What is knee replacement surgery. How is it performed. What are the different types of knee replacements. What materials are used in knee implants. How long does recovery take. What are the potential risks and complications. How can you prepare for knee replacement surgery.

Understanding Knee Replacement Surgery

Knee replacement surgery, also known as knee arthroplasty, is a procedure that involves replacing damaged parts of the knee joint with artificial implants. This surgery is primarily performed to alleviate pain and improve mobility in patients suffering from severe knee arthritis or other debilitating knee conditions.

The knee is a complex joint comprising three bones: the femur (thighbone), tibia (shinbone), and patella (kneecap). In a healthy knee, these bones are covered with cartilage that allows for smooth movement. When this cartilage wears away due to arthritis or injury, it can lead to pain, stiffness, and reduced mobility.

Who needs knee replacement surgery?

Knee replacement surgery is typically recommended for individuals who experience:

• Severe knee pain that limits daily activities
• Moderate to severe pain while resting
• Chronic knee inflammation and swelling that doesn’t improve with rest or medications
• Knee deformity, such as bowing in or out of the knee
• Failure to respond to conservative treatments like medications, injections, or physical therapy

Types of Knee Replacement Procedures

There are two main types of knee replacement surgeries:

1. Total Knee Replacement (TKR)

In a total knee replacement, the entire knee joint is replaced with artificial components. This is the most common type of knee replacement surgery and is typically recommended for patients with widespread knee damage.

2. Partial Knee Replacement (PKR)

A partial knee replacement, also known as unicompartmental knee replacement, involves replacing only one part of the knee joint. This procedure is suitable for patients whose knee damage is limited to a specific area.

Is partial knee replacement better than total knee replacement? The choice between partial and total knee replacement depends on the extent of knee damage and the patient’s overall health. Partial knee replacement generally offers a faster recovery time and more natural knee motion, but it may not be suitable for all patients.

The Knee Replacement Surgical Procedure

Knee replacement surgery is a complex procedure that typically takes between 1 to 3 hours. Here’s a step-by-step overview of the process:

1. Anesthesia administration
2. Incision and exposure of the knee joint
3. Removal of damaged cartilage and bone
4. Preparation of the joint surfaces
5. Placement of the artificial implants
6. Testing of the new joint
7. Closure of the incision

How is the damaged knee joint replaced? The surgeon removes the damaged cartilage and bone from the knee joint and replaces them with metal and plastic components. These artificial parts are designed to mimic the natural shape and movement of a healthy knee joint.

Knee Replacement Implants: Materials and Design

The success of knee replacement surgery largely depends on the quality and design of the implants used. Modern knee implants are made from a combination of materials, each chosen for its specific properties:

• Metal alloys (usually titanium or cobalt-chromium): Used for the femoral and tibial components due to their strength and durability
• High-grade plastic (ultra-high-molecular-weight polyethylene): Used for the spacer between the metal components to allow smooth movement
• Ceramic: Sometimes used for the femoral component in patients with metal allergies

Are knee replacement implants one-size-fits-all? No, knee implants come in various sizes and designs to accommodate different patient anatomies and needs. Surgeons choose the most appropriate implant based on the patient’s size, age, activity level, and specific knee condition.

Preparing for Knee Replacement Surgery

Proper preparation can significantly improve the outcome of knee replacement surgery. Here are some key steps patients should take:

Medical Evaluation

Patients will undergo a thorough medical evaluation to ensure they’re healthy enough for surgery. This may include:

• Blood tests
• Electrocardiogram (ECG)
• Chest X-ray
• Review of current medications

Physical Preparation

Strengthening the muscles around the knee before surgery can aid in recovery. A physical therapist may recommend exercises to:

• Improve leg strength
• Increase flexibility
• Enhance overall fitness

Home Preparation

Patients should prepare their home for post-surgery recovery by:

• Arranging for help during the initial recovery period
• Removing tripping hazards
• Installing handrails or grab bars in the bathroom
• Setting up a recovery area on the ground floor if possible

How long before surgery should you start preparing? Ideally, patients should start preparing for knee replacement surgery several weeks to months in advance. This allows time for physical conditioning and necessary home modifications.

The Recovery Process After Knee Replacement

Recovery from knee replacement surgery is a gradual process that requires patience and dedication. Here’s what patients can expect:

Immediate Post-Surgery Period

In the first few days after surgery, patients will:

• Begin walking with assistance (usually within 24 hours)
• Start physical therapy exercises
• Manage pain with prescribed medications
• Learn to use assistive devices like walkers or crutches

First Few Weeks

During this period, patients typically:

• Continue with physical therapy exercises
• Gradually increase walking distance and duration
• Begin to perform light household activities
• Have stitches or staples removed (if applicable)

Long-Term Recovery

Full recovery can take several months to a year. During this time, patients will:

• Continue strengthening exercises
• Gradually return to normal activities
• Work on improving knee flexibility and range of motion

How long does it take to fully recover from knee replacement surgery? While most patients can resume many normal activities within 3 to 6 weeks, full recovery typically takes 3 to 12 months. The exact timeline varies depending on factors such as the patient’s age, overall health, and commitment to rehabilitation.

Potential Risks and Complications

While knee replacement surgery is generally safe and effective, like any major surgery, it carries some risks. These may include:

• Infection
• Blood clots
• Implant problems (loosening or wear)
• Continued pain or stiffness
• Nerve or blood vessel damage
• Allergic reactions to implant materials

Can complications occur years after knee replacement? Yes, while most complications occur in the short term, some issues like implant loosening or wear can develop years after the surgery. This is why regular follow-ups with the orthopedic surgeon are important.

Long-Term Outlook and Lifestyle Changes

Most patients experience significant improvement in knee pain and function after knee replacement surgery. However, maintaining the health of the new knee joint requires some lifestyle adjustments:

Exercise and Physical Activity

Regular, low-impact exercise is crucial for maintaining knee health. Recommended activities include:

• Swimming
• Cycling
• Walking
• Golfing

High-impact activities like running or contact sports are generally discouraged to prevent premature wear of the implant.

Weight Management

Maintaining a healthy weight is essential to reduce stress on the knee implant. Patients are often advised to:

• Follow a balanced, nutritious diet
• Engage in regular physical activity
• Consult with a nutritionist if needed

Regular Check-ups

Patients should schedule regular follow-up appointments with their orthopedic surgeon to monitor the implant’s condition and address any concerns promptly.

How long do knee replacements typically last? With proper care and lifestyle modifications, modern knee replacements can last 15 to 20 years or more. However, younger or more active patients may require revision surgery sooner.

Knee replacement surgery has revolutionized the treatment of severe knee arthritis, offering patients improved mobility and quality of life. While the procedure and recovery process can be challenging, the long-term benefits often outweigh the temporary discomfort. As with any major medical decision, patients should thoroughly discuss the pros and cons of knee replacement with their healthcare provider to determine if it’s the right choice for their individual situation.

Knee Replacement Surgery: Procedure, Types and Risks

Knee replacement is one of the most successful orthopedic surgeries performed today. Most patients experience reduced or eliminated knee pain, increased ability to move and an overall improvement in quality of life.

HSS performs more total knee replacement surgeries than any other US hospital. HSS surgeons invented the first modern total knee replacement in the 1970s and have continually improved on surgical techniques, technology and prosthetic materials ever since. In 2020, HSS became the first hospital in the United States to complete a total knee replacement using augmented reality (AR) assistance.*

What is knee replacement surgery?

Knee replacement is where portions of the bones that form the knee joint are removed and replaced with artificial implants. It is performed primarily to relieve knee pain and stiffness caused by osteoarthritis.

Most people who get this surgery have advanced knee arthritis, in which the knee cartilage is worn away and the surface of the knee becomes pitted, eroded, and uneven. This causes pain, stiffness, instability and a change in body alignment. Knee replacement surgery can also help some people who have a weakened knee joint caused by an injury or other condition.

What are the different types of knee replacement surgery?

There are two main types:

• total knee replacement, where the entire joint is replaced with artificial surfaces
• partial knee replacement, where only one damaged compartment of the knee is replaced

Total knee replacement is the more common of these two procedures.

Knee anatomy

To understand a total knee replacement, also known as total condylar knee arthroplasty, you must be familiar with the structure of the knee, a complex joint that consists of three bones:

• the femur (thighbone)
• the tibia (shinbone)
• the patella (kneecap)

Strong ligaments connect the powerful muscles of the thigh and calf to the bones around the knee to control knee motion and function. Cartilage (such as the meniscus) and other soft tissues cover and cushion the bones to help them glide together smoothly.

