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What Is The Latest In Knee Replacement Surgery

We’ve Got The Lowdown On The Latest Surgical Techniques

Knee pain treatment and the latest technology in knee replacements

At first, Emily Patenaude didnt notice the pain. Waking up from general anaesthesia after undergoing a knee replacement at Victoria General Hospital in British Columbia, she was too high and happy. The hurt came a few days later, when she weaned herself off the prescribed opiates.

She knew it would be bad. Her surgeon and his team had been telling her so for months before making an incision in her left leg to remove her old, arthritic knee and replace it with a metal-and-plastic version. It all began 21 years earlier on a nursery ski slope. A turn gone awry caused a fracture that spiralled up from her ankle to her kneecap. Although it healed, unbeknownst to her, the initial trauma caused cartilage in the knee to begin to break down. Eventually, the joint became so weak, she appeared bow-legged on her left side.

Fast-forward to the summer of 2014, when she was taking care of her granddaughter. She was entertaining the young girl by hauling her around in a wheeled contraption until her knee was so swollen, inflamed and sore that she sank into a sofa and couldnt get up for several months.

Osteoarthritis, the most common joint disorder in the world, had been stealthily creeping in for years.

Total knee arthroplasty is the fastest-growing way to deal with this crippling problem.

Is there hope for more knee replacement alternatives in the future?

Holding out hope for new and improved options for a knee replacement

A partially bionic knee

Bridging the gap

What Happens During Knee Arthroplasty

The day of surgery, you will receive anesthesia to prevent pain during the operation. You will have either a regional or general anesthetic. Your anesthesia team will decide what type of anesthesia is right for you.

Knee arthroplasty takes about an hour or two. The surgical team will:

  • Make an incision in the knee area.
  • Remove any damaged cartilage and bone.
  • Place the knee implant and position it properly.
  • Secure the implant into place using cement or without cement.
  • Insert a piece of polyethylene that creates a smooth, gliding surface between the metal parts of the implant.
  • Close the incision.

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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Revision Knee Replacement Surgery

If the prior knee replacement component doesnt work for a longer time then it must be replaced to avoid any physical problem. You can opt for a second surgery known as revision total knee replacement which becomes essential if the initial surgery fails to prove effective.

The wear-and-tear on components, infection, component loosening and knee joint problems are the most common cause for revision surgery. Other reasons are mostly knee stiffness and bone fractures.

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Knee Replacement Alternatives To Consider

Knee Replacement Surgery Photograph by Mark Thomas/science Photo Library

Crunching sounds as you climb stairs, chronic aching and swelling: Knee osteoarthritis is a real pain. If youre suffering with it, you may be considering surgery.

Getting a knee replacement is one approach, but you may not need surgery, at least not right away. And some patients cannot undergo knee replacement surgery for various reasons. Other people with knee pain are too young for a knee replacement the artificial knee is only likely to last 15 or 20 years, after which the person may need revision surgery.

There are several things you can try first, on your own or with a professionals help, that can help with knee pain and even delay the need for replacement.

Arthritis doesnt go away, but there are things you can do to lessen the pain and stay more active.

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Average Age For Knee Replacement Surgery Is Dropping Due To Obesity

  • The number of total knee replacement surgeries is growing larger every year, with even more expected over time.
  • Research suggests that the leading cause is the rise in rates of obesity.
  • Excess weight can put increased stress on knees, leading to joint injuries.
  • Medical experts say modest weight loss significantly improves the symptoms of knee osteoarthritis and reduces the risk of needing a knee replacement.

As the number of total knee replacement surgeries continue to climb, a study out of Queensland, Australia points at a possible major cause and with it a possible solution.

Obesity and weight gain, the study found, is both increasing the amount of TKRs done, as well as driving down the average age of the recipient.

Using data from the Australian Bureau of Statistics 2017-18 National Health Survey with the Australian Orthopaedic Association National Joint Replacement Registry, researchers found that, of the 56,217 Australian TKR patients in that time frame, 57.7 percent were obese.

TKR patients who were obese were also an average of seven years younger than patients who were not obese.

Additionally, women ages 55 to 64 with obesity were 17 times more likely to need TKR than those who were not obese.

Men living with obesity were 5.8 times more likely to need TKR than their peers who were not obese.

Those statistics ring true, orthopedic surgeons say.

And with obesity projected to continue to increase, this is only going to increase as well, he said.

New Implant Technology A New Twist On Knee Replacement

Favorite pastimes come and go. From long hikes to softball or cycling, its common to switch from one interest to another over the years. To be forced to leave favorite activities behind entirely due to knee pain, however, can be a heartbreaker. Unfortunately, this scenario plays out all too often as knee pain due to various forms of arthritis, degenerative joint disease or injury strands formerly active individuals on the sidelines. Stephanie McHale Donvan was one of the sidelined until she found out about a Massachusetts-based company with the power to give back her favorite activities.

