In What Cases Do You Use Human Tissue For Knee Replacement
In rare cases, cadaver tissue can be used for reconstruction of the extensor mechanism in selected knees. These are complex cases with previous trauma that has ruptured the quadriceps tendon in addition to causing arthritis of the knee. For the majority of knee replacements, no human tissue is ever needed.
What Happens After Total Knee Replacement
Talk with your healthcare provider about what you can expect after your surgery. You may have significant pain around your incision after your procedure, but pain medicines may help to relieve your pain. You should be able to get back to a normal diet fairly quickly.
You may get imaging, like an X-ray, to see the results of the surgery. You might be able to go home within a day or two.
Your provider will let you know when you can put weight on your leg. You may have specific instructions about limiting your movements. You might need to use a cane, walker, or crutches for a few days or weeks. A physical therapist can help you maintain your range of motion and strength. You should be able to go back to most light activities within a few weeks. During this time, you may find it helpful to have some extra help at home.
You might have some fluid draining at the incision site. This is normal. Let your provider know right away if you have an increase in redness, swelling, or draining at the incision site. You should also let your provider know if you have a high fever, chills, or severe pain that does not improve.
Make sure to keep all of your follow-up appointments with your surgeon. You may need to have your stitches or staples removed a week or so after your surgery.
Most people note a significant decrease in their pain following a total knee replacement. You may have some remaining stiffness in the joint, as well as more limited range of motion.
How Do Artificial Knee Joints Work
The knee joint forms where the femur meets the tibia and fibula . The patella , located on the front of the knee, moves up and down against the femur. These bones are connected by ligaments, muscles and cartilage that help form the joint hinge and give the joint its flexibility.
Although there are four bones around the knee joint, only the femur, tibia and patella are affected by an implant.
While many device companies design and manufacture knee implants, which in turn can be made from a variety of metals, plastics and ceramics, artificial knee joints consist of three components.
The three components of a knee implant include:
- Femoral component
- This metal piece attaches to the end of the femur. It has a groove that allows the patellar component to slide up and down smoothly as the knee bends and straightens.
- Tibial component
- This flat, two-piece metal and polyethylene part is attached to the tibia. The metal part sits on top of the tibia and has a stem that is inserted into the tibia for stability. The plastic part, or tibial spacer, acts as a cushion between the metal tibial component and the metal femoral component.
- Patellar component
- This plastic piece is dome-shaped to match the resurfaced shape of the patella. Because the patella rests against the femur, the alignment of the patellar component and femoral component is crucial for proper function. The patella is held in place by the quadriceps tendon and patellar tendon.
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What Type Of Anaesthetic Will I Need
There are two different types of anaesthetic for this operation:
- A spinal anaesthetic
- A general anaesthetic
At the pre-assessment clinic you can talk about the type of anaesthetic for your knee replacement. An anaesthetist will explain to you which type of anaesthetic is most suitable for you but your preference will always be taken into account. Most people have a spinal anaesthetic.
What Causes Knee Pain Years After Knee Replacement
Loosening of the implant: This is most often the cause of pain years or decades after the knee replacement; however, it is seldom the cause of persistent pain right after surgery. 3 Infection: Infection is a serious and worrisome concern. Any increase in pain after knee replacement should raise concerns for infection.
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Titanium And Titanium Alloys
Pure titanium is generally used in implants where high strength is not necessary. For example, pure titanium is sometimes used to create fiber metal, a layer of metal fibers bonded to the surface of an implant which allows bone to grow into the implant or allows cement to better bond to the implant for stronger fixation.
Titanium alloys are bio-compatible in nature. They commonly contain amounts of vanadium and aluminum in addition to titanium. The most used titanium alloy in knee implants is Ti6Al4V. Titanium and titanium alloys have great corrosion resistance, making them inert biomaterial .
Titanium and its alloys have a lower density compared to other metals used in knee implants. Additionally, the elastic nature of titanium and titanium alloys is lower than that of the other metals used in knee implants. Because of this, the titanium implant acts more like the natural joint, and as a result, the risk of some complications like bone resorption and atrophy are reduced.
Ceramic On Metal Ceramic On Ceramic Ceramic On Polyethylene
Maybe ceramic is the way to go? After all, what could go wrong with installing a hip replacement device made of the same substance as dinner plates?
