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What Type Of Knee Replacement Implant Is Best

Devices Features And Manufacturers

13Joint Replacement Surgery FAQs: Knee Replacement Implants

When researching implants for knee replacement, it is important to realize that while devices used in total knee replacement surgeries are the most common, there are also devices designed for partial knee replacement surgery. Of these two types of procedures, partial knee replacement is less common, and addresses less than 10 percent of knee replacement patients. Unlike a TKR, a partial replacement requires removal of only part of the bone in the knee joint. Manufacturers produce variations of devices to address both surgical options, and your surgeon will let you know whether a total or partial replacement is appropriate.

Here are some of the device features that may guide you and your surgeon to the right selection:

  • range of motion
  • customizability: size and shape
  • stability
  • your activity level

Speak to your surgeon about features that are important for you, and know that each device is designed for different types of patient needs, level of joint disease, and anatomy.

The history of a device and its success rate can prove comforting. Some manufacturers share this information. Your surgeon may be able to attest to past results or guide you to useful information online.

Here are some of the leading TKR devices. Weve included summaries of product information from device manufacturers. Its best to visit manufactures sites to understand device features and benefits in more detail.

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 Are The Risks And Complications Of Revision Knee Replacement

Any surgery can have potential complications. The complexity of revision joint surgery increases the chance of surgical complications, which include but are not limited to:

  • wound drainage
  • damage to nerves or blood vessels
  • intra-operative fractures
  • pulmonary embolism

Infection, bleeding, damage to nerves or blood vessels, and intra-operative fractures can be minimized by using antibiotics before and after surgery, employing sterile surgical techniques and utilizing well-planned surgical exposures. Patients who are obese are particularly at increased risk of infection and wound drainage issues post operatively.

Similar to primary knee replacement, some mild swelling of the knee or ankle may be present after surgery for as long as three to six months. Swelling can be treated by elevating the leg, applying an ice pack, and wearing compression stockings.

Prior medical conditions, such as heart and lung complications or stroke conditions, can be aggravated by a revision procedure. These conditions may also develop in patients after revision surgery. Very rarely, death can occur. The decision to perform revision joint surgery is made when the benefits of pain relief and functional improvement outweigh the risk of potential complications.

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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:

  • Infection

  • 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.

Pre-Operative Education

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.

Hip Implant Materials And Fixation

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The majority of people who undergo hip replacement receive a traditional in which the surgeon uses a stemmed device and prosthetic head to replace the upper part of the femur and a hemispherical shaped cup to replace the acetabulum.

However, some patients may be candidates for in which the head and neck of the femur are not removed. In this procedure, the surgeon resurfaces or sculpts the femoral head to accept a metal cap with a short stem. Hip resurfacing is usually most successful in male patients under the age of 55, who are larger in stature There is little data to support functional benefit of one type of hip replacement over the other, although if revision surgery is needed, this may be easier after hip resurfacing.

Figure 6: Illustrations and X-ray images of a traditional hip replacement versus a hip resurfacing implant

Hip implants come in two primary types: the traditional single-piece implants and modular models, in which the stem and head of the implant portion that is placed in the femur can be matched independently. Although the single piece implants provide a good fit for many patients, “modular devices were developed to improve the fit of the implant to the patient’s specific anatomy,” explains Dr. Padgett. However, he adds, some modular implants have recently been found to be associated with problems related to the linkage between the various parts.

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Injections For Knee Pain

There is 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 experts, 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.

Benefits Of Cemented Implants

Cemented knee implants have been used for years, so we know that they can be effective in the long term. On average, a cemented implant will last 10 to 20 years or more before it needs to be replaced. The cement dries very quickly, so the implant is securely in place when the surgery is complete.

Cemented implants may be a better option for patients who have poor-quality bone due to conditions like osteoporosis for these patients, bone growth may not be sufficient enough to hold the implant in place. Cemented implants are often recommended for patients who are older, overweight, and less active, as well.

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Why Might I Need A Total Knee Replacement

You might need a total knee replacement if you have significant damage to your knee joint. Different types of medical conditions can damage this joint, such as:

  • Osteoarthritis

  • Injury or fracture of the knee joint

  • Bone tumor in the knee joint

This damage might be very painful and limit your normal activities. The procedure may help decrease your pain, improve your joint mobility, and quality of life. Usually, healthcare providers only recommend total knee replacement when you still have significant problems after trying more conservative treatments, like pain medicines and corticosteroid shots .

Talk with your doctor about the benefits and risks of having minimally invasive total knee replacement instead of traditional total knee replacement. Minimally invasive total knee replacement uses a smaller incision than a traditional knee replacement, so it may lead to less pain and decreased recovery time. It is not yet clear whether the procedure leads to an increased risk of certain complications, though.

In some cases, you may have other surgical options, like shortening the bone or a partial knee replacement. Talk with your doctor about the risks and benefits of all your options.

What Does The Doctor Do Prior To Revision Surgery

Which implant is best for knee replacement?

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.

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Who Gets Knee Replacement Surgery

You may consider knee replacement surgery if:

  • Arthritis in the knee or a knee injury has severely damaged the mating surfaces of the joint.
  • Pain and stiffness give you trouble doing everyday activities, such as walking up or down stairs or getting in and out of a car.
  • Swelling and inflammation dont go away with rest and medication.Your knee is deformed, such as looking swollen or not shaped normally.

