Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Length of total knee replacement surgery
Pain and pain management
What Is Partial Knee Replacement
A partial knee replacement is an alternative to total knee replacement for some people with osteoarthritis of the knee. This surgery can be done when the damage is confined to a particular compartment of the knee. In a partial knee replacement, only the damaged part of the knee cartilage is replaced with a prosthesis.
Once partial knee replacement was reserved for older patients who were involved in few activities. Now partial knee replacement is often done in younger people as their recovery is quicker and usually less painful. About 5% to 6% of people with arthritic knees are estimated to be eligible for partial knee replacement.
Care After The Operation
Please give some thought as to how you will be looked after once you have had the operation, well in advance. Most people like to be independent, but you are going to need support with day-to-day activities for a while. If you have an able-bodied partner, this might fall to them, but otherwise you may need a friend or relative to come to stay with you for a while. Some people may arrange to stay in a care home until they have their mobility and independence back.
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Know All Of Your Treatment Options
Your doctor may give you additional or alternate information regarding knee pain and total knee replacement surgery. If you have questions about treatment options, schedule an appointment to discuss whats right for you. Contact us today to learn more about NUsurface as a knee pain treatment option.
Your Knee Has Become Deformed
If your arthritis is advanced, it can affect the way you walk, which can also lead to further problems elsewhere in your body.
As arthritis progresses, the knee may become bowed or knock-kneed, Heckmann says. If this type of deformity develops over time, a knee replacement may be indicated.
In addition, people with arthritis may also lose the ability to straighten their knee, according to Heckmann. If this occurs, you should seek an evaluation with an orthopaedic surgeon, as this loss of motion may be permanent, even after the knee has been replaced, he adds.
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Is Partial Knee Replacement An Option
The knee is divided into three compartments:
- the medial compartment
- the lateral compartment
- the patellofemoral compartment
If you have a problem in only one of the three compartments, you may be able to have what is called a partial knee replacement. Since only one area of the knee is resurfaced, recovery from partial knee replacement is faster. Because many patients have arthritis in more than one knee compartment, the majority of people who undergo knee replacement surgery about 90% need to have all three compartments resurfaced. This is called a total knee replacement, or total knee arthroplasty.
An Artificial Meniscus May Soon Be Available
If you are suffering from knee pain following meniscus surgery or are without viable treatment options, the NUsurface®Meniscus Implant may provide an alternative option, once it has approval from the U.S. Food and Drug Administration. NUsurfaces design mimics the function of the natural meniscus and redistributes weight across the knee joint. The implant is made from medical grade plastic and, as a result of its unique materials, composite structure, and design, does not require fixation to bone or soft tissues.
NUsurface can potentially address the treatment gap of those who are too old for meniscus repair and too young for total knee arthroplasty. U.S. clinical trials completed enrollment in June 2018, and the company expects to file for U.S. Food and Drug Administration approval soon.
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Lose Weight To Lessen Stress On Your Knees
Number one on Valaiks list of ways to reduce knee pain and delay knee replacement: reaching and maintaining a healthy weight.
Extra weight puts pressure on the knees and increases stress on the joint, increasing pain and making it hard to exercise, Valaik explains. Research compiled by the Johns Hopkins Arthritis Center confirms that carrying extra pounds raises your risk of developing knee arthritis and speeds up the destruction of cartilage that cushions the joint.
I know its not easy, he says, but losing weight really helps, whether youre dealing with arthritis in one or both knees. If you are overweight or obese, consulting with a nutritionist or a bariatric specialist may be the right place to start.
Why You Might Say Not Yet
Here are a five reasons knee replacement might not be right for youat least for now:
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Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
Can I Ever Come Back To Sports
The short answer is, yes. With proper rehabilitation, many athletes are able to go back to the playing field. Doctors have even found that patients who exercise, and avoid non-recommended sports showed stronger knee functions than those who avoid exercise and being active after surgery. The reason may be that by exercising, you build up muscles and other structures that support your knee. Athletes are also especially better at correcting their form, and protecting their knee.
While the knee may be back in good form, extra caution is still needed. Some sports, like powerlifting, put too much stress on the knee, and hence these sports or similar activities must be avoided. However, sports like swimming and cycling are recommended by surgeons to help build strength and flexibility. One study found that athletes who underwent TKR were able to return to low impact sports 13 weeks after surgery. Still, it is important to consult with your doctor before going back to any kind of physical activity.
Physical therapy is an important part of recovery. Doctors send patients home with a list of exercises. Sticking to the program is even more important for athletes. Doctors usually tailor an intensive rehabilitation program based on the needs of an athlete.
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Testing For Total Knee Replacement Surgery
To evaluate you as a candidate for this type of surgery, your doctor will go through several tests and procedures.
Theyll evaluate the other joints next to your knee, such as the hip and the ankle, to see if the surgery will deliver the desired function. If either of those two joints are seriously damaged, replacement surgery could actually make that damage worse, or at least limit the benefits of the knee surgery.
Your doctor will also review your medication, since some may complicate the surgery or the recovery.
A standard battery of X-rays and MRI scans will probably be necessary to completely evaluate the knee. An MRI can reveal if there are other causes of the pain and lack of function, such as a stress fracture. But X-rays will reveal most of what your doctor needs to know.
Additionally, you could undergo chest X-rays, blood tests, urine tests, and an EKG to see if you have anemia, infection, a heart or lung disease, or anything else that could complicate surgery.
