and therefore harder to replace
• The surgical procedure can take longer
• Kneecap resurfacing may be required
• Options may become more limited. For instance, early on, a patient may only need a partial knee replacement, but if they wait, they may need total knee replacement which is a more complex procedure.

Delaying Knee Replacement Surgery May Diminish Health

Make a Knee Replacement Surgery Appointment

Most patients who have had knee replacement surgery not only report positive outcomes including reduced pain or complete freedom from knee pain, many say they would have had knee replacement surgery sooner.

Five Reasons Why Knee Replacements Fail

Wear and loosening

Properly functioning implants depend on their appropriate fixation to the bone. Fixation is usually achieved by cementing the implant onto the bone. Some surgeons prefer instead to use biologic fixation, meaning no cement placed between the implant and the bone.

Although implants are firmly fixed at the initial knee replacement surgery, they may become loose over time. The cause of loosening may not always be clear but high impact activities, excessive body weight and wear of the polyethylene component may all act as contributing factors. Friction caused by the joint surfaces rubbing against each other wears away the surfaces of the implant, creating tiny particles that accumulate around the joint. In a process called aseptic loosening, the bond of the implant to the bone is destroyed by the body’s attempt to digest these wear particles. During this process, normal, healthy bone is also digested , which can weaken or even fracture the bone.

When the prosthesis becomes loose, the patient may experience pain, change in alignment, or instability.

Infection

Revision surgery of the infected knee can take several forms. Depending on the degree of infection and damage, the surgeon will determine one of two basic courses of action:

Instability

Leg fractures

Stiffness

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Extending The Life Of Your Knee Implant

Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

To assist doctors in the surgical management of osteoarthritis of the knee, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Surgical Management of Osteoarthritis of the Knee – Clinical Practice Guideline | American Academy of Orthopaedic Surgeons

Total Knee Replacement Facts

• Patients with severe destruction of the knee joint associated with progressive pain and impaired function may be candidates for total knee replacement.
• Osteoarthritis is the most common reason for knee replacement operation in the U.S.
• Risks of total knee replacement surgery have been identified.
• Physical therapy is an essential part of rehabilitation after total knee replacement.
• Patients with artificial joints are recommended to take antibiotics before, during, and after any elective invasive procedures .

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Total Knee Replacement Risks And Complications

The vast majority of total knee replacement surgeries are successful however, complications can occur.

Below is a list of some potential complications. In rare instances, these complications are life-threatening. A small percentage of patients will require a second, revision surgery.

Complications tend to be higher in patients who use tobacco and who are older or obese.

My Avoidance Of Surgery

I first injured my left knee at age five, when I struck my left instep against the sharp edge of a concrete step during a fall. The next injury occurred in fall on a gravelly playground at age seven.

At age 19, I sprained the same knee on a trampoline. That was the most interesting injury because it resulted in several occasions of the knee stiffening without painI would rise from my desk at school and, later, at work, with my knee remaining bent for a short time.

I sprained the same knee seven additional times over the years. These were all short-lived injuries that healed quickly, but in 2007, I discovered a book about knee health that I use even today. It explains the workings of the knee, how to exercise properly, how to use a proper diet to maintain healthy joints, how to use alternative medical knowledge for the joints, and even some information about how to decide to have surgery or not.

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How Do I Know If I Need Knee Replacement Surgery

You may need surgery if:

• Your knees are stiff and swollen.
• There is pain throughout the day, even at rest.
• Walking, getting up or climbing stairs is difficult and painful.
• Medication and therapy do not offer enough relief.
• Knee cartilage is so damaged and worn away that you are walking “bone on bone,” in which the bones of the joint are scraping together.

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Protecting Your Knee Replacement

After surgery, make sure you also do the following:

• Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
• Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
• Make sure your dentist knows that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
• See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays. Your surgeon will talk with you about the frequency and timing of these visits.

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Reasons For The Procedure

Treatment for disability and knee pain finds a solution with knee replacement surgery. Osteoarthritis happens to be the most common condition that demands knee replacement surgery. In patients suffering from osteoarthritis, the joint cartilage gradually undergoes damage. This breakdown of joint cartilage can result in pain and restrictive movement.

Patients suffering a chronic and degenerative joint disease will not be able to perform normal activities such as climbing stairs or even walking. Patients suffering from this condition will experience a lot of pain. There could be inflammation at the knee and the area may swell up.

Rheumatoid arthritis can also cause degeneration of the knee joint. Further, arthritis that results due to injury to the knee can also lead to knee joint damage. Some other reasons for permanent damage to the knee joint could be ligament tear, torn cartilage, and fractures.

Doctors may recommend other forms of treatment such as reduction in weight, to reduce the stress on the knees. If other forms of medical treatment such as medications for pain, and anti-inflammatory treatment, have not yielded results, doctors recommend knee replacement surgery. If the use of cortisone injections in the knee joint, physiotherapy, or the use of assisted devices is not satisfactory, knee replacement surgery may be an effective treatment.

What Are The Risk Factors For A Failed Knee Replacement

Age, activity level, surgical history and a persons weight can contribute to implant failure. Younger, active patients, people who are obese, and those who have had prior knee surgeries all have a higher increased risk of a failed implant.

Younger, more active patients have a higher rate of revision than older, less active patients because they place more stress on their prosthesis over more time. Obese patients have a higher incidence of wear and loosening because of the increased force of their weight, and they are more prone to infections because of their increased risk of wound healing. Patients with previous knee surgeries are at higher risk for infection and implant failure.

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Helping Patients To Make Informed Decisions

We’re funding research to improve patient experience before, during and after knee replacement surgery. This includes a project based at the University of Sheffield which aims to help patients make informed decisions about their surgery. The research team will use the UK National Joint Registry dataset to develop and validate a personalised, web-based decision aid to help patients considering knee joint replacement to make informed choices about their treatment.