When you bend or straighten your knee, the end of the femur rolls against the end of the tibia, and the patella glides in front of the femur.

When the cartilage that cushions the joint degrades or is worn away completely, the bones rub together and become scraped and rough. This causes inflammation known as osteoarthritis, which results in pain and stiffness that make walking and other movement difficult. The implants used in knee replacement are smooth like the surfaces of a healthy knee.

How is a total knee replacement performed?

First, the orthopedic surgeon makes an incision (cut) in the knee and moves the patella (kneecap) to the side. If are any bone spurs (small bony growths) 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 (ACL) and, in some cases, the posterior cruciate ligament (PCL). 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 (plastic tray) 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)

What are knee replacement implants made of?

The selection of knee replacement prosthesis design and materials depends on each individual patient. The main implant components are made of metal – usually titanium or chrome-cobalt alloys. The implants are fixated in place either with a cement bonding agent or by osseointegration, in which a porous metal stem extends into the tibia and the patient’s natural bone grows into it. A plastic platform or spacer will be inserted between the tibial and femoral implant surfaces. The spacer is made of polyethylene.

Most femoral components are made of metal alloys (cobalt chromium) or metal-ceramic alloys (oxidized zirconium). The patellar component is plastic (polyethylene). The tibial insert component is also plastic (polyethylene). The tibial tray component can be made of the following materials:

• cobalt chromium (metal alloy)
• titanium (metal alloy)
• polyethylene (plastic)

Video: Animation of a total knee replacement

Partial knee replacement overview

A partial knee replacement is also known as unicompartmental knee arthroplasty or unicondylar knee arthroplasty. In this surgery, damaged cartilage and bone are removed and replaced only in one diseased compartment of the knee. This differs from a total knee replacement, in which bone and cartilage from the entire joint are replaced.

Partial knee replacement is suitable for people who experience arthritis only in one compartment (section) of the knee joint, rather than throughout the joint. It can also provide relief from pain and stiffness in some people who have medical conditions that make them poor candidates for total knee replacement surgery.

Can I avoid or postpone a knee replacement?

The choice on whether to have surgery to address arthritis of the knee joint depends on multiple factors, including:

• the condition of the knee joint
• the patient’s age and activity level

In cases where the damage from arthritis is minimal, and/or if the patient does not have a very active lifestyle, nonsurgical treatments by be tried, including:

• physical therapy
• NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen
• weight loss to reduce pressure on the knee

How do I know if I need knee replacement surgery?

You may need surgery if:

• Your knees are stiff and swollen.
• There is pain throughout the day, even at rest.
• Walking, getting up or climbing stairs is difficult and painful.
• Medication and therapy do not offer enough relief.
• Knee cartilage is so damaged and worn away that you are walking “bone on bone,” in which the bones of the joint are scraping together.

How long does a knee replacement last?

Knee replacement implants are expected to function for at least 15 to 20 years in 85% to 90% of patients. However, the implants do not last forever.

After a period of 15 to 20 years, general wear and tear may loosen the implant. Depending on the patient, this may cause no symptoms, or it may cause any of the following:

• pain
• loose implant particles
• knee instability
• infection

When these symptoms arise, orthopedic surgeons recommend having knee revision surgery to replace the original implant. Infection, especially, requires a prompt revision surgery. Infection after knee replacement surgery is rare, but a knee replacement implant cannot defend itself from infection if bacteria are introduced to the body. Learn more about the low infection rates at HSS.

Can knee replacement be done as an outpatient?

Most patients stay in the hospital one or two nights after surgery. Some patients are able to return home the same day after an outpatient procedure. Learn more by reading Outpatient Knee Replacement Surgery: Frequently Asked Questions.

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 (physical therapy) 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 (walker, cane, or crutches)
• climbing stairs with aid of a device

How long does it take to walk after a knee replacement?

Most patients progress to a straight cane, walker or crutches within two or three days after surgery. As the days progress, the distance and frequency of walking will increase.

Patients are usually able to drive a car within three to six weeks after surgery and resume all other normal activities by or before six weeks. Complete recuperation and return to full strength and mobility may take up to four months. However, in many cases, patients are significantly more mobile one month after surgery than they were before they had their knee replacement

What can I expect at HSS?

Hospital for Special Surgery has been at the forefront of modern knee replacement since the operation was first introduced in the late 1960s. We have led the field ever since in a number of ways:

• The numbers: HSS has been ranked the No. 1 hospital for orthopedics by U.S. News & World Report for 11 years straight.
• Along with high rankings in patient satisfaction, HSS performs the most knee replacements with the lowest reported infection rates in the United States.
• Research and advancement: Smaller incisions, new implant materials and design, and sophisticated instrumentation have been – and continue to be – the areas of expertise of the hip and knee replacement surgeons of the HSS Adult Reconstruction & Joint Replacement Service.
• HSS routinely uses the latest surgical techniques and technology, such as robotic-assisted and computer-assisted surgery.
• Regional anesthesia: Isolating the anesthesia to a particular body area helps avoid the potential problems that may accompany a general anesthetic. These techniques have been developed and refined by the HSS Department of Anesthesiology, Critical Care & Pain Management. Learn more about Safe Knee Surgery: How Anesthesiology Plays a Role

How to prepare for knee replacement

There are certain steps that can improve your recovery time and results. It is important to follow your knee replacement surgeon’s instructions both before and after surgery, as well as that of your rehabilitation therapist’s recommendations. Learn more about reparing for knee replacement by reading Your Pathway to Recovery: A Patient’s Guide to Total Knee Replacement (TKR).

References

Back in the Game patient stories

Knee replacement – NHS – How it is performed

You’ll usually be admitted to hospital on the day of your operation. The surgeon and anaesthetist will usually come and see you to discuss what will happen and answer any questions you have.

Most people would have seen their surgeon at a pre-assessment clinic and had the chance to the operation.

A senior-level surgeon, consultant or registrar will do the operation. They may be helped by junior doctors. You should be told at your pre-operative assessment who will be doing the operation. Ask if you’re not told.

How the operation is done

Knee replacement surgery is usually performed either under general anaesthetic (you’re asleep throughout the procedure) or under spinal anaesthetic or epidural (you’re awake but have no feeling from the waist down).

The worn ends of the bones in your knee joint are removed and replaced with metal and plastic parts (a prosthesis) 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.

Total knee replacement

In a total knee replacement, both sides of your knee joint are replaced. The procedure takes 1 to 3 hours:

• Your surgeon makes a cut down the front of your knee to expose your kneecap. This is then moved to the side so the surgeon can get to the knee joint behind it.
• The damaged ends of your thigh bone and shin bone are cut away. The ends are precisely measured and shaped to fit the prosthetic replacement. A dummy joint is positioned to test that the joint is working properly. Adjustments are made, the bone ends are cleaned, and the final prosthesis is fitted.
• The end of your thigh bone is replaced by a curved piece of metal, and the end of your shin bone is replaced by a flat metal plate. These are fixed using special bone ‘cement’, or are treated to encourage your bone to fuse with the replacement parts. A plastic spacer is placed between the pieces of metal. This acts like cartilage, reducing friction as your joint moves.
• The back of the knee cap may also be replaced, depending on the reasons for replacement.
• The wound is closed with either stitches or clips and a dressing is applied to the wound. In rare cases a splint is used to keep your leg immobile, but you’re usually encouraged to move your knee as early as possible.

You’re likely to still have some difficulty moving after your operation, especially bending your knee. Kneeling may be difficult because of the scar.

Partial (half) knee replacement

If only one side of your knee is damaged, you may be able to have a partial knee replacement. This is a simpler operation, which involves a smaller cut and less bone being removed. It’s suitable for around 1 in 4 people with osteoarthritis.

The advantages of partial knee replacement include a shorter hospital stay and recovery period.  Blood transfusions are also rarely needed. This type of joint replacement often results in more natural movement in the knee and you may be able to be more active than after a total knee replacement.

Talk to your surgeon about the type of surgery they intend to use and why they think it’s the best choice for you.

