Ial Knee Replacement Surgery Results In Better Outcomes And Is Cost
Dr. Hassan Ghomrawi
Partial knee replacements are economically superior to total knee replacements in older adults, and with a few small improvements, can be an attractive option for younger patients as well, new research from Weill Cornell Medical College and Hospital for Special Surgery investigators suggests.
Knee replacement surgeries are expected to surpass one million annually by 2020, with half of these surgeries being performed on patients younger than 65. Historically, physicians have recommended total knee replacements for all adult patients including those who have end-stage osteoarthritis in part of the knee joint. But in their study, published March 4 in the Journal of Bone and Joint Surgery, the Weill Cornell investigators found that partial knee also known as unicompartmental replacements provide greater economic value to patients over the age of 65 compared to total knee replacement, as they are less likely to face surgical complications and require less physical therapy than those who undergo total knee replacement surgery.
âWith a unicompartmental knee replacement, youâre more likely to return to work earlier and have better function compared to total knee replacement, which requires more rehabilitation and has more complications,â said lead author Dr. Hassan Ghomrawi, an assistant professor of healthcare policy and research at Weill Cornell and a research scientist at Hospital for Special Surgery.
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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.
Why Do Implants 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 to use biologic fixation.
Although implants are firmly fixed at the initial knee replacement surgery, they may become loose over time. 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 bodys attempt to digest the wear particles. During this process, normal 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. Aseptic loosening is the most common mode of failure of knee implants.
Infection: Infection is a devastating complication of any surgical procedure. In total knee replacement, the large foreign metal and plastic implants can serve as a surface for the bacteria to latch onto, inaccessible to antibiotics. Even if the implants remain well fixed, the pain, swelling, and drainage from the infection make the revision surgery necessary. With current surgical techniques and antibiotic regimens, the risk of infection from total knee replacement is less than 1%.
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What Is Knee Revision Surgery
Knee replacements have been carried out in the UK since the 1970s, with approximately 80,000 performed every year in England and Wales. This includes both total and partial knee arthroplasty where either the whole knee or one side of the knee is removed and fitted with a prosthesis . These operations are for people who have problems such as severe arthritis, injury or deformity in the knee joint, which cause pain and greatly impact mobility and quality of life.
On the whole, these are successful procedures, and many patients have good outcomes. However, the new joint parts do not last forever, and this is where knee revision surgery comes in. If the new joint fails, a second surgery is required to revise the joint: taking out any old or dysfunctional prostheses, clearing any debris or inflamed tissues and creating a new joint replacement. Without further complications, most successfully-replaced knee joints can be expected to last around 20 years before needing to be replaced again, however, this is greatly dependent on the age and activity level of its recipient. Overall, long-term follow-up of patients receiving knee replacements showed that only 3.9% required revision of the joint within 10 years, rising to 10.3% requiring revision by 20 years. However, in younger individuals , the rate rose to 35% needing a second surgery. Overall revision rates for the UK are below 5%.
What To Expect With Knee Revision Surgery
According to the American Academy of Orthopaedic Surgeons knee revision surgery is more complex than total knee replacement surgery. This is because where in your original surgery, your joint was replaced with an implant, when the implant itself develops problems, your surgeon is actually going in and repairing that original implant. Or, it may need to be removed and a new joint put in, or parts of it replaced.
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Wound Irritation Or Breakdown
Surgery will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this.
Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely further surgery.
Knee Revision In Palm Beach County Fl
If you are having pain or problems with your knee implant, visit us at Personalized Orthopedics of the Palm Beaches for a comprehensive evaluation with one of our board-certified orthopedic surgeons. We will carefully assess the entirety of your case to ascertain if a revision knee surgery is indeed necessary and if you are eligible. Included in the evaluation are a detailed physical exam and a battery of tests to pinpoint the cause of your symptoms.
Our orthopedic surgeons have established a reputation of excellence for having performed numerous successful joint replacement surgeries and revision surgeries, helping scores of patients in Boynton Beach and the neighboring areas regain their normal function and enjoy a good quality of life. You can rest assured that youre in very good hands!