The best way to know for sure is to talk to your doctor and your orthopedic surgeon. They can give you guidance as to what you should expect if you do have to have total knee replacement surgery and walk you through the process. If the surgery goes well, you can expect less pain and more function as you recover and rehabilitate giving you the quality of life you may now be missing.
Alternatives To Knee Replacement Surgery
Although many patients have tried steroid injections or gel shots to increase the lubrication of their knee joints, this is not the best approach. Steroid shots actually kill off stem cells, cartilage cells, and increase cartilage breakdown. Even the commonly used local anesthetics used in the knees can be toxic to stem and cartilage cells. Those who suffer from mild arthritis may benefit from precise injections of highly concentrated platelet-rich plasma . These natural growth factors from your own platelets can support healthy cartilage. The Regenexx protocols allow for the ability to produce better and more individualized platelet products that the typical PRP centrifuge. If you suffer from moderate or severe arthritis, precise guided injections of your own stem cells may be a better choice to provide relief.
Since there are alternative options and a great number of risks associated with knee replacement surgery, you may want to just say no while you explore your options. Our Regenexx Procedure Candidate Form is a great place to start understanding if regenerative orthopedic medicine is right for you.
Regenexx® procedures are covered by some employers and auto insurance policies. They are not currently covered by Medicare or Medicaid.
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Articles On Knee Osteoarthritis
Knee osteoarthritis can affect your every move: walking, climbing stairs, even sitting or lying down. Surgery can help bring relief, but doctors almost always advise trying other treatment options first. These include:
Medications you take by mouth. Over-the-counter options include acetaminophen as well as nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen . NSAIDs fight inflammation. Stronger NSAIDs are available by prescription.
Creams or ointments you rub onto the skin. Different forms are sold over the counter. You can get stronger versions with a prescription.
Medications injected into the joint. Corticosteroid injections, also called cortisone shots, fight inflammation and can offer fast pain relief that may last up to several months. Injections of hyaluronic acid boost the natural joint fluid that keeps knees moving smoothly. They may take up to a couple of months to have their full effect but can last up to 6 months or more.
Exercise and physical therapy. Exercise strengthens the muscles that support your knee. Physical therapy also helps. A physical therapist can design the program for you and see if you need supportive braces, splints, or canes. If you need to lose weight, diet and exercise can help you shed some pounds and take some of the pressure off your knees.
How The Operation Is Done
The worn ends of the bones in your knee joint are removed and replaced with metal and plastic parts which have been measured to fit.
You may have either a total or a partial knee replacement. This will depend on how damaged your knee is. Total knee replacements are the most common.
Read more information about what happens on the day of your operation.
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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.
How Does A Knee Replacement Work
A total knee replacement surgery can take from one to three hours. During that time, an orthopedic surgeon will remove damaged cartilage and bone before fitting the replacement joint, called an implant, with help from the latest robotic-assisted technology. Using this device, your surgeon can pre-plan the procedure and get the most accurate measurements, ensuring that your implant is perfectly fitted. It also helps with bone resurfacing and the removal of cartilage. Implants come in a variety of different designs created by different manufacturers, but will always contain metal and plastic components that fuse to the resurfaced bone. Your orthopedic surgeon will select the design that best fits each patient based on their lifestyle habits and the severity of the biological joints deterioration, said Dr. Doherty.
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Conversion To Total Knee Replacement
When patients with a partial knee replacement are properly selected, this minimally invasive procedure is quite successful. That said, some patients continue to develop arthritis in other areas of the knee. In addition, some patients wear out the unicompartmental knee implant, or it can come loose within the knee. All of these situations would require additional surgery, and possibly the conversion to a total knee replacement.
Conversion from a partial knee replacement to a full knee replacement can be more difficult because of the prior surgery, but it is not uncommon, and results of conversion are good.
Other potential problems with partial knee replacement are similar to the risks of all joint replacements, which include infection, blood clots, and problems with anesthesia. It is important to have a discussion with your healthcare provider about the risks of this surgical procedure.
How Bad Should My Knee Feel Before Getting Knee Replacement
Have you had knee pain for a long time and cant handle the pain anymore?
You may be thinking about having knee replacement surgery. The surgeon may have already told you that you need TKR surgery.
You may have been putting the surgery off like me until the pain and lack of mobility became unbearable. TKR surgery is a big decision and it took me a long time to commit.
Delaying TKR can greatly affect your lifestyle by not allowing you to enjoy the activities that you choose to participate in. Delaying the surgery can cause further wear on the joint, your leg may begin to bow and it can also cause you to develop a limp when walking .
The doctor can tell you that you need the surgery but you are the only person who can determine how much pain and inconvenience is enough.
In my case the results were amazing and I often wonder if I should have had the surgery sooner.
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Taking Care Of Yourself At Home
Be guided by your doctor or surgeon, but general suggestions include:
- The pain and stiffness take time to ease, so be patient. It may take around three months before you feel fully recovered.
- Keep your wound site clean and dry.
- Avoid smoking cigarette smoke can increase your risk of lung infections.
- Avoid any sporting activities for at least two months.
- Follow the suggestions given to you by medical staff on how to walk, climb stairs, and get in and out of chairs safely.
- Avoid jumping, jolting the knee joint or kneeling down.
- Use aids to help you around the home for example, handrails at the bath and toilet, footstools, raised toilet seats, crutches and walking sticks.
- Check your knee carefully for any signs of infection. These can include redness, swelling, warmth or seepage.
- See your doctor or surgeon if you experience anything unusual, such as clicking or popping sounds coming from the knee joint, or a sudden loss of joint control or movement.