Hi, my name is Stephanie. Im 60 years old, Im from Arlington Massachusetts, and I had my right knee replaced with a Conformis custommade knee in 2016. Now Im back to riding my bike, hiking in the woods, and taking my dog for very, very long walks

I was about 51 when the pain started, she recalled. The first twinge happened on Hardings Beach one summer, playing in the waves with my daughter. The pain in my knee became like a giant, gnawing toothache. I felt like I was dragging around a tree trunk of a leg. I couldnt go sledding with my daughter, I couldnt even walk up stairs without pulling myself up by the railing. I went through five years of constant pain, cortisone shots, expensive knee braces, daily ibuprofen and Tylenol, swelling, elevating my leg and telling my daughter constantly, No. Mommy cant do that. I was probably a real drag to be around.

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Is Knee Replacement Major Surgery

The key indication for knee arthroplasty is to provide relief from pain caused by severe arthritis. Two types of knee replacement surgery is performed:

Before the procedure

Before the procedure, a complete physical examination, as well as several diagnostic tests including a blood test, will be done. Medical history , any medications and drug allergy if any should be informed to the doctor prior to the surgery. The patient is advised to stop smoking for as long as possible prior to the surgical procedure.

The types of used prostheses include the following:

  • Fixed bearing

  • PCL-substituting

Surgery

Surgery is usually performed under general, spinal or epidural anesthesia. The procedure usually takes 1-2 hours, the orthopedic surgeon with excise the damaged cartilage or bone and replace it with a metal or plastic implant for restoration of function and alignment.

How Long Does A Knee Replacement Last

The Latest on Knee Replacement HealthCasts Episode 6

Knee replacement implants are expected to function for at least 15 to 20 years in 85% to 90% of patients. However, the implants do not last forever.

After a period of 15 to 20 years, general wear and tear may loosen the implant. Depending on the patient, this may cause no symptoms, or it may cause any of the following:

  • pain
  • knee instability
  • infection

When these symptoms arise, orthopedic surgeons recommend having to replace the original implant. Infection, especially, requires a prompt revision surgery. Infection after knee replacement surgery is rare, but a knee replacement implant cannot defend itself from infection if bacteria are introduced to the body. Learn more about the at HSS.

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What Happens After Knee Arthroplasty

After surgery, you will get moved to a recovery room. The healthcare team will watch you for a short time to make sure you wake up from the anesthesia without complications. Theyll also monitor your vital signs and pain level.

Occasionally, people who have knee replacement surgery go home the same day. If you need to stay in the hospital, it will likely be for one day. Additional time spent in the hospital is based on medical necessity.

How Does The Patient Continue To Improve As An Outpatient After Discharge From The Hospital What Are Recommended Exercises

For an optimal outcome after total knee replacement surgery, it is important for patients to continue in an outpatient physical-therapy program along with home exercises during the healing process. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring and maintain muscle strength for the purposes of joint stability. These exercises after surgery can reduce recovery time and lead to optimal strength and stability.

The wound will be monitored by the surgeon and his/her staff for healing. Patients also should watch for warning signs of infection, including abnormal redness, increasing warmth, swelling, or unusual pain. It is important to report any injury to the joint to the doctor immediately.

Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. Swimming is the ideal form of exercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint.

Patients with joint replacements should alert their doctors and dentists that they have an artificial joint. These joints are at risk for infection by bacteria introduced by any invasive procedures such as surgery, dental or gum procedures, urological and endoscopic procedures, as well as from infections elsewhere in the body.

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When Did I Have A Full Knee Replacement

About 12 years after my injury, I finally had medical coverage for knee replacement surgery. The procedure wasnt as bad as I had feared. About twelve years after I injured my knee, I finally had medical coverage. By then, the damage was so great, and walking was so painful, that a full knee replacement was my best option.

Joint Injections: Knee Replacement Alternative Gel

Knee Replacement Surgery Photograph by Jim Varney/science Photo Library

Another alternative recommended by doctors and surgeons is gel knee injections, also known as viscosupplementation.

The injectables contain hyaluronic acid, a naturally occurring compound found in the synovial fluid of the joints. The gel-like substance aids in joint lubrication, reduces inflammation, and promotes bone and cartilage growth.

Knee replacement alternative gel injections have been used for decades and are often a recommended course of action before a doctor recommends surgical therapy. A 2019 study found that newer monoinjections of hyaluronic acid gel can be just as effective as older options that require multiple once-per-week injections. This is great news as it means fewer trips to the doctor, less money out of pocket, and less pain.

Unfortunately, this, too, is often just a temporary solution. If a patient has osteoarthritis, the disease will continue to progress, and eventually surgery will be recommended by the patients doctor.

NSAIDs and gel injections can be effective. Oftentimes, though, they are just temporary solutions.

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A Word About The Newest Knee Replacement Implants

One temptation of patients and surgeons alike is to be attracted to the newest knee replacement on the market. Undoubtedly, this implant will claim to function better and last longer than other knee replacements. While these newer implants may be better, it is also important to understand they do not have long-term data on how well these implants will function over time.

