What Ligaments Are Removed During A Total Knee Replacement
Reviewed by: Aubrey Bailey, PT, DPT, CHT
Surgeons are constantly looking for ways to improve a surgery. Total knee replacements have morphed over the years to become less invasive and improve recovery times. A new style of totalknee replacement surgery is emerging that doesn’t replace any ligaments. Traditional surgeries replace one or two out of the four knee ligaments.
Depending on the type of surgery you have, two or fewer of the four ligaments in your knee may be removed.
Total Knee Replacement Surgery
Your doctor may have told you that you are a candidate for total knee replacement surgery. This surgery removes the damaged and painful areas of the thigh- and shinbones. These areas are then replaced with specially designed metal and plastic parts.
Standard surgical incision for knee replacement
The standard surgical incision is between 8 to 12 inches. The incision is made through the quadriceps tendons and muscles to position the replacement parts. Patients generally have two to three months recovery time. Much of the postoperative pain a patient feels is a result of the cutting of the tissues. While tissues are healing, scar tissue forms, which may cause pain and stiffness.
Minimally invasive total knee replacement procedure
This new technique at Midwest Orthopaedics at Rush has revolutionized total knee replacement surgery . The short incision total knee replacement is a surgical modification using a smaller incision that requires less muscle dissection, which generally results in more rapid and less painful recovery with better early range of motion and improved function.
Potential benefits of this minimally invasive technique include increased range of motion sooner after surgery, less blood loss during surgery, faster recovery and a shorter hospital stay. In fact, many patients leave the hospital the same day.
For additional information about the Midwest Orthopaedics at Rush experts in minimally invasive total knee replacement, call 877 MD BONES .
When Its Time For Knee Replacement Surgery
Knee arthritis can get worse in spite of treatment. If youve tried these methods and are still dealing with pain, it might be time to discuss knee replacement with an experienced orthopaedic surgeon. Total knee replacement is a major procedure, but it can offer better quality of life and improved mobility that last for many years.
A total knee replacement is more of a resurfacing of the bones in the knee: the end of the femur , the top of the tibia and the inward facing surface of the patella, or kneecap. The surgeon removes the bony surfaces and replaces them with metal and plastic implants. The plastic serves the same purpose as the cartilage, helping the implants glide against each other smoothly.
Valaik notes that there are constant innovations in the field of knee replacement. For instance, more surgeons are using regional anesthesia for the procedure, which can mean a shorter hospital stay compared with when general anesthesia is used.
New multimodal pain approaches, surgical techniques and physical therapy after these surgeries are all improving a patients knee replacement experience, he says.
Hip and Knee Replacement at Johns Hopkins
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When Is Total Knee Replacement Surgery Necessary
The knee joint can be damaged by different types of arthritis, injury or trauma. Joints are formed when the ends of bone are connected by cartilage, which serves as a protective cushion. If the cartilage is damaged or tissues around the joint become inflamed or wear thin, the bones can rub against each other, causing pain. When pain makes even everyday activities difficult like walking, climbing stairs, sitting or sleeping total knee replacement may be an option.
What Activities Will I Be Able To Engage In
Most patients require an assistive device for approximately 3 weeks after knee replacement surgery although this varies significantly from patient to patient.
You will also be able to do low-impact exercise such as riding a stationary bike, walking, and swimming after 68 weeks. Your physical therapist can advise you on introducing new activities during this time.
You should avoid running, jumping, as well as other high-impact activities.
Discuss with your orthopedic surgeon any questions concerning your activities.
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Minimally Invasive Knee Replacement
In minimally invasive knee replacement, the surgical procedure is similar, but there is less cutting of the tissue surrounding the knee. The artificial implants used are the same as those used for traditional knee replacement. However, specially designed surgical instruments are used to prepare the femur and tibia and to place the implants properly.
Minimally invasive knee replacement is performed through a shorter incisiontypically 4 to 6 inches versus 8 to 10 inches for traditional knee replacement. A smaller incision allows for less tissue disturbance.
In addition to a shorter incision, the technique used to open the knee is less invasive. In general, techniques used in minimally invasive knee replacement are “quadriceps sparing,” meaning they avoid trauma to the quadriceps tendon and muscles in the front of the thigh. Other minimally invasive techniques called “midvastus” and “subvastus” make small incisions in the muscle but are also less invasive than traditional knee replacement. Because the techniques used to expose the joint involve less disruption to the muscle, it may lead to less postoperative pain and reduced recovery time.
