How Long Will The New Knee Joint Last
For 8090% of people who have total knee replacement, the new joint should last about 20 years, and it may well last longer.
If you’ve had a partial knee replacement, you’re more likely to need a repeat operation about 1 person in 10 needs further surgery after 10 years.
The chances of needing another operation is greater if you’re overweight and/or involved in heavy manual work.
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.
Find The Best Knee Replacement Implant: Top Brands
There are more than a dozen manufacturers of artificial knee implants. However, like anything else, some knee implant manufacturers have a larger market share than others. In the US, the most popular knee replacement parts manufacturers are Zimmer , Stryker, DePuy and Smith & Nephew.
Here are the top brands and styles used by surgeons in the US.
Zimmer is the most popular manufacturer of knee replacements. In fact, according to Zimmer, more than 25% of knee replacements implanted worldwide are a Zimmer product. Thats a whole lotta implants!
Different Styles
Biomet
Biomet, who has recently merged with Zimmer and is now called Zimmer Biomet, offers a nickel-free implant for those with allergies. They also offer an antioxidant polyethylene material insert component to pair with their tibial and femoral parts. In saything this, there is nothing to prove that antioxidant plastic holds any true benefit. Admittedly, it sounds pretty good though!
Different Styles
Among the most popular manufacturers in the US, Stryker offers total, partial, and revision knee replacement systems that are suitable to a wide variety of patients. Stryker implants are used in over 100 countries.
Different Styles
DePuy
Different Styles
Smith & Nephew offers a wide range of replacement variations that fall under their Legion family. This includes replacements made from oxidized zirconium, a nickel-free metal thats suitable for patients with metal allergies.
Different Styles
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How Does Partial Knee Replacement Differ From Total Knee Replacement
Most arthroplasties target the entire knee joint, an operation called a total knee replacement. But some people choose to have a partial knee replacement.
To understand the difference, it helps to know the knees compartments, or sections. It has three:
- Inside .
- Outside .
- Under the kneecap .
The partial approach fixes a single section. So healthcare providers call it unicompartmental replacement. A total knee replacement addresses all three sections. Generally, only younger adults with symptoms in one knee section benefit from partial replacement.
Nothing To Eat Or Drink
The hospital should give you clear instructions about fasting. These instructions are important. If there is food or liquid in your stomach during your anaesthetic, it could come up into your throat and damage your lungs.
If you are not having a general anaesthetic, you will still be asked to follow these instructions. This is because a general anaesthetic may be needed unexpectedly, and you need to be prepared.
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How Is A Total Knee Replacement Performed
First, the orthopedic surgeon makes an incision in the knee and moves the patella to the side. If are any bone spurs are present, as sometimes occurs in osteoarthritis, they will be removed.
Next, the two menisci between the femur and tibia are removed, as are the anterior cruciate ligament and, in some cases, the posterior cruciate ligament . In some types of knee replacement, the PCL is retained.
During the main phase of the operation, the surgeon cuts and remove cartilage and some bone from the upper part of the tibia and lower sections of the femur. The femoral sections removed are two knobby protuberances called the femoral condyles. The tibia and femur are then be capped with metal implants to create new surfaces for the joint. The surface of the femoral component mimics the shape of the original femoral condyles. If the kneecap has also degraded, the surface on its underside may also be cut away and replaced with a polyethylene implant.
Finally, the various layers of tissue are repaired with dissolvable sutures and the skin incision is closed with sutures or surgical staples. A bandage will be wrapped around the knee and the patient is be taken to recovery.
Fixed-bearing knee implant with a polyethylene articulating surface sandwiched between the metal tibial implant and metal femoral implant.
Side-view illustration of a knee with a fixed-bearing knee implant in place.
X-ray of a knee after total knee replacement, showing the implanted prosthesis)
Types Of Knee Implants
Thinking about a total knee replacement? There are a few different kinds of knee implants that are used in this procedure. The different types are categorized by the materials that rub against each other when you flex your knee:
Metal on plastic. This is the most common type of implant. It features a metal femoral component that rides on a polyethylene plastic spacer attached to the tibial component. The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant life span. However, one problem that can happen with plastic implants is an immune reaction triggered by tiny particles that wear away from the spacer. This can cause bone to break down, leading to loosening and failure of the implant. Advances in manufacturing have greatly reduced the rate of wear in the plastic.
Ceramic on plastic. This type uses a ceramic femoral component instead of metal . It also rides on a plastic spacer. People who are sensitive to the nickel used in metal implants might get the ceramic type. Plastic particles from this type of implant also can lead to an immune reaction.
To learn more about your options for knee replacement surgery, read the Harvard Medical School guide Total Knee Replacement.
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What Actually Moves Inside An Artificial Knee Joint
In an artificial knee joint, highly polished cobalt-chromium metal moves against a very durable plastic spacer to allow movement. This bearing is lubricated by your bodys own synovial fluid, which is constantly replenished by living cells. The power to move the artificial knee, once implanted in your body, comes from your own muscles. That is why the condition of your muscles affects how quickly you recover after any type of knee surgery, including a total knee replacement.
Total Knee Replacement Procedure
During a total knee replacement, the top of your shin bone and bottom of your femur are resurfaced with plastic or metal parts, according to an article from Hopkins Medicine. Knee replacements are made to reduce pain that you can get from degeneration of the joint.
Cartilage may wear down, which results in bone-on-bone contact in your knee. When your bones rub together, they’re slowly damaged and cause more pain. Putting a smooth metal surface over the bones or replacing a part with smooth plastic can get rid of your knee pain.
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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.
