Why Total Knee Replacement
Osteoarthritis can affect one or several areas in the knee joint, and the consultant may recommend a partial knee replacement if only one part of the knee is affected. Alternatively a total knee replacement may be considered to be the best option. This is an implant that covers all of the damaged surface in the knee, and is often a very reliable and permanent solution when the damaged area affects more than one compartment of the knee. The National Joint Registry report for 2018 records that in 2017 89% of primary knee procedures were for total knee replacement. Many patients choose this because the outcomes are very good and the procedure very successfully returns the joint to excellent functionality.
What To Expect After Knee Replacement Surgery
When the surgery is over, you will need to stay in the hospitals recovery room for observation. Usually, patients can return to their hospital rooms within a few hours after their pulse, blood pressure, and breathing are stable. Since knee replacement is major surgery, its common for the patient to be in the hospital for a few days before returning home. You will begin physical therapy during this in-hospital time.
When its time to head home, your medical team will have a transition plan to help with continued physical therapy and pain management. Its crucial that you are diligent about following these recommendations to regain the range of motion and strength needed in the joint.
What Happens During Partial Knee Replacement
During partial knee replacement, the orthopedic surgeon makes a small incision to gain access to the affected compartment of the knee. He or she gently moves supporting structures of the knee out of the way and removes damaged cartilage and bone tissue from the surfaces of the tibia and the femur in the arthritic area. The surgeon then prepares these surfaces for insertion of the prosthesis components which are specifically sized to the patients joint. Cement is used to secure these components. All surrounding structures and tissues are restored to their anatomic position and the incision is closed.
Depending on which compartment is affected and whether the patients anterior cruciate ligament is intact, the surgeon will use either a unicondylar fixed bearing knee replacementthe most commonly used prosthesisor a mobile bearing unicondylar knee replacement. These prostheses are made of plastic and metal components.
Figure: Example of a fixed bearing unicondylar knee replacement
Figure: Mobile bearing unicondylar knee replacement
Some surgeons at HSS apply computer-assisted techniques and robotic tools to partial knee replacement. This technology allows the surgeon to create and manipulate a 3D image of the patients knee in advance of surgery, a process that allows for highly precise removal of damaged tissue and refined positioning of the prosthesis during the actual procedure, says , Attending Orthopedic Surgeon at HSS.
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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.
What Does Knee Replacement Surgery Involve
The team at Tri-State Orthopaedics provide the latest advancements in treating chronic knee problems. When conservative options arent enough, your provider may recommend knee replacement surgery. Also called arthroplasty, this procedure involves replacing the structure of the damaged knee joint with metal and plastic parts to restore the normal function of the knee and relieve chronic pain.
Knee replacement is an incredibly common and successful procedure. Over 90% of people who have knee replacement experience significant improvement in pain and their ability to get around. For most people, knee replacement restores a good quality of life, giving back independence and allowing you to engage in activities you used to enjoy. However, recovery is often a long road. If youre scheduled for or considering knee surgery, here are some helpful dos and donts in your path to recovery.
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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.
What The Alternatives To Knee Replacement
A healthcare provider may recommend knee replacement surgery after other treatments for knee pain dont help anymore. These earlier options may include:
- Exercise or physical therapy to strengthen the muscles around the joint which will provide stability.
- Medications such as NSAIDs and cortisone shots.
- Walking aids or supports and bracing.
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Walk As Soon As Possible
Recovery from joint replacement surgery isnt always easy, but getting back on your feet as soon as the doctor says its okay can help you recover. Walking helps prevent complications like blood clots, improves circulation, and keeps your joints limber. You dont have to wait until you return home after surgery. Most patients can start walking while still in the hospital. Walking helps deliver important nutrients to your knee to help you heal and recover. You can expect to use a walker for the first couple of weeks. Most patients can walk on their own roughly four to eight weeks after knee replacement.
Types Of Arthritis That Affect The Knee
This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.
Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.
Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.
OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .
