Differences Between Total And Partial Knee Replacement
Knee replacement surgery is recommended when conservative treatments like 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.
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.
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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What Should You Do
It is always appropriate to discuss with your surgeon any questions, concerns, or interest that you have in joint replacement surgery. That said, it is also important to be willing to listen to your surgeons’ preferences regarding surgery. Most surgeons will not offer to use an implant that they do not know well, but some might. Having familiarity with a particular implant, and the instruments used to implant it within the body is a critical part of the surgery.
If you are interested in a particular implant or material, ask your surgeon to explain more about it. Your surgeon should be able to answer your questions and also explain why they may or may not recommend that particular implant. Keep in mind, implant companies often want you to believe that a newer implant is far superior, but that is not always the case. There is tremendous value in the utilization of implants that have an excellent long-term track record, and the use of implants that have less of a track record can present the potential for problems.
What Kind Of Metal Is Used In Knee Replacements
Artificial knee materials can be made of strong plastic, metal, or ceramic. All knee replacements, partial or total, will have parts made of a few different materials . In most cases, each component is built from titanium, cobalt-chromium alloys, or a titanium and cobalt mixed metal. The chosen materials must be durable, allow for some flexibility with movement and be biocompatible .
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Use Pain Medications With Care
Except in very rare cases, the American Association of Hip and Knee Surgeons advises against using opioid medications for knee osteoarthritis. Opiate pain relievers, in addition to being addictive, are not proven to address knee pain over the long term any better than nonsteroidal, anti-inflammatory drugs .
Though safer than opioid drugs, NSAIDs arent for everyone, and Valaik advises caution in using them. Even over-the-counter drugs like naproxen and ibuprofen can have side effects, so check with your doctor, he says.
You can get an increase in blood pressure with NSAIDs. Larger studies have linked some of these pain relievers with a small increase in the risk of heart attack.
And the more you take, the more likely you are to have heartburn, stomach irritation or even bleeding ulcers, he notes.
What Are The Alternatives
Knee replacement surgery may be necessary in certain cases. But patients should speak with their doctors about alternatives to knee replacement surgery.
- Diet and Exercise
- Reducing weight can reduce the wear and tear on the knee. Losing one pound relieves as much as five pounds of stress on the knee. Muscles absorb stress on the knee. Building muscle can reduce knee pain.
- Physical Therapy
- Physical therapists help shape a routine to best build muscle. Heating, cooling and other therapies can reduce knee pain.
- Oral Medications
- Over-the-counter versions of Tylenol can reduce pain. Drugs like Motrin, Advil and Aleve can reduce inflammation as well. Stronger prescription versions are available.
- Knee Injections
- Cortisone shots in the knee can ease pain and inflammation. Hyaluronic acid derivatives work as shock absorbers. HADs supplement naturally occurring synovial fluid in the knee. Knee arthritis causes people to lose this natural fluid.
- Arthroscopic Surgery
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Whats The Structure Of An Artificial Knee Jointinformationen About $cms: If$$cms: Valueconvert2$$cms: End: If$
An artificial knee joint is made up of several parts:
- A metal cap that is placed on the end of the thigh bone , like a crown on a tooth, after the damaged joint surfaces have been removed. This cap is also called the femoral component.
- A platform that replaces the top surface of the lower leg. This platform also usually consists of a metal alloy, and is called the tibial component. On its underside, theres a short stem that is anchored in the tibia .
- A plastic spacer made of polyethylene between the upper leg component and lower leg component. This replaces the joint space and meniscus and helps the artificial knee joint to move smoothly. Some prostheses use a fixed bearing, while others use a mobile bearing that can easily turn around its own axis or glide forward and back.
If the back of the kneecap is severely damaged by osteoarthritis, it can be replaced by a plastic cap as well.
Heres What The Ideal Knee Implant Should Have Going For It:
- Allow for normal activities and motion
- Last the expected 15-20 years or more.
- Have a good track record of use in joint replacement recipients .
- Meets your condition, needs, and any additional requirements . Your surgeon will ask about lifestyle, allergies and so forth.
- Be a familiar brand and style to the chosen surgeon.
Thinking of having a knee replacement? Get matched to a top surgeon in your area who can work with you to choose the best implant. These surgeons also offer PeerWells PreHab & ReHab program for free!
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New Quad Sparing Technique May Provide Faster Recovery For Patients With Arthritis Of The Knee
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:
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.
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Injections For Knee Pain
Valaik says theres good science behind cortisone shots and other injections, such as hyaluronic acid injections, that lubricate the inner workings of the knee and help relieve arthritis pain.
According to Valaik, there is less evidence supporting the benefits of other injectable substances, including platelet-rich plasma and concentrated bone marrow or stem cells, but further studies will reveal more about their efficacy in treating knee arthritis.