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:
Loosening of the components of the knee
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.
Johns Hopkins offers in-person educational sessions to help you prepare for knee replacement surgery. During your class, we’ll review important aspects of your care and what to expect before and after surgery. You will be able to ask questions and meet many of the staff who will be caring for you in the hospital.
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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:
All prescription medicines
Over-the-counter medicines such as aspirin or ibuprofen
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:
X-rays, to get information about your hip
MRI, to get more detailed information about your hip
Electrocardiogram , to make sure your heart rhythm is normal
Follow any other instructions from your healthcare provider.
Common Conditions That Can Lead To Knee Replacement
We treat the entire spectrum of knee problems. Many can be treated without surgery, but some may lead to partial or total knee replacement surgery, including:
- Osteoarthritis Osteoarthritis is one of the leading causes of knee replacement. It is a chronic, degenerative condition, meaning it will continue to get worse over time. While there are many non-surgical treatment options, partial or total knee replacement may become necessary for some patients with osteoarthritis. Rheumatoid arthritis and post-traumatic arthritis can also lead to the need for knee replacement surgery.
- Avascular Necrosis Avascular necrosis happens when the blood supply to the bone is cut off temporarily or permanently. This can cause the bone tissue to die, which can affect nearby joints. If avascular necrosis affects the knee, a total knee replacement may be a treatment option.
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Are There Any Reasons Why I Cant Have A Knee Replacement
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
- your thigh muscles are very weak and may not be able to support your new knee joint
- there are deep or long-lasting open sores in the skin below your knee, increasing your risk of infection.
More About The Advantages Our Surgeries Provide
Our mini-incision knee replacement surgeries are performed by board-certified orthopedic surgeons and facilitated by innovative medical technologies, such as MAKOplasty® knee resurfacing procedures to minimize incisions and scarring, and the RIO Robotic Arm Interactive Orthopedic system that helps ensure optimal implant positioning. This leading-edge approach to knee replacement helps our patients experience streamlined recoveries and encourages a more natural knee motion once the joint has healed. Our surgeons also perform minimally invasive joint replacement revision surgeries for patients whose prostheses have broken or worn out.;;;
If youve been considering knee replacement surgery and would like to discuss possible;knee pain treatment;options with a Tampa General Hospital orthopedic surgeon, call 1-800-822-DOCS or;use our online Physician Finder to receive a referral to our orthopedics program.
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Obesity And Knee Replacement
The review of found that obese patients faced additional risks when they had a knee replacement procedure. Such risks include a shorter life of the joint replacement, a greater chance of misalignment or implant failure, and more post-surgical complications. Obesity already puts people at risk for a number of health risks, including cancer, diabetes, and heart disease. This recent finding only adds to the list of possible implications.
Although they do realize the benefits of having the procedure, knee replacements do not last as long in obese patients. The study found that, at 7 years post-op, obese patients were much more likely to have an implant failure. This leads to a much higher rate of revisions in obese patients as well.
Any patients struggling with obesity that may need a knee replacement should speak with their doctor about managing their weight. A knee replacement can do wonders with eliminating pain and restoring the ability to participate in everyday activities. Obesity can only get in the way of these benefits.
What Is Partial Knee Replacement
A partial knee replacement is an alternative to total knee replacement for some people with osteoarthritis of the knee. This surgery can be done when the damage is confined to a particular compartment of the knee. In a partial knee replacement, only the damaged part of the knee cartilage is replaced with a prosthesis.
Once partial knee replacement was reserved for older patients who were involved in few activities. Now partial knee replacement is often done in younger people as their recovery is quicker and usually less painful. About 5% to 6% of people with arthritic knees are estimated to be eligible for partial knee replacement.
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Set Yourself Up For Success
If you and your doctor think joint replacement is reasonable, give yourself time beforehand to deal with health issues that may interferesuch as obesity or uncontrolled diabetes. And take these steps:
Pick an experienced surgeon who frequently performs joint replacement and has a low complication rate: At least 50 surgeries a year and a 3 percent or lower complication rate are good benchmarks. The medical facility you choose should do at least 400 joint replacements annually.
Because a key risk of surgery is infection, ask about the facilitys overall infection rate . Or check Consumer Reports hospital ratings.
