When is it time for knee replacement surgery. What are the key indicators that suggest you might benefit from this procedure. How can you determine if knee replacement is right for you. What factors do doctors consider when recommending knee replacement.

Understanding Knee Replacement Surgery: A Common and Effective Procedure

Knee replacement surgery stands as one of the most successful medical procedures, with over 790,000 operations performed annually in the United States. This procedure, more accurately described as a joint resurfacing, involves the placement of metal components to recreate the joint surface, with a plastic separator in between. In some cases, the procedure may also include resurfacing the inside of the kneecap (patella) with plastic.

The success rate of knee replacement surgery is remarkably high. According to the American Academy of Orthopaedic Surgery (AAOS), approximately 90% of modern total knee replacements continue to function effectively more than 15 years post-surgery. This impressive statistic underscores the procedure’s long-term effectiveness in improving patients’ quality of life.

The Impact of Arthritis on Knee Health

Arthritis is the primary condition leading to knee replacement surgery. There are three main types of arthritis that commonly affect the knee:

• Osteoarthritis: The wear-and-tear type of arthritis
• Rheumatoid arthritis: An autoimmune condition causing joint pain and damage
• Post-injury arthritis: Arthritis resulting from previous knee trauma

Dr. Nathanael Heckmann, an orthopaedic surgeon at Keck Medicine of USC, explains, “These different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion. When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee.”

When Conservative Treatments No Longer Suffice

Before considering knee replacement surgery, patients typically explore more conservative treatment options. These may include:

• Medications
• Steroid injections
• Physical therapy

However, as arthritis progresses, these treatments may become less effective over time. Dr. Heckmann notes, “Anti-inflammatories, injections and physical therapy are temporary measures to provide pain relief, but they don’t reverse the underlying cause of pain and don’t allow cartilage to regenerate.” When conservative treatments no longer provide adequate relief, it may be time to consider surgical options.

Daily Life Disruptions: A Key Indicator for Knee Replacement

One of the most significant signs that knee replacement might be necessary is when knee pain begins to interfere with daily activities and self-care. Dr. Jay Lieberman, chief of orthopaedic surgery at Keck Medicine, explains, “In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life. If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.”

Pain that persists even during rest or sleep can be particularly debilitating and may indicate the need for surgical intervention. Dr. Lieberman adds, “If you also have consistent pain at night, this can be quite debilitating,” suggesting that such symptoms could make a patient a good candidate for knee replacement.

Persistent Swelling and Deformity: Advanced Signs of Knee Deterioration

Chronic knee swelling that doesn’t respond to other treatments is another indicator that knee replacement might be necessary. Dr. Lieberman explains, “A knee that is consistently swollen despite the use of anti-inflammatory medications, steroid injections and physical therapy suggests degeneration of the cartilage and/or instability of the knee, which can be confirmed with an X-ray.”

As arthritis progresses, it can lead to visible deformities in the knee. Dr. Heckmann notes, “As arthritis progresses, the knee may become bowed or ‘knock-kneed.’ If this type of deformity develops over time, a knee replacement may be indicated.” Additionally, some patients may lose the ability to fully straighten their knee, which could become a permanent issue if not addressed promptly.

Post-Surgery Expectations: Adjusting Your Lifestyle

While knee replacement surgery can significantly improve quality of life, it’s essential for patients to have realistic expectations about post-surgery activities. High-impact activities may need to be limited or avoided to protect the new joint. However, Dr. Lieberman reassures, “Total knee replacement is quite successful in enabling patients to return to an active lifestyle.”

Patients should discuss their lifestyle goals and expectations with their surgeon to ensure they have a clear understanding of what activities will be possible after recovery.

The Decision-Making Process: When to Consider Knee Replacement

Deciding to undergo knee replacement surgery is a personal decision that should be made in consultation with your healthcare provider. Key factors to consider include:

1. The severity of your knee pain and its impact on daily life
2. The effectiveness of conservative treatments
3. Your overall health and ability to undergo surgery
4. Your willingness to modify certain activities post-surgery

Dr. Lieberman emphasizes, “If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.” It’s crucial to have open discussions with your orthopaedic surgeon about your symptoms, lifestyle, and goals to determine if knee replacement is the right choice for you.