This 2015 randomized trial showed that COM hips still regrettably produced metal wear particles that ended up in the blood stream. Some good news for COM hips could be found in this 2015 study. It concluded that while there was swelling around these devices, when compared to minimally invasive MOM hips, there were no pseudotumors seen in COM hips. However, based on this analysis of many studies, there doesnt seem to be any advantage of COC compared to COP.;How does COM and COC compare? Ceramic on metal doesnt seem to have the same durability as ceramic on ceramic based on this study.
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Metallosis After Knee Replacement
Metallosis is a syndrome associated with metal joint implants, where friction between two metal surfaces releases metal ions into the joint, and these trigger an inflammatory response.
The term ‘metal-induced synovitis‘ describes those parts of the synovial joint lining that bloat up and become rubbery and filled with a florid black staining due to the metal ions.
Within the knee this condition is usually related to a previous knee replacement in which the polyethylene components have worn down and inadvertently allowed metal components to come into contact where they normally would not. In particular it is often the polyethylene part of the metal-backed patella that is at fault, where the polyethylene breaks down and allows the back of the patellar component to make friction contact with the metal femoral;component2. Metal-backed patellar components are no longer in frequent use but of course there are still many patients who had had this type of implant done in previous years. Mechanisms of failure of the polyethylene include polyethylene wear, fracture of the polyethylene or the underlying bone, and dissociation of the polyethylene from its metal backing.
The condition is more frequently recognised in hip replacements. Although rare in the knee, metallosis is a diagnosis must be thought of when investigating a patient whose knee is not settling after a knee replacement
Joint Replacement For Metal Sensitive Patients
Patients who have metal allergies or sensitivities may have concerns about the implants used for joint replacement, which are typically made of titanium or cobalt chromium metal alloys. Fortunately, Dr. Pritchett has options for these patients that can help with metal sensitivity issues and may also provide superior wear characteristics over traditional metal implants.
Dr. Pritchett has practiced in the Seattle area for over 30 years. He is heavily involved in research to continue to improve upon joint replacement implants and techniques. His ultimate goal is to help patients suffering from joint pain and arthritis return to their normal activities, and to contribute to advances in technology, techniques, and implants that can improve upon long-term results for patients.
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Frequently Asked Questions About Total Hip And Knee Replacement Materials
What is the chance of my body rejecting the implant?
Unlike an organ transplant, the risk of your body rejecting the artificial hip or knee parts is exceedingly rare. The materials used in the typical replacement surgery are well tolerated by the body and have a long track record of successful implantation. While in rare cases the parts may become loose or infected, this is typically related to other factors and not due to your body rejecting the parts.
How do I know if I have a recalled implant?
I have a history of nickel allergy and/or break out in a rash with certain types of jewelry. How do I know if I am allergic to the implants?
How do I know if I have developed metal poisoning from the replacement parts?
Can I have a hip or knee replacement if I am allergic to metal?
This article has been written and peer reviewed by the AAHKS Patient and Public Relations Committee and the AAHKS Evidence Based Medicine Committee.;Links to these pages or content used from the articles must be given proper citation to the American Association of Hip and Knee Surgeons.
How Do You Break Up Scar Tissue After Knee Surgery
Mild cases of arthrofibrosis may be resolved with intensive physical therapy alone. Other treatments include manipulation under anesthesia, when a physician manipulates the knee in a controlled fashion to break up the scar tissue. Surgery may also be an option for some patients.
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What Is The Most Advanced Knee Replacement Surgery
Minimally-invasive quadriceps-sparing total knee replacement is a new surgical technique that allows surgeons to insert the same time-tested reliable knee replacement implants through a shorter incision using surgical approach that avoids trauma to the quadriceps muscle which is the most important muscle
Different Types Of Knee Replacement Implants
Oct 3, 2016 | Patient
*This post was co-authored by Grace McClure and;Dr. Trevor North
This checklist of factors to finding the best implant may seem overwhelming, but luckily, this decision is usually left in the hands of your orthopedic surgeon. After all, surgeons have preferred implant manufacturers and only a couple different styles they work with. Very rarely do surgeons operate with multiple brands and more than a few styles. Your surgeon should be an expert in the exact type of implant you will receive.