Other procedures

In some cases, there may be other types of surgery you can have, including:

Kneecap replacement

If only your kneecap is damaged, an operation called a patellofemoral replacement or patellofemoral joint arthroplasty can be performed. This is a simpler surgery with a faster recovery time. However, the long-term results are still unclear and it’s not suitable for most people with osteoarthritis.

Mini-incision surgery

This is usually used for partial knee replacements.

The surgeon makes a smaller cut than in standard knee replacement surgery. Specialised instruments are then used to manoeuvre around the tissue, rather than cutting through it. This should lead to a quicker recovery.

Read the NICE guidance on mini-incision surgery for total knee replacement.

Image-guided surgery

The surgeon performs this operation using computerised images, which are generated by attaching infrared beacons to parts of your leg and to the operating instruments. These are tracked on infrared cameras in the operating theatre. Results so far suggest that this may enable the new knee joint to be positioned more accurately.

Most hospitals don’t yet have the equipment to do this and only around 1 in 100 knee replacements are performed in this way.

Patient-specific knee replacement

This is a more recent advance in knee replacement surgery. A guide is created using MRI scans. This helps to create the best fitting prosthesis for each patient.

The potential advantage is that the prosthesis may last longer, as the most accurate fitting is used. However, as this is a new technique, the results and long-term effects aren’t fully known yet.

Page last reviewed: 02 August 2019
Next review due: 02 August 2022

Total Knee Replacement Surgery (Arthroplasty) in NYC

Total Knee Replacement Surgery (Arthroplasty) in NYC – Dr. Peter Sculco

What is total knee arthroplasty?

Total knee arthroplasty, also known as total knee replacement surgery, is a procedure performed by an orthopedic surgeon, during which the ends of the bones in a knee joint are replaced to create new joint surfaces. New joint surfaces are sometimes needed when patients suffer long-term joint damage due to osteoarthritis of the knee or post traumatic arthritis of the knee. Unlike partial knee replacement surgery, which only removes a certain portion of the joint, total knee replacement is done when there is severe damage to the joint. It is typically recommended when knee pain is affecting your ability to participate in daily activities like walking and climbing stairs.

Why is total knee replacement surgery performed?

The primary reason for undergoing knee replacement surgery is to improve the function of the knee joint and to alleviate joint pain. Total knee arthroplasty may be necessary for patients who suffer from any of the following conditions:

• Osteoarthritis of the knee is a type of knee arthritis characterized by painful inflammation of the knee joint caused by cartilage deterioration. The condition can cause severe pain and loss of knee functionality over time.
• Post traumatic arthritis of the knee is caused due to damage to the cartilage in the knee that develops following an injury, such as a fracture.
• Rheumatoid arthritis of the knee is a chronic inflammatory disorder characterized by the deterioration of cartilage in the knee due to the immune system attacking the tissues. This type of arthritis can affect other joints in the body as well.

Dr. Peter K. Sculco may recommend total knee replacement surgery if you are suffering from any of the following signs of knee joint dysfunction:

• Knee pain that does not go away, even with medication
• Constant pain throughout the day, even while resting
• Limited range of motion in the knee joint
• Stiffness and swelling
• Difficulty standing for long periods of time
• Inability or difficulty with usual physical activities, such as walking or climbing stairs
• Little or no improvement in knee function following conservative treatments

What does total knee replacement involve?

Each total knee replacement procedure is tailored to the individual needs of the patient and may vary from case to case. The general steps involved with a total knee arthroplasty include:

• Administering regional anesthesia and a sedative so you are comfortable throughout surgery
• Making an incision along the front of the knee to access the knee joint
• Removing damaged cartilage and bone from the knee joint and preparing the area for the implant
• Securing the components of the knee implant into their proper placement
• Fitting the new components together and closing the incision

By employing his Rapid Recovery approach — including various interventions taken before, during, and after surgery — Dr. Sculco is able to help his patients return to their everyday lives faster following total knee replacement surgery.

Rapid Recovery for Total Knee Replacement

Typically, patients can expect to experience some swelling and pain after undergoing knee replacement surgery. Dr. Sculco is dedicated to improving your recovery by limiting post-surgical pain and other side effects. Over the years, he has been involved with extensive research on topics including less invasive surgical techniques, anesthesia use, anti-inflammatory medications, and specific instruments used during the procedure. This research has led Dr. Sculco to a fine-tuned recovery approach that has been proven to decrease inflammation and pain following surgery, as well as accelerate the body’s healing process so patients can get back to doing what they love faster. Learn more about Dr. Sculco’s recovery approach by visiting our Rapid Recovery page.

If you’re suffering from lowered range of motion and pain in your knee joint, the first step to getting back to your normal life quickly is scheduling an evaluation with an experienced orthopedic surgeon. Dr. Peter K. Sculco provides customized treatment plans and personalized care paired with world-class orthopedic training. Call 212. 606.1771 today to request an appointment.

Your submission was successful! We will get back to you as soon as possible.

Knee replacement – NHS – NHS

Knee replacement surgery (arthroplasty) is a common operation that involves replacing a damaged, worn or diseased knee with an artificial joint.

Adults of any age can be considered for a knee replacement, although most are carried out on people between the ages of 60 and 80.

A smaller operation called a partial knee replacement tends to be performed on younger people aged between 55 and 64 where the artificial joint is expected to need redoing within 10 years.

When a knee replacement is needed

Knee replacement surgery is usually necessary when the knee joint is worn or damaged so that your mobility is reduced and you are in pain even while resting.

The most common reason for knee replacement surgery is osteoarthritis. Other health conditions that cause knee damage include:

• rheumatoid arthritis
• haemophilia
• gout
• disorders that cause unusual bone growth
• death of bone in the knee joint following blood supply problems
• knee injury
• knee deformity with pain and loss of cartilage

Who is offered knee replacement surgery

A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility.

You may be offered knee replacement surgery if:

• you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
• your knee pain is so severe that it interferes with your quality of life and sleep
• everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
• you’re feeling depressed because of the pain and lack of mobility
• you cannot work or have a social life

You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.

Types of knee replacement surgery

There are 2 main types of surgery:

• total knee replacement – both sides of your knee joint are replaced
• partial (half) knee replacement – only 1 side of your joint is replaced in a smaller operation with a shorter hospital stay and recovery period

Other surgery options

There are other types of surgery which are an alternative to knee replacement, but results are often not as good in the long term. Your doctor will discuss the best treatment option with you. Other types of surgery may include:

• arthroscopic washout and debridement – a tiny telescope (arthroscope) is inserted into the knee, which is then washed out with saline to clear any bits of bone or cartilage
• osteotomy – the surgeon cuts the shin bone and realigns it so that your weight is no longer carried by the damaged part of the knee
• mosaicplasty – a keyhole operation that involves transferring plugs of hard cartilage, together with some underlying bone from another part of your knee, to repair the damaged surface

Preparing for knee replacement surgery

Before you go into hospital, find out as much as you can about what’s involved in your operation. Your hospital should provide written information or videos.

Stay as active as you can. Strengthening the muscles around your knee will aid your recovery. If you can, continue to do gentle exercise, such as walking and swimming, in the weeks and months before your operation. You can be referred to a physiotherapist, who will give you helpful exercises.

Read about preparing for surgery, including information on travel arrangements, what to bring with you and attending a pre-operative assessment.

Recovering from knee replacement surgery

You’ll usually be in hospital for 3 to 5 days, but recovery times can vary. 

Once you’re able to be discharged, your hospital will give you advice about looking after your knee at home. You’ll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your knee.

Most people can stop using walking aids around 6 weeks after surgery, and start driving after 6 to 8 weeks. 

Full recovery can take up to 2 years as scar tissue heals and your muscles are restored by exercise. A very small amount of people will continue to have some pain after 2 years.

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 wound
• 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
• deep vein thrombosis (DVT)
• 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.

The National Joint Registry

The National Joint Registry (NJR) 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.

Video: knee replacement

This animation shows how knee replacement surgery is done and explains why it may be needed.

Media last reviewed: 1 April 2021
Media review due: 1 April 2024

Page last reviewed: 02 August 2019
Next review due: 02 August 2022

Knee Replacement Surgery – Brigham and Women’s Hospital

What is Knee Replacement Surgery?

Knee replacement surgery, also called knee arthroplasty, replaces a worn or damaged knee with an artificial implant (prosthesis).

A knee replacement procedure is recommended for patients who have developed severe knee damage due to osteoarthritis or rheumatoid arthritis. This procedure may also be necessary for patients who have had fractures, torn cartilage or ligaments that have led to irreversible damage to the knee.