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Commonly Required And Suggested Home Preparations
Deep bending and squatting can lead to knee injuries during the recovery period. A patient can minimize these risks by making advanced arrangements and preparing his or her home. For example:
- Arrange for a spouse, friend or other caregiver to provide meals and help around the house.
- Arrange for transportation, as most patients cannot drive for the first 4 to 6 weeks after surgery.
- Stock up on pre-made meals and toiletry items to avoid having to run errands post-surgery.
- If possible, arrange to spend sleeping and waking hours on the same floor in order to avoid stairs.
- If possible, adjust the bed height to help ease the transition in and out of bed.
- Take away or move anything that might be tripped over, such as area rugs or electrical cords.
- Make sure all stairs have sturdy railings.
- Install small rails or grab bars near toilets and in showers.
- Install a modified toilet seat a higher seat will put less stress on the knees and make it easier to sit down and get up.
- Put a small stool in shower to avoid standing on a slippery surface.
- Have a comfortable, supportive chair with an ottoman to keep leg elevated for intervals.
- Have cold packs on hand to help alleviate swelling.
- Consider practicing using walkers, canes and other assistive devices ahead of time to ensure proficiency using them.
What Are The Chances That The Operation Will Be Successful And What Happens If It Is Not
The chances of a successful knee replacement are very high, with patient satisfaction rating at about 95-97% when aided by a rapid recovery programme.The vast majority of patients report either substantial or complete pain relief after recovery from the operation. A study carried out by the University of Bremen in 2011 found that patients who had undergone total knee replacement were considerably more physically active within a year of the operation. Revision surgery is a second operation to correct a failed knee replacement. This can occur because over time the prosthetic has become loose or worn, perhaps causing secondary problems such as infection or instability. Occasionally an early revision may be necessary due to infection, instability or malalignment of the implant. Stiffness due to excessive scar tissue formation around the joint or a trauma resulting in fracture may also be reasons for a revision. Revision surgery is more complex than primary surgery, it needs careful planning, with specialised implants and tools.
Mr Rajaratnam has one of the lowest revision rates on the National Joint Registry over the last 10 years, implanting approximately 4,000 knee replacements.
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What To Expect On The Day Of Surgery
On the day of surgery, you will first go to a pre-operative room where you will change into a hospital gown. A nurse will then record your vital signs and place a peripheral IV in your hand or arm.
After briefly meeting with members of the surgical and anesthesia teams, you will be taken into the operating room.
If undergoing general anesthesia, you will be given medications to put you to sleep and an endotracheal tube connected to a breathing machine will be placed. If you are undergoing regional anesthesia, you will be given a sedative to relax you while the anesthesiologist performs a nerve block .
Knee replacement surgery will then typically proceed with the following steps:
- The surgeon will first clean the area around the knee with an antiseptic solution.
- The surgeon will make an incision on your knee .
- The damaged parts of your knee joint will be removed. If the minimally invasive technique is used, the surgeon will use special surgical instruments to minimize tissue disturbance.
- Next, the surgeon will attach a prosthesis to the bone, most commonly with cement.
- Once the prosthesis is placed, the incision site will be closed with staples or stitches. A drain may be placed at the surgical site, which will be removed later.
- A sterile bandage will then be placed over the knee wound.
Criteria For Revision Knee Replacement: Why Is It Needed
In more than 80 percent of the total knee replacement cases, the knee implants last for at least 15 years. Therefore, they may last for life in the case of the elderly. However, younger candidates are at an increased risk of implant failure. Such individuals may eventually require revision surgery when the implants fail.
There is some amount of bone loss in the total knee replacement procedure. This is the reason why doctors may not be able to use the regular implants that they used in the original procedure. Sometimes, they decide to use special implants with thicker stems that are fitted deep into the bone.
The following are some of the reasons why the doctors may recommend a revision knee replacement:
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The National Joint Registry
The National Joint Registry collects details of knee replacements done in England, Wales, Northern Ireland and the Isle of Man. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Data Protection Act to see what details are kept about you.