Care After The Operation
Please give some thought as to how you will be looked after once you have had the operation, well in advance. Most people like to be independent, but you are going to need support with day-to-day activities for a while. If you have an able-bodied partner, this might fall to them, but otherwise you may need a friend or relative to come to stay with you for a while. Some people may arrange to stay in a care home until they have their mobility and independence back.
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When Should I Seek Medical Attention After Knee Replacement
After you go home, call your healthcare provider right away if you develop any of the following symptoms:
- Chest pain and/or shortness of breath.
- Fever higher than 101 degrees Fahrenheit .
- Incision problems, like bleeding, leaking, swelling, redness or odor.
- Pain in your calf, ankle or foot that is new and gets worse.
A note from Cleveland Clinic
If you have severe knee pain but medications and therapy arent helping, knee replacement may provide the answer. This common and effective surgery can reduce pain and get you back to everyday activities. Talk to your healthcare provider or an orthopedic provider about whether knee arthroplasty is a good option for you.
How Long Will My New Joint Last
In recent years, improvements in medical equipment and surgical techniques have meant that many knee replacements last longer than they did in the past.
A new study looking at over 6,000 people who have had knee replacement shows:
- More than 4 in 5 people who have total knee replacements can expect them to last for at least 25 years.
- 7 in 10 people who have a unicompartmental knee replacement can expect it to last for at least 25 years.
Clearly this will vary between different people, and you still need to take care of your new knee.
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How To Put On A Knee Brace
- Choose the right style of knee brace. There are different styles of knee braces for different severity of your condition. If you have moderate pain, then you can also wear a compression sleeve.
- Most knee braces come with straps or velcro, so they can be put directly on the knee . All you need to do is to roll up the pants, and put the knee brace on.
- Keep the knee brace at the center of your knee for best results.
- After wearing the knee brace, tighten its straps to get the best compression effect.
Watch the video below to see how to put on a knee brace
Posterior Cruciate Ligament Substituting
This design replaces ligament with plastic components. It is recommended primarily for patients with severely damaged knees or weak ligaments. Also used in revision surgery.
It is indicated for patients with severe knee deformities or who have had previous knee replacement surgery or have had a knee cap removed.
The PLC substituting design has a tall post attached to the tibia which fits into a deep box attached to the femur. The two are not connected with any kind of hinge joint. A polyethylene bearing attaches to the tibial component.
A 2016 study of the PLC substituting design found that 88.5 percent of PLC substituting implants used in initial knee replacement surgery survived 10 years. For revision surgery, the 10 year survival rate was 75.8 percent if the revision surgery was due to some cause other than infection, and 54.6 percent if revision was due to infection.
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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.
Implanting The Tibial Component
The bottom portion of the implant, called the tibial tray, is fitted to the tibia and secured into place using bone cement. Once the tray is in place, the surgeon will snap in a polyethylene insert to sit between the tibial tray and the femoral component, and act as a kind of buffer. This insert will provide support for your body as you bend and flex your knee.
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Can Patients Become Allergic To The Knee Replacement Parts
The metals used in artificial knees are alloys of cobalt-chromium and titanium. The bearing portion of the joint is made of a high-grade, wear-resistant plastic. The metal-plastic bearing combination is the most common type used in knee replacement implants worldwide. These metals have been used in humans for many decades and millions of patients with very successful results. Allergic reaction to artificial knee parts is virtually unheard of, and is not a routine clinical concern.
In the extremely rare case of a true metal allergy verified by testing, there are material science options to replace a knee without exposure to titanium, nickel, or cobalt-chrome, which are the usual metals used in standard knee replacements. In other words, metal-allergic patients can still get a knee replacement.
When Can I Get Back To My Everyday Activities After Knee Arthroplasty
Your doctor will give you specific instructions. But many people can get back to their everyday activities three to six weeks after surgery.
Your healthcare provider will give you specific instructions about recovery. You will gradually increase activity, starting with a slow walking program. You will be encouraged to stand, climb stairs and perform other normal household activities as soon as possible.
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Can Ceramic Parts Be Used In Knee Replacements
Yes. The advantage is the lower wear rate of ceramics when compared to metals. In the United States, ceramic knees are used on a limited basis since the Food and Drug Administration has not approved them for general use. Several years ago, we conducted one of the few clinical trials in the country on ceramic knees.
Ceramic parts are useful in the rare cases of a true metal allergy in selected patients. Ceramic components will likely become more common in the future. At the time, ceramic materials in total knees are more common overseas. Balancing the very low wear rates of ceramics is the fact that we do not have enough scientific data from U.S. studies to support their routine use in total knee replacements as of yet.
When General Anesthesia May Be Needed
Despite the reasons to consider regional anesthesia, there may be times when general anesthesia is either favored by a patient or doctor, or medically necessary:
- Medical conditions: General anesthesia may be preferable for someone who’s had significant spinal surgery such as a lumbar fusion, which can make regional anesthesia more difficult. Spinal deformities, including scoliosis, may also make regional anesthesia more challenging. Also, medical conditions such as aortic stenosis make general anesthesia a safer option.
- Patient anxiety: Many patients who choose general anesthesia do so because they simply understand that option better than regional anesthesia. They could also be anxious about having a spinal injection. If you have questions, speak with your doctor to learn more about how regional anesthesia is administered and the effects it can have.
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Custom Knee Replacement Components
Some experts believe that custom components lead to better results for patients.4 Others believe custom components have limited benefit and should be reserved for patients who have unusual knee anatomy or face challenging revision surgeries.
Custom cutting blocksCustom cutting blocks are based on the patients knee anatomy. The goal is to help the surgeon make precise cuts to the patients bone. Research regarding the effectiveness of custom cutting blocks is mixed.5
Custom cutting blocks are used in about 6% of surgeries.6 They do not have to be used with custom components.
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 .
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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.