If knee replacement surgery is necessary, our expert orthopaedic surgeons will help you determine what procedure is right for you and help guide you through the process of recovery.

Knee Replacement Options

When medications and other treatments cannot keep knee pain at a manageable level, surgery to replace the knee joint may be appropriate.

Total Knee Replacement

Total knee replacement (TKR) is the standard treatment for advanced osteoarthritis. During this procedure, plastic and metal inserts are used to replace bone and cartilage in all sections of the knee, including medial, lateral and the kneecap.

The vast majority of total knee replacements function for more than 10 years and over 80 percent last more than 20 years after surgery. More than 90 percent of knee replacement surgery patients experience a significant reduction in knee pain.

Partial Knee Replacement

While total knee replacements are more common, 8-to-10 percent of patients with chronic knee pain qualify for a partial knee replacement. Patients who undergo a partial knee replacement rather than a total knee replacement often recover more quickly.

Partial knee replacement is a surgical option for patients with localized damage to one part of the knee joint. This surgery replaces one damaged portion of the knee while leaving healthy areas intact. It’s typically performed on the inside (medial) section of the knee, but in some cases, it’s performed on the outside (lateral) section. Surgery which replaces the knee cap and the trochlear surface of the femur alone is called a patella femoral arthroplasty.

This procedure is more conservative than a total knee replacement, involving smaller incisions, faster recovery and possibly improved long-term range of motion than the standard total knee replacement. The knee may also feel more natural. However, in the future, you may need a conversion to a total knee replacement.

Minimally Invasive Partial and Total Knee Replacement

Minimally invasive is a term used for any type of surgery that is less invasive than traditional or open surgery. Minimally invasive partial or total knee replacement surgeries are innovative procedures that can be as effective as traditional surgery.

Minimally invasive knee replacements use smaller and fewer incisions around the knee, and have been proven to reduce postoperative pain, minimize trauma to tissue, and quicken recovery time.

The most appropriate candidates for minimally invasive knee replacements have minimal or moderate deformity, maintain a healthy weight, have few pre-existing health conditions and are motivated to participate in the rehabilitation process.

Are You a Candidate for Knee Replacement?

To determine the most appropriate knee replacement surgery for you, our knee surgeons consider a wide range of factors, including severity of symptoms, overall health and response to previous treatment.

If you are experiencing the following, surgery may be advised.

• Severe pain that prevents you from participating in everyday activities
• Have weakness in your knee and cannot move it fully
• If your symptoms don’t improve with non-surgical treatments

For those who may have been diagnosed with advanced osteoarthritis, the condition of your knee joints will determine your surgical options. Surgery on the knee is common for severe osteoarthritis with a high success rate.

Optimizing Health Before Surgery

At Brigham and Women’s Department of Orthopaedic Surgery, we address each patient’s health before surgery. Clinical research has shown that better control of a patient’s medical and physical condition prior to surgery results in far better outcomes.

Pre-Surgical Rehabilitation (“Prehab”)

The speed and quality of your recovery may be improved with regular exercise and careful use of the knee. We provide all patients with educational materials and screening procedures to help ensure the best post-surgical outcomes.

All patients also have access to an online program where you will find the exercises that are part of our pre-surgery rehabilitation program. Our innovative “Prehab” program provide pre-surgical strengthening exercises that have been shown to accelerate recovery and contribute to better outcomes.

Knee Joint Reconstruction | Total Knee Replacement Portland

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts.   The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion.  Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms. 

Indications

Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee.  Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It often affects older people.

In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”.   These factors can cause pain and restricted range of motion in the joint.

Your doctor may advise total knee replacement if you have:

• Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).
• Moderate to severe pain that occurs during rest or awakens you at night.
• Chronic knee inflammation and swelling that is not relieved with rest or medications
• Failure to obtain pain relief from medications, injections, physical therapy, or other conservative treatments.
• A bow- legged knee deformity

Causes

The exact cause of osteoarthritis is not known, however there are several factors that are commonly associated with the onset of arthritis and may include:

• Injury or trauma to the joint
• Fractures at the knee joint
• Increased body weight
• Repetitive overuse
• Joint infection
• Inflammation of the joint
• Connective tissue disorders

Diagnosis

Your doctor will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.

X-rays typically show a narrowing of the joint space in the arthritic knee.

Procedure

The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.

The surgery is performed under spinal or general anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are cut at appropriate angles using specialized jigs. The femoral component is attached to the end of the femur with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws. Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, like the original meniscus cartilage. The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed; drains are inserted and a sterile dressing is placed over the incision.

Post-operative care

Rehabilitation begins immediately following the surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Knee immobilizers are used to stabilize the knee.  You will be able to walk with crutches or a walker.  A continuous passive motion (CPM) machine can be used to move the knee joint. Continuous passive motion is a device attached to the treated leg which constantly moves the joint through a controlled range of motion, while the patient relaxes. Your physical therapist will also provide you with a home exercise program to strengthen thigh and calf muscles.

Risks and complications

As with any major surgery, possible risks and complications associated with total knee replacement surgery include:

• Knee stiffness
• Infection
• Blood clots (deep vein thrombosis)
• Nerve and blood vessel damage
• Ligament injuries
• Patella (kneecap) dislocation
• Plastic liner wears out
• Loosening of the implant

If you find difficulty in performing simple activities such as walking or climbing stairs because of your severe arthritic knee pain, then total knee replacement may be an option for you. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume your normal activities of daily living

Knee Surgery: Types & Recovery

Knee Surgery

You may need surgery when your knee has structural damage. You may also need it if your knee pain has not responded to other methods of pain relief for structural damage or other conditions, such as osteoarthritis. If you choose surgery, a physician anesthesiologist will prevent you from feeling pain during the operation. As pain management specialists, physician anesthesiologists also play a key role in pain relief and recovery after surgery. This postsurgical pain relief is critical for effective participation in physical therapy and rehabilitation.

What are some types of knee surgery?

The most common knee surgeries involve arthroscopy — a surgical technique used to repair many different types of knee problems — or knee replacement.

Arthroscopic surgery

Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patient’s body through small incisions.

For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeon’s work. Surgical instruments are inserted into the joint through a second incision.

The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:

• Removal or repair of a torn meniscus — a type of cartilage in your knee that cushions and stabilizes the joint
• Reconstruction of a torn anterior cruciate ligament (ACL), which is a ligament that helps stabilize the knee joint
• Removal of inflamed synovial (connective) tissue
• Trimming of damaged articular cartilage
• Removal of loose fragments of bone or cartilage
• Treatment of patella (kneecap) problems
• Treatment of knee sepsis (infection)

Knee replacement

In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic, or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.

After knee replacement surgery, you may have some temporary pain in the new joint. Nonetheless, physical therapy can often begin the day after surgery. Physical activity after surgery is considered a key to success. That makes postoperative pain relief particularly important, so you can be active and participate effectively in physical therapy.

Knee replacements can be expected to last at least 15 years; some last 20 years or longer. Because knee replacements do not last forever, age is a factor in deciding between surgery and other pain management alternatives.

What type of anesthesia should I use?

Your choice of anesthetic depends on many factors, such as the surgery being performed, your risk factors, and your preferences. Your choice may affect the risk of complications, cost, and time spent in the medical facility. It also may affect how quickly you can begin physical therapy.

Always consult with your physician anesthesiologist on the best option for you.

• Regional anesthesia is a common option for arthroscopic surgery. It numbs only the area of the body that requires surgery. You remain awake and aware. Regional anesthesia includes spinal or epidural anesthesia and peripheral nerve blocks. Some research has found that regional anesthesia can provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia.
• Local anesthesia may be an option for arthroscopic surgery, although it is less commonly used. A one-time injection numbs just a small area around the surgical site. Advantages to local anesthesia include lower risk of complications, lower cost, and faster release from the medical facility.
• General anesthesia, which renders you unconscious during surgery, is sometimes used for knee replacement. But regional anesthesia can also be an option for this surgery.

How do I manage pain during my recovery?

You should consider a number of options for pain relief following knee surgery. These options should be discussed with a pain management specialist, who can explain the pros and cons of each option or combination of options, including effectiveness, potential side effects, potential for addiction, and impact on the recovery process. Physician anesthesiologists who specialize in pain management can work with you before and after surgery on a plan tailored to your condition, personal history, and preferences.