Injections can provide temporary relief typically a few months which can help you stay on your feet and postpone surgery, he says.
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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Learning To Live With Your New Knee
Having a total knee replacement provides significant pain relief for more than 90 percent of people who have the surgery.
It can take some time to get used to the new knee, so its important to understand what is normal during recovery and how having an artificial knee can affect your day-to-day life after surgery.
Your new knee doesnt come with an owners manual, but recognizing potential issues and preparing for them can help maximize your quality of life after surgery.
Its not unusual for your artificial knee to make some popping, clicking, or clunking sounds, particularly when you bend and extend it. This is most often normal, so you shouldnt be alarmed.
Several factors can affect the likelihood of these noises or sensations after surgery, including the
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.
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Complications That Can Arise
Just like any surgical procedure, knee replacement surgery can have complications. Complications are more likely to occur when having a total knee replacement than a partial knee replacement. Some of these complications occur because of the surgery itself. Others occur because of a faulty implant and are the subject of ongoing litigation.
Common complications include:
- Nerve damage
- Different leg lengths
If the person has a chronic illness, the risk of complications increases. For example, a person with sleep apnea a sleep disorder that causes a person to have pauses in breathing while asleep has a higher in-hospital mortality risk following joint replacement surgery.
If the person has revision surgery a second surgery required to adjust or replace an implant if it fails the risk of complications increases.
More serious complications, like joint infection, occur in less than 2 percent of patients. Infection is considered one of the most serious complications that can occur after surgery. When organisms enter the wound during surgery, they can attach to the prosthesis and are difficult to kill with antibiotics.
Symptoms of early joint infection include pain and swelling in the joint, a leaking wound and fever. Depending on the type of bacteria, infections can be dealt with one of two ways: Debridement, washing out the infection, exchanging the plastic spacer and leaving the metal implants intact and staged surgery, where the implant is completely removed.
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!
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!
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.
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.
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What Happens During Total Knee Replacement
Your provider can help explain the details of your particular surgery. An orthopedic surgeon will perform the surgery aided by a team of specialized healthcare professionals. The whole procedure may take a couple of hours. In general, you can expect the following:
Most likely, you will be given spinal or general anesthesia so that youâll sleep through the surgery and wonât feel any pain or discomfort during the procedure. Or you may receive local anesthesia and a medicine to keep you relaxed but awake.
A healthcare professional will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.
You may receive antibiotics, during and after the procedure, to help prevent infection.
Your surgeon will make an incision over the middle of your knee, cutting through your skin and underlying tissue.
He or she will remove the damaged portions of your thigh and shin bone, removing a little of the bone beneath as well.
Next, metal implants are placed into the joint space, usually cementing them into the remaining bone.
In most cases, your surgeon will also remove part of the underside of the kneecap.
A plastic spacer is inserted into the space between the metal implants, for ease of movement.
The layers of your skin and muscle will be surgically closed.
Getting Back To Normal
It will be some weeks before you recover from your operation and start to feel the benefits of your new knee joint. Make sure you have no major commitments including long-haul air travel for the first six weeks after the operation.
Keeping up your exercises will make a big difference to your recovery time. Youll probably need painkillers as the exercise can be painful at first. Gradually youll be able to build up the exercises to strengthen your muscles so that you can move more easily.
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Advanced Orthopedic Care In Colorado Springs
Here at the Colorado Center of Orthopaedic Excellence, our goal is to provide comprehensive orthopedic care under one roof. Our surgeons, podiatrists, physical therapists, occupational therapists, and other medical staff collaborate to treat a wide range of musculoskeletal problems and provide you with world-class orthopedic care. We have been an official partner of various U.S. Olympic teams, including the Paralympics.
Walking and knee movements are very important to quick recovery after surgery. We recommend exercise to our patients as soon as the day after surgery. The Colorado Center of Orthopaedic Excellence offers physical therapy and rehabilitation services right here, so you dont have to look elsewhere for your post-surgery recuperation.
If you have any questions about our orthopedic services or you would like to schedule an appointment with one of our physicians or therapists, please call us today at or request an appointment online. We look forward to getting you back in the game!
Why Is Knee Injection Done
Knee injection is performed to treat the pain arising from various diseases of the knee joint. The type of medication injected and the frequency depends on the condition being treated. Based on the diagnosis and extent of the disease, the doctor would recommend a treatment plan.
Indications for the various agents used for knee injections are as mentioned below.
- Botox inhibits the sensory neurons causing pain. Hence, joint pain and stiffness significantly improve.
Platelet-rich plasma injections
- PRP is obtained from the patients own blood. It contains growth factors that stimulate collagen formation and lubricate the joint. PRP can improve joint function and reduce pain.
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