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:

  • . This may be a function of the smaller incision and the fact that the incision stays out of the important quadriceps muscle/tendon group.
  • The major apparent risks of the procedure compared to traditional total knee replacement:

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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!

    Cruciate Retaining Vs Posterior Stabilized

    Perfect knee implants, courtesy of a 3

    There are two different variations of a TKR. Speak to your doctor about which approach is best for you.

    Removal of the posterior cruciate ligament . The posterior cruciate ligament is a large ligament in the back of the knee that provides support when the knee bends. If this ligament cant support an artificial knee, a surgeon will remove it during the TKR procedure. In its place, special implant components are used to stabilize the knee and provide flexion.

    Preservation of the posterior cruciate ligament . If the ligament can support an artificial knee, the surgeon may leave the posterior cruciate ligament in place when implanting the prosthesis. The artificial joint used is cruciate-retaining and generally has a groove in it that accommodates and protects the ligament, allowing it to continue providing knee stability. Preserving the cruciate ligament is thought to allow for more natural flexion.

    Partial knee replacement , sometimes referred to as a uni-compartmental knee replacement, is an option for a small percentage of people. Far fewer PKRs are performed than TKRs in the United States.

    During a PKR, a surgeon removes the arthritic portion of the knee including bone and cartilage and replaces that compartment with metal and plastic components.

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    Whats The Difference Between Partial And Total Knee Replacement

    Depending on whether one or several parts of the knee joint are affected by osteoarthritis, a partial or total knee replacement is considered:

    • In a partial knee replacement, only one side of the lower end of the thighbone is replaced, along with the corresponding part of the top end of the shinbone opposite it. Partial knee replacement surgery is only possible if both cruciate ligaments and the medial and lateral ligaments are still intact. Major misalignments like noticeable knock knees or bow legs cant be corrected with these implants. Partial knee replacement surgery is also known as unicompartmental knee arthroplasty.
    • In a total knee replacement, also known as total knee arthroplasty, both lower ends of the thigh bone and all of the top end of the shinbone are replaced.

    Front view of the right knee Left: Partial knee replacement Right: Total knee replacement

    What Are The Different Types Of Total Knee Implants

    Different types of implants can be used in total knee replacement surgery. The most suitable type will depend on things like the stability of the ligaments, the condition of the bones and muscles and any misalignments :

    • In non-constrained implants, the upper and lower part of the implant aren’t connected to each other. For this type of implant to work, the medial and lateral ligaments have to be relatively stable because they still coordinate the movements of the knee bending, straightening, and rotating it. For most types of implants, the anterior cruciate ligament is removed before they are implanted. This ligament is often damaged by the osteoarthritis anyway.
    • Semi-constrained implants are used if the posterior cruciate ligament isn’t stable enough and has to be removed. In these implants, the two components are connected by a type of hinge that provides stability in place of the cruciate ligaments. The hinge determines how far the knee implant can be bent and straightened.
    • In constrained implants, the two components for the upper and lower leg are linked together with a hinged mechanism and attached to the bone on each side using a long stem. Constrained implants are used if both the medial and lateral ligaments aren’t stable enough. Other reasons include poor bone condition and severe misalignments .

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    What Are The Advantages Of Knee Replacement

    Long-term, you may still feel some discomfort and have to limit high-impact activity to protect the replacement joint. But knee replacement can relieve a lot of the pain and help you move much better. More than 90% of people who have a total knee replacement still function well 15 years after surgery.

    Risks Of The Procedure

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    As with any surgical procedure, complications can occur. Some possiblecomplications may include, but are not limited to, the following:

    • Bleeding

    • Blood clots in the legs or lungs

    • Loosening or wearing out of the prosthesis

    • Fracture

    • Continued pain or stiffness

    The replacement knee joint may become loose, be dislodged, or may not workthe way it was intended. The joint may have to be replaced again in thefuture.

    Nerves or blood vessels in the area of surgery may be injured, resulting inweakness or numbness. The joint pain may not be relieved by surgery.

    There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.

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    Posterior Cruciate Ligament Substituting

    This design replaces ligament with plastic components. It is recommended primarily for patients with severely damaged knees or weak ligaments. Also used in revision surgery.

    It is indicated for patients with severe knee deformities or who have had previous knee replacement surgery or have had a knee cap removed.

    The PLC substituting design has a tall post attached to the tibia which fits into a deep box attached to the femur. The two are not connected with any kind of hinge joint. A polyethylene bearing attaches to the tibial component.

    A 2016 study of the PLC substituting design found that 88.5 percent of PLC substituting implants used in initial knee replacement surgery survived 10 years. For revision surgery, the 10 year survival rate was 75.8 percent if the revision surgery was due to some cause other than infection, and 54.6 percent if revision was due to infection.

    How Do I Determine If I Need A Knee Replacement

    If youre considering knee replacement surgery, talk to an orthopedic surgeon. Orthopedic surgeons specialize in operations to fix joints and muscles.

    Your orthopedic surgeon will:

    • Ask about your symptoms, including how severe they are and how long youve had them. The surgeon may also ask whether anything makes symptoms better or worse, or whether symptoms interfere with your daily life.
    • Take your medical history to learn about your overall health.
    • Examine you to check knee motion, strength and stability.
    • Order X-rays of your knee. The images can help the surgeon understand how much damage is in your knee. Advanced imaging is rarely helpful in the arthritic knee.

    The orthopedic surgeon will then make a recommendation for surgery or another treatment option.

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