Some of the options to consider and discuss are:

• Analgesics such as acetaminophen (Tylenol). These act solely to relieve pain.
• Anti-inflammatory medicines like aspirin, ibuprofen, and naproxen sodium. These act to relieve pain and reduce inflammation.
• Peripheral nerve blocks. These involve the injection of an anesthetic into specific nerves to block pain signals between the brain and the knee.
• Opioids. These drugs, which block pain signals to the brain, are sometimes necessary to relieve severe or persistent pain, but patients should take them only as needed and use as low a dose as possible. Monitoring by a pain management specialist is important because opioids can be addictive.
• Multimodal therapy. This is commonly used for pain management after knee replacement surgery and typically involves opioids and one or more additional pain relief methods. Multimodal therapy can improve pain control while limiting opioid use.

It is important to consider all options in consultation with a pain management specialist. For example, a recent study found that patients undergoing minimally invasive knee replacement left the hospital sooner and with less pain when given a combination of medications that act by different mechanisms to control pain, rather than relying on one type of pain medication.

Physician anesthesiologists work with your surgical team to evaluate, monitor, and supervise your care before, during, and after surgery—delivering anesthesia, leading the Anesthesia Care Team, and ensuring your optimal safety.

90,000 Arthroscopy of the knee joint: price – MedicaMente

Arthroscopy of the knee joint, operation in MedicaMenta

At the MedicaMente Surgery Center, knee arthroscopy is used both for therapeutic purposes (surgical or curative arthroscopy) and for diagnostic purposes (diagnostic arthroscopy).

Diagnostic arthroscopy

Diagnostic arthroscopy of the knee joint is prescribed for acute or chronic pathologies, knee injuries, if it is impossible to make an accurate diagnosis, to monitor the effectiveness of drug treatment or restore the joint after surgery.

Arthroscopy for diagnostic purposes is the most reliable manipulation. During arthroscopy, the traumatologist can carefully examine the intra-articular structures of the knee (cartilage, ligaments, menisci, tendons, etc.). The lenses of the arthroscope have a 30x magnification, allowing you to see the smallest details on the monitor screen, which means that the probability of missing critical information is extremely small. Immediately after the diagnosis is made, the detected pathological changes can be removed.

Therapeutic arthroscopy of the knee joint

Medical arthroscopy provides for the implementation of surgical treatment. With its help, it is possible to restore the integrity of the ligament, remove bone or cartilage fragments, and eliminate ordinary dislocations.

Indications for surgical arthroscopy of the knee joint:

• Injuries to the anterior and posterior cruciate ligaments causing knee instability.
• Damage to the menisci – tears and degenerative fibrillation.
• Meniscus cysts.
• Dislocations of the patella.
• Osteochondropathy of the knee joint (Koenig’s, Larsen’s, Leuven’s disease).
• Mediopatellar fold syndrome.
• Hoffa’s fatty body hypertrophy.

What we are ready to offer:

Modern methods of treatment

Clinic “MedicaMente” has two operating rooms equipped with the latest technology, which enables the Center’s doctors to carry out operations of any complexity with a high guarantee of success.The performed knee surgeries are as atraumatic and effective as possible, since the surgical intervention is performed using modern minimally invasive technologies.

Experience of surgeons in Moscow

Our surgeons are highly qualified and have vast experience in the surgical treatment of diseases of most profiles. The competence of doctors is confirmed by scientific degrees, rich practice, certificates and diplomas of internships in leading clinics in Moscow, Europe and the United States.Doctors and nurses of the clinic regularly undergo refresher courses … Doctors of the Center

Efficiency and safety of operation

Operations are carried out under full monitoring of vital signs. All devices used are certified and connected to an autonomous station, which guarantees their uninterrupted operation. The operating room equipment undergoes regular maintenance, as well as testing according to the ANTI-HIV and ANTI-HEPATITIS systems.In case of emergency resuscitation measures, the clinic is equipped with the necessary equipment. There is a special intensive care unit. The work of the nursing staff is organized so that the patient is always under control. … photo from operating room

Professional care and comfort

The comfort of patients in MedicaMenta is provided at the highest level. Delicate and attentive staff, qualified care, comfortable single and double rooms equipped with comfortable functional beds, a staff call system, TVs, wireless internet wi-fi, air conditioning, private bathrooms.The pleasant interior and cozy atmosphere of the clinic create optimal conditions for a speedy recovery … photo of the hospital wards

Tests for arthroscopic knee surgery

You can take tests for an operation in our clinic, a polyclinic at your place of residence or any diagnostic center.

1. Analyzes

• Urinalysis, general
• Clinical blood test
• Biochemical blood test (protein, urea, creatinine, bilirubin)
• HIV, test for hepatitis B and C, RW
• Blood group and Rh factor
• Coagulogram (platelets, clotting time, bleeding)

2.X-ray of the knee joint in frontal and lateral projection, MRI of the knee joint

3. CT or Rg-chest organs

4. ECG with interpretation, conclusion of a cardiologist

5. Conclusion of the therapist on the possibility of surgical treatment

Additionally, the following can be prescribed: ultrasound of the knee joint, additional projections of radiographs, CT of the knee joint.

How is arthroscopy done?

Arthroscopy is a minimally invasive surgical method that does not require opening the joint.Examination of the joint cavity is carried out with a special endoscope (arthroscope). Access to the joint is carried out through 2-3 punctures (no more than 1 cm). An arthroscope is inserted into the incision. The arthroscope is connected to a small camera that transmits a close-up image of the joint on a video monitor, allowing you to see the smallest details on the monitor screen. If necessary, the surgeon can immediately repair the damaged areas of the knee joint using special instruments that are inserted through additional incisions.

In our medical center, arthroscopy of the knee joint is usually performed under general anesthesia (general anesthesia). And only in certain cases, the operation can be performed under local anesthesia. Depending on the severity of the disease and the chosen tactics, arthroscopic knee surgery can last from 1 to 3 hours.

Rehabilitation after knee arthroscopy

1-2 days. The patient is in the hospital. Bed rest, analgesic and antibiotic therapy.Wound treatment. Walking with support (with crutches).

2-5 days. Already on the 2nd day, the patient can stand on the operated leg, the stitches are removed on the 10th day. Early recovery after arthroscopic surgeries can shorten the patient’s stay in the clinic. Upon discharge from the clinic, a sick leave is issued. Walking without crutches is possible. In some cases, wearing an orthosis is required.

After arthroscopy, you need to perform special physical exercises, you can go in for swimming.This will create the necessary dosed load on the joint. In addition, physiotherapy can be carried out on the recommendation of a doctor. The recovery period after arthroscopy of the knee joint depends on many factors – the age, the patient’s health, the punctuality of adherence to medical prescriptions, how extensive the changes in the joint were. The average rehabilitation period is 2-3 months (office work is possible in 2-3 weeks, physical labor – in 4-6 weeks).

90,000 Knee arthroscopy in Moscow

The indications for knee arthroscopy are:

• damage to menisci

• cruciate ligament injuries

• damage to the cartilaginous covering of the joint

• chronic instability of the patella

• damage to the lateral (collateral) ligaments

Very often arthroscopic knee surgery is performed on patients after sports injuries.Patients involved in such sports as alpine skiing, football, hockey, basketball, running, volleyball, cycling, wakeboarding, etc. are prone to injuries of the knee joint.

When the ACL (anterior cruciate ligament) is damaged, the most common mechanism of injury is rotation with a fixed tibia. Very often, along with the anterior cruciate ligament, menisci and / or collateral ligaments are damaged.

Congenital dysplasia of the femoral block is a predisposing factor for chronic instability of the patella and chronic dislocations of the patella.

During an arthroscopic operation, the surgeon examines all articular surfaces, menisci, cartilage, ligaments, and intraoperatively a final decision is made regarding the scope of surgical intervention and treatment of articular pathologies.

The duration of knee arthroscopy depends on the amount of surgery. The approximate duration of surgery for plastic ligaments, meniscus stitching – 2 hours, meniscus resection – 40 minutes – 1 hour.

After arthroscopy of the knee joint, depending on the type and extent of the operation, the patient may be allowed to immediately stand up and step on the lower limb, gently bend and unbend the leg. However, there are operations that require a longer recovery, after which the patient will need to walk on crutches with partial load on the operated limb and wear a special bandage – an orthosis (splint).