Ask any orthopedic surgeon about the implants they have seen come and go over the course of their career. Just because an implant is newer does not necessarily mean it is better.

Patients and surgeons should try to find an appropriate balance between modern design and not being a ‘test’ patient. Your surgeon can help guide you to an appropriate knee replacement that is best for you.

Do Eat A Healthy Diet

Keep hydrated by drinking plenty of fluids. However, avoid alcohol after surgery because it retardshealing. Eat whole, unprocessed foods rich in fiber, vitamins, and minerals.

Keeping yourself at a healthy weight limits the stress on your knees. If you were overweight before yoursurgery, try a medically supervised weight loss plan to help you lose the weight and keep it off.

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Why Do Doctors Recommend Knee Replacement Surgery

Doctors typically recommend a patient undergo a partial- or full-knee replacement surgery if they have advanced osteoarthritis. Another reason they would recommend surgery is if the patient has tried multiple conservative treatment options without success. They are still in pain or the pain has worsened.

The most common condition that requires knee replacement surgery is advanced osteoarthritis. However, there are other conditions that can lead to this type of surgery, including:

  • Gout
  • Death of one of the leg bones

Tests Before Knee Replacement Surgery

What are the latest developments in knee surgery?

About six weeks or so before your operation you will have an appointment for a pre-admission or pre-assessment clinic. At this clinic a nurse will assess your fitness for your knee surgery.

There are several tests that may be needed and they include:

  • Blood tests to check that you arent anaemic and that your kidneys and liver are working well enough for you to undergo the operation.
  • Urine test to make sure you havent got a urine infection and that there isnt any glucose in your urine.
  • Blood pressure.
  • Infection screen this includes looking for meticillin-resistant Staphylococcus aureus . MRSA is a germ that is difficult to treat and can cause complications of a knee replacement.
  • A heart tracing .

You may have the chance to speak with an anaesthetist, physiotherapist, occupational therapist or social worker at this clinic but this isnt always possible.

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Joint Effort: Breakthroughs In Hip And Knee Replacement Surgery

Oct 13, 2021Jasmine Aimaq

If you’re like millions of Americans, you may be dealing with an aching hip or a couple of creaky knees, especially if you’re starting to feel the effects of age.

Despite your pain and discomfort, going through a total joint replacement surgery might seem dauntinglong recovery times, hospital stays, swelling and pain are nobody’s idea of fun.

If you’re unsure about total joint replacement surgery, there’s good news: Total joint replacement has come a long way in recent years. Breakthroughs in surgery mean less pain, a faster recovery and a lot less time in the hospital so you can get back to the things you love. In many cases, you may not even need to stay overnight.

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Sean S. Rajaee, MD

“We have made so much progress in hip and knee replacements that 60%-70% of our patients can go through the process as outpatients,” says Dr. Sean S. Rajaee, a board-certified orthopaedic surgeon and co-director of the Outpatient Hip and Knee Center at Cedars-Sinai. “People who come and see us are thrilled to learn that we can use minimally invasive techniques, and that they’ll be home and up and about much sooner than they thought.”

The goal of total joint replacement is not to switch out your entire knee or hip. It’s to relieve pain and improve mobility by replacing the hip or knee joint with an implant or “prosthesis.”

Another breakthrough may be making an even bigger difference.

How Patients Can Reduce Painful Symptoms Between Now And Their Treatment Date

If a patient has tried multiple non-invasive treatments without success and their next step is surgery, they can take steps to reduce their pain until their surgery date.

Some ways to ease knee pain:

  • Exercise/physical therapy: If a patient has a degenerative condition like osteoarthritis, it is best if they seek the assistance of an exercise professional like a physical therapist. They can create a treatment plan that will strengthen the leg and promote flexibility without increasing the risk of pain or joint damage.
  • Supplements: In addition to NSAIDs, supplements like glucosamine and chondroitin can reduce pain and increase mobility in some patients.
  • Bracing: A knee brace provides stability and properly aligns the joint, easing pressure and reducing pain.

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Who Needs Knee Revision Surgery

A knee revision may be necessary for anyone whose prosthetic knee implant fails due to injury or wear, or who gets an infection in the area around implant.

In elderly people who have a knee replacement, the artificial knee implants may last for life. But in younger patients, especially those who maintain an active lifestyle, knee prostheses may eventually fail, requiring a second replacement later in life.

The most common reasons people for knee revision are:

  • Infection: The risk of infection from a total knee replacement is less than 1%, but when infections do occur, a knee revision of one kind or another is necessary.
  • Instability: This occurs when the soft tissues around the knee are unable to provide the stability necessary for adequate function while standing or walking.
  • Stiffness: In some patients, excessive scar tissue may build up around the knee and prevents the joint from moving fully.
  • Wear and tear: This can include loosening or breakage of prosthesis components due to friction over time.

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