What Happens During Knee Replacement Surgery
During the surgery, a surgeon removes damaged cartilage and some bone from the surfaces of your knee joint. Cartilage is tissue that covers your bones where they meet. Healthy cartilage is smooth and helps the bones glide over each other when you move. When cartilage becomes rough and wears away, the bones rub against each other, causing pain.
After removing the damaged knee cartilage and bone, the surgeon attaches the artificial parts to your bones. The artificial parts are made of metal and plastic. They will give your knee new, smooth surfaces.
Knee replacement surgery may replace all the damaged parts of your knee or just part of your knee . In a total knee replacement, the surgeon replaces 3 surfaces:
- The end of the shinbone
- The end of the thighbone
- The back of the kneecap
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Types Of Knee Replacement Surgery
Knee replacement can be total or partial.
Total knee replacement : Surgery involves the replacement of both sides of the knee joint. It is the most common procedure.
Surgery lasts between 1 and 3 hours. The individual will have less pain and better mobility, but there will be scar tissue, which can make it difficult to move and bend the knees.
Partial knee replacement : Partial replacement replaces only one side of the knee joint. Less bone is removed, so the incision is smaller, but it does not last as long as a total replacement.
PKR is suitable for people with damage to only one part of the knee. Post-operative rehabilitation is more straightforward, there is less blood loss and a lower risk of infection and blood clots.
The hospital stay and recovery period are normally shorter, and there is a higher chance of more natural movement.
Knee Replacement Recovery Time And Recuperation
Total knee replacement surgery generally takes about 60 to 90 minutes, but you should expect to be in the operating room for over two hours. Rehabilitation will begin within 24 hours of surgery.
After your surgery, the nursing staff will position you in bed and help you turn until you are able to move on your own. You may have a pillow between your legs if ordered by your surgeon.
Very soon after surgery, a physical therapist will come to your room to teach you appropriate exercises and review your progress. Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles.
Your rehabilitation program will begin as soon as you are medically stable and there are orders from your doctor to begin postoperative mobility. All patients begin rehabilitation within 24 hours of their surgery. Your motivation and participation in your physical therapy program is key to the success of your surgery and recovery. The physical therapist will assist you in the following activities:
- sitting at bedside with your feet on the floor
- transferring in and out of bed safely
- walking with the aid of a device
- climbing stairs with aid of a device
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Prehabilitation For Knee Replacement
Evidence suggests that patients who engage in prehabilitationpre-surgical physical therapy to strengthen the muscle surrounding the kneemay experience slightly less pain and better knee function after surgery. However, these reported effects do not seem to significantly affect patients length of stay in the hospital, medical costs, or post-surgical quality of life.1
Who Can Benefit From Partial Knee Replacement
Partial knee replacement is appropriate for patients with arthritis that is confined to a single compartment of the knee and is generally restricted to patients who are not morbidly obese. The surgery is not appropriate for patients with marked stiffness in the knee or those with a significant angular deformity. Intact ligaments are generally a requirement for a partial knee replacement. Patients with are not candidates for partial knee solutions since inflammatory-type arthritis typically involves the entire joint.
Additional considerations are evaluated on a case-by-case basis with the surgeon and patient determining together whether partial knee replacement is the best treatment option. Selecting the right patient is considered one of the most important steps to ensuring a good functional outcome and longevity for a partial knee replacement. “” rel=”nofollow”> View HSS surgeons at HSS who perform partial knee replacement.)
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How Does Partial Knee Replacement Differ From Total Knee Replacement
Most arthroplasties target the entire knee joint, an operation called a total knee replacement. But some people choose to have a partial knee replacement.
To understand the difference, it helps to know the knees compartments, or sections. It has three:
- Inside .
- Outside .
- Under the kneecap .
The partial approach fixes a single section. So healthcare providers call it unicompartmental replacement. A total knee replacement addresses all three sections. Generally, only younger adults with symptoms in one knee section benefit from partial replacement.
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:
Cortisone injections into the knee joint
There may be other reasons for your doctor to recommend a knee replacementsurgery.
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