Rehabilitation after arthroscopy of the knee joint begins from the first day after the operation and is carried out strictly under the supervision of a doctor from the ECSTO Rehabilitation Medicine Department.

You can check the prices for arthroscopy of the knee joint with the assistants of the ECSTO Department of Traumatology and Orthopedics.

Meniscus arthroscopy (arthroscopic knee meniscus surgery

If a meniscus rupture is detected, several options for surgical treatment (arthroscopy of the meniscus) are possible:

• if the meniscus rupture is acute (that is, it happened recently), is located in a well-supplied area of ​​the meniscus and, thus, there is a high chance that it will grow together, it can be sewn

• if the meniscus is degeneratively changed and the shape of the rupture does not allow it to be firmly fixed with a special fixator, then resection is performed, i. e.e. removal of only that part of the meniscus that is damaged. The intact part of the meniscus is preserved. Typically, the resection volume is only 15% of the total meniscus area.

The most dangerous meniscus tears are “watering can handle” tears, when a large part of the meniscus is torn off and easily dislocated. In this case, a “blockade of the knee joint” can occur – that is, the knee closes in a state of flexion or extension, and movements in the joint become impossible due to the dislocation of the damaged part of the meniscus and its jamming between the articular surfaces.

In this case, the orthopedic traumatologist will first need to unblock the patient’s joint and then perform the operation. During arthroscopy, the damaged part of the meniscus is resected or sutured.

Reconstruction of knee ligaments

One of the most common injuries of the knee joint is injury to the anterior cruciate ligament (ACL). The cruciate ligament can be reconstructed.

Arthroscopic reconstructive operations consist in the fact that from an autograft (i.e.That is, from the patient’s own tendon) a new ligament is formed, it is installed in the bone canals and fixed with special fixators.

After reconstruction of the cruciate ligament, complex rehabilitation therapy is required, including physiotherapy procedures and special exercises. Within 3 weeks, the patient will need to walk on crutches and wear a special bandage – a splint, which will restrict movement in the knee joint. At the same time, a week after the operation, during classes, a rehabilitation therapist will gradually develop movements in the knee joint using a special device ARTROMOT.

Less often, the posterior cruciate ligament (PCL) is damaged; reconstructive operations are also performed for it according to the same principle.

In case of damage to the collateral (lateral) ligaments of the knee joint, conservative treatment is most often carried out in the form of immobilization of the knee joint in a special soft orthosis for 3 weeks, followed by the gradual development of movements. Reconstructive surgery is required if there is chronic chronic instability.

Patella stabilization

Patients with chronic patellar instability, i.e. with multiple dislocations and subluxations of the patella, surgical stabilization is required.

In this case, it is possible to carry out several types of surgical interventions, one of which is the reconstruction of the medial patellofemoral femoral ligament (MPFL). During the operation, an autograft is formed from the tendon of the semitendinosus muscle.A vertical canal is created in the patella, and a canal is also created in the femur at the point of anatomical attachment of the medial patellofemoral femoral ligament. The autograft is passed through the formed canals and fixed with an absorbable screw.

After reconstruction of the MPFL, complex rehabilitation is required under the supervision of a rehabilitologist, wearing a special orthosis and gradual development of movements in the operated joint.

Knee surgery: Germany, Switzerland, Austria

Perpetual knee problem

Whether they are footballers, skiers or other athletes, they all have one thing in common: knee injuries are common to them.

It’s not just professional footballers who suffer from frequent knee injuries: knee problems, foot deformities or bone wear are not uncommon at any age.

When to see a knee specialist?

Common to all diseases of the knee joint is that they often severely restrict daily activities. Normal physical activity is absent or possible only through severe pain.Movement speed and stamina are limited. Sometimes a single visit to a specialist is enough to get help.

Which specialists deal with knee problems?

Naturally, any patient in need of a specialist in the field of knee joint treatment wishes to receive highly qualified medical care. Thus, the patient is wondering where to find the best specialists or clinic in the field of knee joint treatment in Germany, Switzerland and Austria.

Since this question is difficult to answer objectively, and a respected doctor will never claim that he is the best, you can only rely on the experience of a specialist. Knee specialists are qualified doctors in the field of


orthopedics


and


traumatology


… They have many years of training behind them, in particular in the field of knee joint treatment. As a rule, in this area there is close cooperation between doctors of sports medicine, sports orthopedics and


rheumatology


, and


radiology


…

The structure of the knee joint

The knee joint is the largest in the human body. Here, the femur (femoral), the lower leg (tibia) and the patella (patella) are connected to each other. The fibula is located outside the knee joint, but as such is not involved in knee movement. Between the bone parts there are two soft cartilaginous fibers, the meniscus, which perform the function of shock absorption. Additional connection is provided by two crossed ligaments (anterior and posterior cruciate ligaments) that extend from the articular surface of the tibia to the opposite region of the femur.

Like any other, the knee joint is surrounded by an articular capsule. Inside it is a lubricant, the so-called synovial fluid (synovia). Since the knee, unlike the hip or shoulder joint, is not equipped with a stable attachment of the joint head and glenoid (like a head in a motorcycle helmet), joint stability is primarily achieved with the help of muscles and ligaments.

Common knee injuries and diseases

The well-functioning and stability of the joint is impaired by inadequate stress, for example, when playing football or skiing.As a result, today there are more and more injuries that require, for example,

cruciate ligament surgery

,


surgical treatment of the meniscus, plasty of the knee ligaments


and


cartilage transplantation.

Since the human bone apparatus is a combination of various bones, ligaments and joints that interact directly with each other, it is not surprising that a violation in one joint leads to problems in others.The body thus tries to compensate for the initial deformation. Thus, X- and O-shaped legs can cause significant discomfort, which requires correction with knee surgery.

But today, not only injuries and congenital disorders are common. Severe pain can also be caused by degenerative diseases such as


osteoarthritis


knee joint.

Arthroscopic surgeries – Medicinas center ARS; +371 67201007

Arthroscopic operations

The human skeleton consists of 206 bones (approximately), which are connected to each other by both fixed joints and joints with a small range of motion, and joints.Performing various movements of the body and limbs every day, we do not think about how this happens. The hand is raised above the head or the leg is bent at the knee – this is such a common movement that a person does not even think about how many and in what order of elements are involved in this process. until something happens … Arthroscopic surgeries at the ARS Medical Center are performed at the ARS Day Hospital.

The knee is one of the most frequently damaged and one of the most important joints.A pronounced load with a different range of motion, as well as a rather complex design of the knee joint, determines frequent injuries and diseases of this joint.

What are the most common knee complaints?

Patient complaints can be divided into two groups – pain and instability .

Causes of knee pain:

• In young people, pain is most often associated with injuries to the meniscus. Often, the patient recalls an episode of trauma, after which complaints began to appear.
• Meniscus tears are more typical in middle-aged people without specific injuries – the problem develops gradually, the tissues tear and disperse from the load, approximately like in used clothes.
• In the elderly, the cause of pain is joint deformity – arthrosis (degenerative, progressive joint disease characterized by changes on the surface of the joint). The cartilage that makes up the surface of the joint becomes uneven and the meniscus is damaged.
• With the development of arthrosis, changes appear in the bones – osteoarthritis . It is a slowly progressive disease of the joints, which is characterized by damage to the entire structure of the joint, destruction of articular cartilage and the emergence of new bone formations (osteophytes), which cause structural and functional changes in the joint.

The second group of complaints instability or a feeling of insecurity in the knee joint. The most common cause is a ruptured ligament in the joint.Over time, pain is always added to the instability of an untreated joint.

Arthroscopic surgeries are performed in the day hospital

ARS :

Operates:

VIDEOS:

Cost

90,000 Minimally invasive surgery in the treatment of injuries and diseases of the knee joint

Center of Traumatology and Orthopedics of the Main Military Clinical Hospital. N.N. Burdenko is more than three centuries of work for the health of our fellow citizens.Today the hospital is a multidisciplinary medical center that has no competitors in scale in our country. The professionalism of the medical staff of the center was built on the traditions founded by the heroes of front-line medicine, thereby ensuring the high scientific potential of the team.

The staff of the Center for Traumatology and Orthopedics of the Main Military Clinical Hospital are high-level experts. Among them: honored workers of national health care, international members of traumatological and orthopedic societies, highly qualified doctors, candidates and doctors of medical sciences.They are key experts in the provision of specialized medical care to the injured, wounded and sick in military field conditions and in peacetime.