Find out about recalls.;Ask your surgeon whether the device he or she is planning to use has ever been recalled, advises Lisa McGiffert, director of the;Safe Patient Project;at Consumers Union, the policy and mobilization division of Consumer Reports. And request the unique device identifier for your implant in case it is recalled in the future.
In addition, make sure you dont have an allergy or a sensitivity to any of the materials in your device and that your surgeon isnt planning to use a metal-on-metal implant. These have caused health problems in some people.
Ask your doctors how theyll manage your pain after the procedure. A multimodal pain management program is best, Kraay says. That means a combination of techniques, such as nerve blocks, epidural injections, and NSAIDs. This approach can reduce the need for opioid medications.
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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Dr Thomas Ferro: Founder Of Nano
Dr. Thomas Ferro is the Founder of Nano®, the Medical Director of the Bone & Joint Center in Arroyo Grande, California, and a board-certified and fellowship-trained orthopedic surgeon. With three decades of innovation and experience, he is widely regarded in the medical community as the leader in breakthrough joint replacement technology and personally performs a high volume of replacements each year.
Lose Weight To Lessen Stress On Your Knees
Number one on Valaiks list of ways to reduce;knee pain;and delay knee replacement: reaching and maintaining a healthy weight.
Extra weight puts pressure on the knees and increases stress on the joint, increasing pain and making it hard to exercise, Valaik explains.;Research;compiled by the;Johns Hopkins Arthritis Center;confirms that carrying extra pounds raises your risk of developing knee arthritis and speeds up the destruction of cartilage that cushions the joint.
I know its not easy, he says, but losing weight really helps, whether youre dealing with arthritis in one or both knees. If you are overweight or obese, consulting with a nutritionist or a bariatric specialist may be the right place to start.
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What Are The Risks
- An infection at the surgical site is possible. Blood clots are a risk as are injuries to a blood vessel or a nerve. These complications are quite rare.
- You may experience some knee joint stiffness.
- Late complications may include infection and a failure or loosening of the prosthesis, as well as continued pain.
Who Is A Candidate For Partial Knee Replacement
People with medial, or lateral, knee osteoarthritis can be considered for partial knee replacement. “Medial” refers to the inside compartment of the joint, which is the compartment nearest the opposite knee, while “lateral” refers to the outside compartment farthest from the opposite knee. Medial knee joint degeneration is the most common deformity of arthritis.
Other factors to consider:
- You may want to consider a knee replacement if your knee pain persists despite your taking anti-inflammatory drugs and maintaining a healthy weight.
- Your provider will ask you to identify the area of pain in your knee, then check your range of motion and the knee’s stability. An X-ray of the knee will determine your eligibility for partial knee replacement. However, your surgeon may not know for certain if you are a good candidate until the surgery has begun.
- You must have an intact anterior cruciate ligament, a sufficient range of knee motion, damage to only one compartment and a stable knee. The angulation of the deformity is also considered.
- In the past, a partial knee replacement was considered only in people 60 and over who were sedentary. Now younger, more active people are increasingly being considered.
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If you have any questions about Total Knee Replacement, feel free to email Dr. Manner at , or schedule an appointment at 425.646.7777.
OverviewKnee replacement is a surgical procedure that decreases pain and improves the quality of life in many patients with severe knee arthritis. Typically patients undergo this surgery after non-operative treatments have failed to provide relief of arthritic symptoms. Surgeons have performed knee replacements for over three decades generally with excellent results; most reports have ten-year success rates in excess of 90 percent.
Broadly speaking there are two types ways to insert a total knee replacement: the traditional approach and the newer minimally-invasive approach.
Traditional total knee replacement involves a roughly 8 incision over the knee a hospital stay of 3-5 days and sometimes an additional stay in an inpatient rehabilitation setting before going home. The recovery period typically lasting from one to three months. The large majority of patients report substantial or complete relief of their arthritic symptoms once they have recovered from a total knee replacement.
The main potential benefits of this new technique include:
The major apparent risks of the procedure compared to traditional total knee replacement:
Nano Its The Way We Do It
Precision, perfection, and a comfortable return to full use of joint function are now available to patients from across the United States. Nano® sounds incredible because it is. Its the way we do it, the way that every step of the procedure revolves around precision, and every component of your new implant is suited to you personally and is created and placed with extreme accuracy.
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