Possible Complications Of Surgery
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen within days or weeks of your surgery. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.
Blood clots may form in one of the deep veins of the body. While blood clots can occur in any deep vein, they most commonly form in the veins of the pelvis, calf, or thigh.
How Is A Total Knee Replacement Performed
First, the orthopedic surgeon makes an incision in the knee and moves the patella to the side. If are any bone spurs are present, as sometimes occurs in osteoarthritis, they will be removed.
Next, the two menisci between the femur and tibia are removed, as are the anterior cruciate ligament and, in some cases, the posterior cruciate ligament . In some types of knee replacement, the PCL is retained.
During the main phase of the operation, the surgeon cuts and remove cartilage and some bone from the upper part of the tibia and lower sections of the femur. The femoral sections removed are two knobby protuberances called the femoral condyles. The tibia and femur are then be capped with metal implants to create new surfaces for the joint. The surface of the femoral component mimics the shape of the original femoral condyles. If the kneecap has also degraded, the surface on its underside may also be cut away and replaced with a polyethylene implant.
Finally, the various layers of tissue are repaired with dissolvable sutures and the skin incision is closed with sutures or surgical staples. A bandage will be wrapped around the knee and the patient is be taken to recovery.
Fixed-bearing knee implant with a polyethylene articulating surface sandwiched between the metal tibial implant and metal femoral implant.
Side-view illustration of a knee with a fixed-bearing knee implant in place.
X-ray of a knee after total knee replacement, showing the implanted prosthesis)
Which Type Should I Have
Your surgeon will discuss this with you. It will depend on how much of your knee is affected by arthritis – it may not be possible to know this until your surgeon has started your operation.
If you have a partial knee replacement it is more likely that you will need to have it done again, than if you have a total knee replacement . Sometimes the reason for choosing to have a partial knee replacement is that it leaves the option to have a TKR at a later date. However it’s also more likely that you will need to have your total knee replacement re-done, if you had a partial knee replacement done before having your total knee replacement.
There are over 150 different designs of knee replacement and some of the differences between all the different types and makes of knee replacement parts aren’t known, particularly how they perform in the long term. In many countries, registries have been set up so that anyone who has had a knee replacement is entered into the register. The information collected is used to monitor how their replacement is performing. In the UK, patients also enter information about their health and quality of life before and after their operation.
A study of over 500 patients with osteoarthritis of the inner part of their knee has compared the effectiveness of total and partial knee replacement. The two groups were followed up five years after surgery, and asked to complete questionnaires about pain, activity and day-to-day living.
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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.
Putting Up And Putting Off Knee Replacement Surgery
Putting up and putting off is the first stage a patient goes through once they are informed they need knee replacement surgery. Patients initially hope that knee replacement surgery isn’t really needed something else will work or it will get better on its own. With this line of thinking, the patient chooses to put up with the bad knee and put off the surgery. They view surgery as a last resort treatment option, but they don’t believe they have reached that last resort.
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Why You Might Say Nows The Time
Here are seven signs that the time might be right for a knee replacement:
You Have Bad Arthritis
Most people who undergo a knee replacement have either osteoarthritis, the wear-and-tear type of arthritis rheumatoid arthritis, an autoimmune condition that causes joint pain and damage or post-injury arthritis.
Osteoarthritis, rheumatoid arthritis and posttraumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion, says Nathanael Heckmann, MD, an orthopaedic surgeon at Keck Medicine of USC and an assistant professor of clinical orthopaedic surgery at the Keck School of Medicine of USC. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.
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What Can I Do To Help My Recovery After Knee Replacement
Soon after surgery, you will be able to walk with a cane or a walker. But you will need help with everyday activities, such as:
- Bathing.
- Cooking.
- Shopping.
Plan ahead to have a friend or loved one help you after surgery, or tell your healthcare provider if youll need help.
Your recovery will also be easier and safer if you adjust your home ahead of time. Things to consider include:
- Bench or chair in the shower, as well as secure safety bars.
- No tripping hazards, like cords and loose carpets.
- Secure handrails along any stairs if you use stairs.
- Stable chair with a back, two arms and a firm seat cushion, along with a footstool to elevate your leg.
- AVOID reclining chairs as they DO NOT allow for proper elevation of your post surgical leg.
How Common Is Knee Replacement Surgery
The surgery is very common. Surgeons started doing it in the 1960s, with regular updates to techniques and implants along the way.
Almost 800,000 knee replacements currently get performed each year in the United States. The surgery is often done in older adults whose knees have worn down over time. But its also become popular in middle age, as people want to stay active.
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Types Of Arthritis That Affect The Knee
Inflammatory arthritis
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
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 .
Recognizing The Signs Of A Blood Clot
Follow your orthopaedic surgeon’s instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.
Warning signs of blood clots. The warning signs of possible blood clots in your leg include:
- Increasing pain in your calf
- Tenderness or redness above or below your knee
- New or increasing swelling in your calf, ankle, and foot
Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
- Sudden shortness of breath
- Sudden onset of chest pain
- Localized chest pain with coughing
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Are There Nonsurgical Treatment Options
Before discussing knee replacement, your doctor may prescribe an anti-inflammatory over-the-counter pain medication such as ibuprofen or naproxen to help with pain and reduce swelling. Cortisone, a steroid hormone, may also be injected into the knee to relieve pain. You might also want to try glucosamine or chondroitin sulfate, common supplements containing material found in the joints, which help with regeneration.Losing weight, thanks to changing your diet and exercising more, also have a positive effect on the joints. Our knees receive four pounds of pressure for each pound of body weight, giving even a slight reduction considerable impact. Beyond that, the increased strength and mobility from exercise can reduce pressure.