To arrange a consultation with one of our orthopedic surgeons, give us a call at 733-5888, or use our online appointment request form.
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Results Of Revision Knee Replacement
The results of revision knee replacement are less favorable than with a first replacement surgery. That said, the results are quite variable, as some problems that require a second surgery are much more straightforward to manage, and others very complex.
The problem with trying to compare results of revision knee replacement is that the reasons to perform the surgery, and the extent of the surgical procedure, is so variable that it is hard to draw conclusions on the data. However, most studies of revision knee replacement showed improved function in most patients .
What Is The Overall Success Rate For Knee Replacement Surgery
According to the Mayo Clinic, knee replacement surgery is one of the most successful orthopedic operations. Knee replacements are also becoming increasingly more common. More than 580,000 knee replacements are performed in the United States each year and the number is growing, according to the American Medical Association. There are two types of knee replacements: a total replacement during which the entire joint is replaced and a partial replacement that is performed when only one part of the knee is damaged. TKR is the more common surgery, and this article provides information on TKR and its success rate.
The success rate of TKR is over 90 percent, and most patients who have the operation experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living, according to the American Academy of Orthopedic Surgeons . While the success rate is high, normal use and activity will cause the joint to wear and most replacements last 15 to 20 years. The number of years your new joint will last varies based on a variety of factors including your weight, activity and overall health.
After leaving the hospital, you will go to outpatient physical therapy two to three times a week for two to six months. In addition, you will have daily exercises to do at home to help with the bending and straightening of your new knee.
Post Surgery Limitations
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What Is Correction Of A Loose Knee Replacement
Reoperation of a total knee replacement to correct a loosened prosthesis as a result of wear and tear of the prosthetic joint surfaces is known as correction of a loose knee replacement. This procedure involves a complete or partial exchange of prostheses implanted during the original total knee replacement with new prostheses.
How Long Will My Hip Or Knee Replacement Last
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
For people considering hip or knee replacement surgery, its something they want and need to know.
In the US alone, surgeons perform more than 600,000 knee replacements and about 330,000 hip replacements each year. These operations can provide a and function for those with severe arthritis. On the other hand, there are risks associated with the operation , there is a long road to recovery even when all goes well, and these operations arent cheap. For knee replacement surgery alone, an estimated $9 billion or more is spent each year in the US .
So, if the first joint replacement is unsuccessful for some reason , a second operation may be necessary. And thats a big deal, especially since “revision surgery” is technically more difficult, recovery can take longer, and success rates may be lower than first operations.
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What To Do To Prepare For Knee Revision Surgery
Steps to prepare for knee revision surgery are fairly similar to those for initial knee replacement surgery. The main difference is that, if you are undergoing a revision procedure, it is likely that this is because of problems with the current artificial joint, which is probably causing pain. Moving around on a painful joint is hard at the best of times, but keeping mobile and building up the muscle around the joint after the operation is not only essential but will also enhance recovery.
Here are seven quick tips to consider when preparing for knee revision surgery:
A New Study Provides New Estimates
In February 2019, two large analyses were published in the medical journal Lancet regarding the longevity of replaced hips and knees, that included nearly 300,000 total knee replacements and more than 200,000 total hip replacements. They found encouraging results:
- Nearly 60% of hip replacements lasted 25 years, 70% lasted 20 years, and almost 90% lasted 15 years.
- Total knee replacements lasted even longer: 82% lasted 25 years, 90% lasted 20 years, and 93% lasted 15 years.
These estimates are quite a bit higher than prior ones and may reflect improvements in surgical technique and materials, general medical care around the time of surgery, or more aggressive mobilization and physical therapy that starts right after surgery. The study authors also suggest that these numbers reflect real life patients , rather than a small number from a single medical center.
Some caveats are worth noting:
- These surgeries were performed in New Zealand, Australia, Denmark, Finland, Norway, and Sweden. The results might be different in the US or other countries.