Center of Traumatology and Orthopedics of the Main Military Clinical Hospital. N.N. Burdenko offers a unique opportunity for comprehensive comprehensive and rehabilitative treatment and highly specialized care for patients with various injuries and illnesses.

One of these areas is the treatment of the knee joint.Injuries and diseases in this area are the most common problems that affect one in three people. They account for about 75% of the total number of injuries and are most often due to sports injuries.

The most common of these: tears of the meniscus, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral (internal lateral) and lateral collateral (external lateral) ligaments, as well as damage to the cartilaginous surface of the joint.These injuries can be either isolated or in combination with each other. For example, the trauma “unfortunate triad” is not uncommon, in which there is a rupture of the anterior cruciate and internal lateral ligaments, as well as the internal meniscus of the knee joint.

Rupture of the meniscus

The meniscus is a crescent-shaped cartilage pad that helps cushion the knee joint and stabilize the load during walking and physical activity. In the knee joint, there are: lateral (external) and medial (internal) menisci.The cause of their damage is a sharp rotation of the thigh with a fixed lower leg under the influence of a person’s own body weight.

Symptoms of meniscus injury at the initial stage are similar to other diseases of the knee joint: pain, swelling, and limitation of movement in the joint. However, after 2-3 weeks, when the reactive edema subsides, characteristic symptoms appear: pain in the knee, aggravated by load on the leg; pain when squatting or walking up stairs; the presence of a “click” when bending the limb in the knee joint; blocking (blocking) of the joint.For a more accurate assessment of damage, an MRI of the knee joint should be performed.

Cruciate ligament rupture

Cruciate ligament rupture is the second most common knee injury. Distinguish:

• the anterior cruciate ligament (ACL), which fixes the joint and keeps the lower leg from pathological forward displacement;
• the posterior cruciate ligament (PCL), which prevents the lower leg from moving back.

The ACL experiences great stress due to its anatomical location in the knee joint and is injured much more often than the PCL. The main mechanism of injury is rotational rotation in the knee joint with a fixed foot. Cruciate ligament ruptures lead to chronic knee instability.

Clinical symptoms of damage in the acute period: hemarthrosis (presence of blood in the joint cavity), pain, swelling, limitation of movement in the joint.In the long term, the patient feels instability in the knee joint when walking and exercising. The pathological symptom of the “front drawer” is manifested by the displacement of the lower leg forward relative to the axis of the limb (in case of damage to the ACL). The symptom of the “rear drawer” is the same if the ZKS is damaged. An MRI of the knee is recommended to confirm the clinical diagnosis.

Collateral (lateral) ligament ruptures

The lateral ligaments, like the cruciate ligaments, serve as a stabilizer for the knee joint. They connect the epicondyle of the femur to the head of the fibula from the outside and from the tibia to the inside. Damage to these ligaments occurs both with a direct mechanism of injury – impact, and with an indirect mechanism – excessive deflection of the lower leg outward or inward.

Clinical manifestations: pain and swelling, aggravated by physical exertion; a feeling of instability in the knee joint. Positive “valgus test” in case of damage to the internal lateral ligament – increased deflection of the lower leg outward.And also a positive “varus test” in case of damage to the lateral lateral ligament – excessive deflection of the lower leg to the inner part. To confirm the diagnosis and determine the treatment tactics, it is necessary to perform an MRI of the knee joint.

Treatment

Today, arthroscopy is the “gold standard” in the treatment of injuries and diseases of the knee joint. Arthroscopy is a minimally invasive surgical technique that allows atraumatic diagnostics of injuries and any therapeutic manipulations inside the joint. With its help, it is possible to restore all intra-articular structures: the ligamentous apparatus, menisci and cartilaginous tissue.

Arthroscopy differs from classical surgical intervention in that two small incisions (up to 1 cm) are made to access the joint, through which instruments and a special video device, an arthroscope, are inserted, which allows examining all intra-articular structures. During such an operation, minimal tissue damage occurs, which ensures a quick and easy recovery process.As a rule, the patient can be discharged 1-3 days after surgery.

Due to the high qualifications of specialists, as well as the availability of the most modern equipment, in the CTC, it is possible to carry out any types of operations in the area of ​​the knee joint: resection and suture of the menisci, plastics of the anterior and posterior cruciate ligaments, plastics of collateral ligaments, plastic replacement of cartilage tissue (chondroplasty), as well as all types of revision operations on the knee joint.

When carrying out arthroscopic operations on the joints in the Center N.N. Burdenko uses medical equipment from Arthrex. It is a global manufacturer and leader in the development of medical equipment and consumables in the field of traumatology and orthopedics. Arthrex has developed over 9,500 innovative products for minimally invasive surgery. The quality of these products and the professionalism of the doctors of the CTC GVKG allow obtaining high results in the treatment of joints.

Rehabilitation

The recovery process for patients after arthroscopic knee surgery is painless and quick. The activation of the patient begins from the first day after the operation. For faster rehabilitation, the patient is prescribed symptomatic therapy and physiotherapy exercises. Full recovery after arthroscopic surgery for meniscus damage takes 2 to 4 weeks. After restoration of the ligaments of the knee joint – from 3 to 6 months.

Early treatment will help you avoid the development of complications in the future. Our experts will give you expert advice. For more information about the features of treatment, you can check directly with the hospital.

The cooperation of the doctors of the Center for Traumatology and Orthopedics of New Medicine and TeleMed opens up new opportunities for high-quality rehabilitation for patients with musculoskeletal disorders using professional high-tech rehabilitation equipment.

New medicine is a modern approach using innovative technologies in the field of medicine. The company offers unique services for home rehabilitation, including the use of telemedicine, rent of high-tech, “smart” rehabilitation equipment, professional care for seriously ill, disabled and elderly people. The company has brought together the best specialists and manufacturers of medical equipment.

TeleMED is a service of remote consultations by a variety of doctors.It allows you to consult a doctor at any time when a question arises about the health (of yours or your loved ones) and immediately receive advice and a clear algorithm of actions. All 24 hours a day. By phone or via the Internet, whichever suits you best. It won’t replace going to the doctor, but it will make your recovery path easier.

Read more about Rehabilitation.

90,000 What Do You Know About The Risks Of Knee Replacement Surgery?

Do you need knee replacement surgery and are you concerned about side effects? Well, you’re right, knee replacement surgery is an important and somewhat difficult surgery.But don’t worry, you can ease your concerns about surgery by reading this article. And you can find everything you need to know about the risks of knee replacement surgery. First of all, it is better to know what is knee replacement surgery. Knee replacement or “knee arthroplasty” is a surgical procedure in which knee joints damaged by osteoarthritis or other causes are replaced with artificial materials. The surgeon removes damaged bones and cartilage from the femur, shinbone and patella and replaces them with an artificial joint during this procedure. The risks of knee replacement surgery are a common concern for all patients, even though it relieves knee pain.

Is Knee Replacement Surgery Dangerous?

All operations can have irreparable complications, from the simplest to the most difficult, if they are not performed by a professional surgical team in a well-equipped environment. Knee replacement surgery is now standard and common surgery, with more than 600,000 people annually in the United States.According to statistics, severe postoperative complications such as infection and blood clots are rare. They occur in approximately 1% and 2% of patients, respectively. According to surgeons, about 4.5 percent of patients under the age of 65 experience postoperative complications during a knee replacement in a hospital. The risk of knee replacement surgery in older people is generally more than double that of people under the age of 65. Although the risks of knee surgery are rare, it is best to know these risks prior to surgery. Here is a complete list of complications of knee arthroplasty after surgery:

1-Anesthetic Complications

During a knee replacement, the surgical team will perform general or local anesthesia to help you relax during the procedure. Complications associated with anesthesia are rare, but patients who are allergic to anesthetics or who use tobacco, alcohol, or recreational drugs are more likely to experience problems. The most common side effects are:

• Difficulty breathing
• discomfort
• shiver
• vomiting
• drowsiness
• aches and pains
• sore throat

2-Thromboembolic disease caused by blood clots

Deep vein thrombosis (DVT) means blood clots form in a vein deep inside your body.This condition is one of the most dangerous complications of any surgery, but it is widespread in orthopedic surgery. These blood clots usually form during surgery or a few hours after surgery, but symptoms may occur two weeks to three months after surgery. If these blood clots enter the lungs through the bloodstream, they can cause pulmonary embolism, which is life-threatening and dangerous. Statistics say that about 4% of patients experience DVT within 90 days after surgery.But keep in mind that if DVT develops and stays in your leg, it could pose a minor hazard that you can reduce with blood thinners and blood circulation enhancers. If you notice any of the following symptoms, blood clots have probably reached your lungs, so tell your doctor immediately:

• Fever
• dizziness and weakness
• Cough that is violent and may or may not be accompanied by blood.
• Rapid heart rate
• Shortness of breath

3-Bleeding

Postoperative bleeding can have various causes, usually occurring in the first hours after surgery. Oftentimes, blood thinners prescribed by your doctor to prevent blood clots can cause bleeding. In these cases, the surgeon must reopen the wound and drain the fluid.