When Is The Best Time For Knee Replacement Surgery
According to a recent study by Northwestern Medicine, 90% of patients who would benefit from a knee replacement surgery are waiting too long. However, the study also found that about 25% of patients are having the procedure prematurely.
So, how do you know if youre putting off your surgery or jumping the gun?
There isnt a specific level of pain or immobility that means its time for a knee replacement rather its a combination of factors unique to you, including:
- Your age
- The amount of pain you feel in your knees
- How well your knees function
Orthopedic doctors look at these factors, as well as imaging results from X-rays and MRIs, to make a recommendation on whether a knee replacement may be an option. This is such an important step because surgery is rarely the first or only option for most people. Plus, this can have an impact on the cost of a knee replacement a doctor needs to actually order a replacement for it to be eligible for any insurance coverage.
As for signs that it might be time for a knee replacement, here are a few things to watch out for:
If you notice any of these signs, make an appointment with an orthopedic doctor. Your doctor will listen to your concerns and symptoms, ask questions about your medical history, lifestyle and goals, and work with you do make a tailored treatment plan.
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Is Kneeling Possible After Knee Replacement
The kneeling position is essential to many daily living activities and is required in certain occupations like carpet laying, painting, and building.
Kneeling is also an intermediate position used by older adults as they get up from the floor and is an essential component of some leisure activities like gardening. Clearly, kneeling is a normal movementa movement that we take for granted until it’s gone.
Does the knee replacement surgery affect our ability to kneel on the floor?
Risks Of Knee Replacement Surgery
Knee replacement surgery is a common operation and most people do not have complications. However, as with any operation, there are risks as well as benefits.
Complications are rare but can include:
- stiffness of the knee
- infection of the joint replacement, needing further surgery
- unexpected bleeding into the knee joint
- ligament, artery or nerve damage in the area around the knee joint
- persistent pain in the knee
- a break in the bone around the knee replacement during or after the operation
In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.
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Things No One Ever Tells You About Getting A Knee Replacement
Heres what you need to know thats not in the brochure: 1. You might not be a good candidate.A study published last year by researchers from Virginia Commonwealth University in Richmond questioned the value of knee replacement for some of the people rushing to get it. After analyzing data from a large study of men and women who had the operation, the researchers found that fully one-third of them were not actually good candidates for the surgery, which is why they got only a very modest benefita 2-point improvement on a common measure of knee function, compared with a 20-point improvement for people who started out with really bad knees.
“Pain that doesnt go away and moderate to severe arthritis are necessary for a knee replacement to do its job,” Lajam says. “If you have the surgery, but its actually a problem of nerve pain, hip pain, or circulation, its not going to help you.” The advice here is not to wait until your knees are completely destroyed before seeking surgery, but to make sure that youve tried other measures first and that you meet both criteriaconsistent pain and advanced arthritis.
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.
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Why Come To Hss For Your Knee Replacement
I call knee replacement surgery a team sport. The two most central players are the surgeon and the patient, but there are many other people on the team who help make it successful. At HSS, our knee replacement surgeons are among the most skilled surgeons in the world. In addition to their deep expertise and extensive training, they have a singular focus on joint replacement surgery. This experience allows them to achieve very high success rates, avoid complications and help effectively relieve our patients pain.
Another advantage is that the knee replacement surgeons at HSS embrace the multidisciplinary aspects of orthopedic care. They work closely with anesthesiologists, rehabilitation specialists, nurses, dietitians, and many others to keep our patients safe and healthy so they can get back to what they love to do.
The fact that HSS is a specialty hospital focused solely on orthopedics and rheumatology is a great advantage. All our staff have great experience and a singular focus. Since we do not have to compete with other departments for resources, we can concentrate all our efforts on obtaining the best outcomes for our patients without any compromise.
How Does Knee Pain Affect Lifestyle
How pain is perceived and tolerated is unique to each individual. If knee pain affects working, socializing, sleeping, maintaining good hygiene, or other daily activities, then it may be time to consider knee replacement surgery.
Knee pain and active lifestylesPeople who live active lives may be more affected by knee pain and decide to have knee replacement surgery sooner. For example, a person whose regular activities include standing for work, babysitting grandchildren, and walking a pet dog may be more affected by arthritic knee pain than a person who lives a more sedentary life.
Pain and joint damage do not always match upThe decision to have knee replacement surgery should not be based solely on medical imaging that shows severe knee degeneration. Rather, it should be based on moderate to severe knee arthritis symptoms that correlate with medical imaging.
See Knee Osteoarthritis Diagnosis
For example, a person whose x-ray shows a severely degenerated knee but who experiences only mild pain is probably not a good candidate for knee replacement. In contrast, a person who has a moderately degenerated knee and experiences severe pain may be a good candidate for knee replacement.
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