- Detailed information was not available regarding which patients were considered eligible for total joint replacement and which were denied surgery because they were considered at high risk for failure or complications. These factors can affect the success of joint replacement surgery.
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What Helps Pain After Total Knee Replacement
Itâs vital to note that pain is often inevitable right after knee replacement surgery. However, you should also know that the success rate of such procedures is 90% to 95%. Successful implant placement also lasts for over a decade.
With that said, there are many ways to manage and ease pain following knee replacement. Here is a general guideline, including a timeline, of what you can do to reduce knee surgery pain.
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Ethics Approval And Consent To Participate
This study was performed according to the Helsinki declaration and approved by the Ethics Committee of Tampere University Hospital . Written informed consent was obtained from all living participants. For retrospective analysis of hospital register data of those patients who had either died or lost to follow-up, permission was obtained from the hospitals Institutional Review Board.
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Questions To Ask Your Physician About Knee Revision Surgery
You want to make sure you are selecting the best option for your knee condition. Be sure to write down and bring your questions to your consultation to ensure that you understand all your options and your surgery. Here are some to get you started:
- Why is revision surgery needed?
- Can physical therapy alone help my condition?
- What is the success rate of knee revision surgery?
- What can I expect after my surgery? Will my mobility be improved?
- Will the surgery get me out of pain?
- What will my recovery time be?
- What activities can I do? What should I avoid doing?
How Long Do Knee Replacements Last
Knee replacements eventually wear out. Because the knee replacement implants are made of metal and plastic, over time, these materials begin to wear, just like the rubber on your car tires. While knee replacements are designed to last a long time, they will not last forever.
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What Does The Doctor Do Prior To Revision Surgery
When the decision for revision knee replacement is made, the surgeon will do a thorough clinical exam and order and laboratory tests. If infection is suspected, aspiration of the knee may be required. The aspirated fluid will then be sent to a laboratory for analysis to identify the specific type of infection.
In addition to X-rays, other imaging modalities may be helpful, such as bone scans, or . These advanced imaging technologies can demonstrate changes in the position or condition of the prosthetic components as well help to pinpoint the cause, location and the amount of bone loss to help plan for the surgery.
Revision Surgery For Infection
Typically, a revision required because of infection involves two separate operations: Initially, the orthopedist removes the old prosthesis and inserts a polyethylene and cement block known as a spacer that has been treated with antibiotics. Occasionally, theyll make cement molds like the original prosthesis and insert antibiotics in that and implant it as the first stage.
During the second procedure, the surgeon removes the spacer or molds, reshapes and resurfaces the knee, and then implants the new knee device. The two procedures usually take place about six weeks apart. Inserting the new device typically requires 2 to 3 hours in surgery, compared to 1 1/2 hours for a primary knee replacement.
If you require a bone graft, the surgeon will either take bone from another part of your own body or use bone from a donor, usually obtained through a bone bank. The surgeon might also install metal pieces such as wedges, wires, or screws to reinforce the bone for the implant or fasten the implant to the bone. A revision requires the surgeon to use a specialized prosthetic device.
Complications that may follow knee revision surgery are similar to those for knee replacement. They include:
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How Successful Is Knee Replacement Surgery
Knee replacement has become the most common form of joint replacement surgery. In 2010 over 721,000 such procedures were performed in the United States.1 Between 1991 and 2010, the incidence of knee replacements increased by over 161%, due partly to improvements in the science of knee replacement implants, experience of surgeons, and the growing population of knee replacement patients.2 Although public perception can be influenced by negative advertising and press, the fact is that knee replacement surgery is one of the most successful surgical procedures performed today and patient perception is by and large positive.3
Stiffness / Lack Of Movement
- This is a problem in revision total knee joint replacement. If your revision is being done as a result of stiffness or lack of movement you will have more movement after revision surgery.
- Nigel will outline to you what his expectations for movement are following your joint replacement.
- If you lose movement, then a manipulation of your knee under a general anaesthetic will need to be performed to break down the scar tissue that has formed so as to give you that movement back.
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