4-Infection

Infection is one of the most serious and often rare hazards in knee replacement.Artificial contamination of joints by various bacteria during surgery can cause this complication, although it can also occur after surgery. Abnormal surgical conditions and the use of non-sterilized implants are significant causes of infection. According to the data, about 1.5% of patients had a joint and wound infection within three months after surgery. Although this complication is rare, if you experience redness, discomfort, or swelling that gets worse, see your doctor for urgent medical attention.

5-Complication of Wound

Under normal conditions, stitches and surgical wounds should heal within two weeks. Otherwise, complications such as delayed wound healing, bleeding and fluid retention in the back of the knee can occur. In this case, surgeons will reopen the wound to remove fluid.

6-Continuing pain or stiffness

Constant pain and stiffness is a complication of knee replacement surgery that people don’t like.It is normal for pain in the early days of surgery to be relieved by pain relievers, but the constant pain is an uncomfortable experience for patients and makes the condition unbearable.

7-Looseness and fracture of the implant

Postoperative mechanical problems such as loosening of the implant, instability and rupture become apparent several weeks or months after surgery. In this case, a follow-up operation and correction of the problem is required. But don’t worry; the need for follow-up surgery is about 0.2 percent over 18 months.Some patients worry about prolonged wear and loosening of the implant, but according to 2018 data, 82% of artificial knee joints are still functional after 25 years. Therefore, to prevent this complication, it is better to control your diet and weight and exercise regularly to strengthen your knee. Be careful; avoid activities that put too much stress on your knees, such as running or jumping.

8-Allergy To Artificial Metal Joints

Are you allergic to metal? Of course, you know if you have this problem and tell your doctor before your knee replacement surgery.Since the main metals in the artificial joint are titanium and cobalt-chromium alloys, if the body is allergic to these metals, it can cause a severe allergic reaction. This allergic reaction often leads to implant rejection and patients may need revision surgery to replace it. The researchers argue that metal hypersensitivity is relatively rare and very difficult to diagnose. Therefore, surgeons should consider this cause as the last cause of knee complications.Because this complication is rare, there is no standard test for diagnosing patients’ metal sensitivity before surgery.

9-Loss of mobility stiffness

scar tissue and sometimes misalignment cause problems around the knee joint that reduce the range of motion of the knee. Physical therapists solve this problem by providing some specific exercises. But if this problem persists, surgeons can remove the scar tissue with subsequent surgery and, if necessary, fix the implant inside the knee.

10-Complications of the Popliteal artery

Arterial damage during knee replacement surgery is also rare, but can be irreversible to the patient if it does. Due to inadequate collateral circulation, severe ischemia can result in irreversible tissue damage requiring amputation if not correctly identified and treated. This is one of the most serious risks that all patients worry about, but don’t worry; the likelihood of this side effect is extremely low.

11-Nerve Damage

Doctors cut and stretch the skin and muscles during surgery, and these factors damage the nerves in the leg and around the knee joint. Symptoms of nerve damage include numbness, tingling, falling legs, tingling sensations, and weakness. Nerve damage from knee replacement surgery is more common than other complications, and 10% of people experience this problem. But the good news is that this condition goes away within six months.

12-Death

Death from knee replacement surgery, which can occur for a variety of reasons, is rare. Surgeons say that death occurs in about one in every 100,000 patients. Today, with the advancement of medical science and the emergence of experienced surgeons, you do not need to worry about this at all. If you are healthy and do not have an underlying medical condition, you can successfully undergo the surgery.

take stock

When the cartilage of the knee joint is damaged due to reasons such as trauma, accident, chronic diseases such as arthritis of the knee joint, it causes severe pain.This pain can prevent a person from performing simple activities such as climbing stairs or walking. Pain can also be present when you are sitting and sleeping. If surgeons cannot control the pain caused by osteoarthritis and joint damage with medication, they will have to fix the problem with knee replacement surgery.

Thus, knee replacement surgery or total knee replacement is the standard treatment that thousands of people around the world undergo every day.And many of them don’t experience any side effects. However, problems with knee replacement after surgery are a significant factor that can prevent patients from undergoing surgery. But if you study all the potential side effects of knee replacement surgery before surgery, the anxiety disappears as postoperative side effects are rare and not common in all patients.

In addition to the side effects listed above, are you aware of any other problems after knee surgery? If so, please email us to add to the rest of the article.

90,000 Knee arthroplasty clinic – surgery at Orthocenter clinic, St. Petersburg

Knee arthroplasty surgery is extremely popular and widespread nowadays. Endoprosthetics is used to treat arthrosis of III, IV, and sometimes stage II, if the disease is accompanied by severe pain syndrome. The essence of the operation is to replace damaged or worn out articular surfaces with artificial ones.

The knee joint is one of the most difficult in the human body. The movement in it combines the phases of sliding and rolling of the articular surfaces. At the same time, the stability of the joint is provided by a complex complex of soft tissues: menisci, ligaments (collateral, cruciate), muscles of the thigh, lower leg and their tendons, joint capsule. The components of this complex change their tension in different phases of movement and ensure the stability of the knee joint in any position. It is extremely important, in addition to the high-quality installation of the artificial articular surfaces themselves, to maintain and sometimes restore the balance of all the soft tissues of the joint.Failure to comply with this condition leads either to restriction of movement in the joint, or to joint instability.

All this determines the complexity of knee arthroplasty, requires an attentive individual approach to each patient, high professionalism of the surgeon, careful planning, meticulous execution of each stage of the operation.

Types of endoprosthetics

Currently, knee arthroplasty in St. Petersburg is used in two types: total, when the articular surfaces are completely replaced, and single-condom, when only a part of the articular surface is replaced with an isolated lesion of the inner or outer parts of the joint.This type of endoprosthetics is used much less frequently due to the ambiguous results of such operations.

Most of the companies manufacturing knee joint endoprostheses produce various models, which differ in the type of fixation of the components to the bone tissue and the degree of connectivity between the components of the prosthesis. Some firms produce so-called gender endoprostheses, which take into account the structural features of the knee joint in men and women.

The task of the surgeon is to select the type of endoprosthesis individually for each patient, to develop a plan for the operation and postoperative treatment.

Modern methods of implantation and modern endoprostheses allow to achieve maximum recovery of the knee joint function after surgery and eliminate pain syndrome. When using sparing approaches, it is possible to carry out implantation of an artificial joint through a small incision, minimally traumatic, which ensures quick recovery. The patient can get back on his feet 2 days after the operation and begin rehabilitation.

Functional result 2 weeks after surgery

In our clinic, as a rule, a hospital stay is 5-7 days after the operation.On the 2nd day, the patient is allowed to sit in bed, hanging his legs from the bed, get up and walk with additional support (crutches, walkers). It is necessary to walk with crutches for a month and a half, then, if necessary, use a cane for up to three months from the date of surgery.

It is advisable, for the most complete recovery after surgery, to undergo a course of rehabilitation treatment in a specialized department or hospital, and after 2-3 months – a course of sanatorium treatment.

It should be noted that in order to obtain the best results of arthroplasty, the qualifications of the surgeon and the quality of the implants are extremely important.

The specialists of our clinic have been engaged in endoprosthetics for many years, regularly undergo internships, improve their qualifications and visit leading foreign clinics for knee endoprosthetics. For endoprosthetics, our clinic uses the most modern implants and surgical techniques that ensure minimal blood loss, minimal pain, the least risk of complications, early recovery and return to a full life.

Do you want to quickly start the path to restoring a healthy lifestyle? Call one of the Orthocenter’s contact numbers in St.