With that said, lets get you acquainted with all things knee replacement implants, shall we? This way, you can assist your care team in matching you with an implant that best matches your lifestyle, activity level and other requirements.
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Cemented Vs Cementless Knee Replacement
Knee replacement surgery is a very common procedure for patients whose arthritis makes it difficult to perform everyday activities. During a knee replacement procedure, the damaged portions of the knee joint are removed and replaced with prosthetic components.
Traditionally, the prosthetics were held in place with bone cement. However, advances in implant technology have led to knee implants that do not need to be cemented into place. Instead, the textured surface of the implant encourages bone growth, so the implant is rigidly fixed to the bone. Both cemented and cementless knee implants are currently used for knee replacements, depending on the needs of the patient.
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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How Do Implants Differ
Materials Metal There are a variety of different metal alloys used but a few of the more popular include:
Titanium and its alloys because titanium is so inert and robust, its been the preferred material of implants for years. The most popular titanium alloy in use is Ti6Al4V.Cobalt-chromium just as widely used as titanium, cobalt-chromium is extremely inert, bio-compatible, and durableideal properties for a surrogate knee joint. The only potential downside here is the purported release of tiny metal ions due to friction when you move, walk, etc. While the fragments are generally harmless , folks with sensitivity to nickel or other metals have been known to develop a reaction.Tantalum the key component of a new bone/metal mix called Trabecular Metal, Tantalum has excellent biological-friendly properties. Trabecular Metal is manufactured with small mesh holes that foster bone regrowth, creating a better bridge between metal and bone.
Which Is The Best Knee Replacement Implant
Find the Best Knee Replacement Implant: Top Brands
- Zimmer Persona Knee An updated total knee design, based on the patella-femoral designs from Zimmer that have decades of clinical history.
- Gender Solutions Natural-Knee Flex Different design for men and women, allowing for PCL-retaining and PCL-sacrificing solutions.
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Are Newer Knee Implants Much Different From Old Ones
Yes. There are newer high-flex knee designs that allow greater safety during deep knee bending. There are also newer gender-specific total knees made to fit the anatomical differences in the knees of men and women. All knee replacement components that we used incorporate these modern design features.
Other variations in total knee implants include a ceramic oxinium surface, the rotating-platform knee, and other brands marketed by implant companies. Discuss this with your surgeon and medical team; they will help you make an informed choice.
Reasons For The Procedure
Knee replacement surgery is a treatment for pain and disability in theknee. The most common condition that results in the need for kneereplacement surgery is osteoarthritis.
Osteoarthritis is characterized by the breakdown of joint cartilage.Damage to the cartilage and bones limits movement and may cause pain.People with severe degenerative joint disease may be unable to donormal activities that involve bending at the knee, such as walking orclimbing stairs, because they are painful. The knee may swell or”give-way” because the joint is not stable.
Other forms of arthritis, such as rheumatoid arthritis and arthritis thatresults from a knee injury, may also lead to degeneration of the kneejoint. In addition, fractures, torn cartilage, and/or torn ligaments maylead to irreversible damage to the knee joint.
If medical treatments are not satisfactory, knee replacement surgery may bean effective treatment. Some medical treatments for degenerative jointdisease may include, but are not limited to, the following:
-
Anti-inflammatory medications
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Cortisone injections into the knee joint
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Viscosupplementation injections
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Weight loss
There may be other reasons for your doctor to recommend a knee replacementsurgery.
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Recovering From Knee Replacement Surgery
For the majority of people knee replacements are very successful. There is a lot of evidence from research showing that patients have less pain and are much more mobile after surgery and this often greatly improves their quality of life. Outcomes are getting better too, as more research is carried out on what the best operation is and how to reduce the risk of complications.
However about 8 people out of 100 are unhappy with their knee replacement 2-17 years later. If they have had to have their knee replaced a second time , they are twice as likely to be unhappy with the outcome.
What Is Worse Hip Or Knee Replacement
A hip replacement is a much less painful operation. People are on crutches for a while, and then their hips feel normal. But it takes six months to a year to recover from total knee surgery, and even then, the knee just doesnt feel normal.
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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.