Advanced Diagnostic Tools in Knee Replacement Decision-Making

While patient symptoms and physical examination are crucial in determining the need for knee replacement, advanced diagnostic tools play a significant role in the decision-making process. These tools provide detailed information about the extent of knee damage and help surgeons plan the most effective treatment approach.

X-rays: The Primary Imaging Tool

X-rays remain the most common and initially used imaging technique for assessing knee arthritis. They can reveal:

• Joint space narrowing, indicating cartilage loss
• Bone spurs (osteophytes)
• Changes in bone density
• Knee alignment issues

Dr. Heckmann explains, “X-rays provide a clear picture of the bone structure and can show the severity of arthritis. They’re often the first step in determining if a knee replacement is necessary.”

MRI: Detailed Soft Tissue Assessment

Magnetic Resonance Imaging (MRI) offers a more detailed view of the knee’s soft tissues, including cartilage, ligaments, and menisci. While not always necessary for knee replacement planning, MRI can be valuable in certain cases:

• Evaluating the extent of cartilage damage
• Assessing ligament integrity
• Identifying other potential sources of knee pain

Dr. Lieberman notes, “MRI can provide additional information, especially in complex cases or when there’s suspicion of other knee problems beyond arthritis.”

CT Scans: 3D Imaging for Precision Planning

Computed Tomography (CT) scans may be used to create three-dimensional images of the knee joint. These detailed images can be particularly helpful in:

• Planning for custom knee implants
• Assessing bone quality and density
• Preparing for computer-assisted surgery

The use of these advanced imaging techniques allows surgeons to tailor the knee replacement procedure to each patient’s unique anatomy, potentially improving outcomes and patient satisfaction.

Innovations in Knee Replacement Technology

The field of knee replacement surgery is continuously evolving, with new technologies and techniques emerging to improve patient outcomes. Understanding these innovations can help patients make informed decisions about their treatment options.

Robotic-Assisted Surgery

Robotic-assisted knee replacement surgery is gaining popularity due to its potential for increased precision. This technology allows surgeons to:

• Create a 3D model of the patient’s knee for pre-operative planning
• Make more accurate bone cuts during surgery
• Achieve better implant positioning

Dr. Heckmann comments, “Robotic-assisted surgery can enhance the surgeon’s ability to precisely position the implant, which may lead to improved function and longevity of the replacement.”

Patient-Specific Implants

Customized knee implants, designed based on a patient’s unique anatomy, are another exciting development in the field. These implants offer several potential benefits:

• Better fit and sizing
• Improved joint kinematics
• Potentially faster recovery times

Dr. Lieberman explains, “Patient-specific implants aim to replicate the patient’s natural knee anatomy more closely, which may result in a more natural-feeling knee after surgery.”

Minimally Invasive Techniques

Advancements in surgical techniques have led to less invasive approaches to knee replacement. These techniques often involve:

• Smaller incisions
• Less damage to surrounding tissues
• Potential for faster recovery and reduced post-operative pain

While not suitable for all patients, minimally invasive techniques can offer significant benefits for those who qualify.

The Role of Physical Therapy in Knee Replacement Success

Physical therapy plays a crucial role both before and after knee replacement surgery. Understanding its importance can help patients prepare for and recover from the procedure more effectively.

Pre-operative Physical Therapy

Engaging in physical therapy before surgery, often referred to as “prehabilitation,” can offer several benefits:

• Strengthening muscles around the knee
• Improving range of motion
• Enhancing overall fitness for surgery
• Potentially speeding up post-operative recovery

Dr. Heckmann notes, “Patients who participate in pre-operative physical therapy often have an easier time with post-operative rehabilitation and may achieve better outcomes.”

Post-operative Rehabilitation

After knee replacement surgery, physical therapy is essential for optimal recovery. The rehabilitation process typically involves:

• Exercises to improve strength and flexibility
• Techniques to reduce swelling and manage pain
• Gait training to ensure proper walking mechanics
• Gradually increasing activity levels

Dr. Lieberman emphasizes, “Dedication to post-operative physical therapy is crucial for achieving the best possible outcome from knee replacement surgery. It helps patients regain function and return to their desired activities more quickly.”

Long-Term Outcomes and Quality of Life After Knee Replacement

While the decision to undergo knee replacement surgery can be challenging, understanding the potential long-term benefits can help patients make informed choices. Research has shown that knee replacement surgery can significantly improve quality of life for many patients.

Pain Relief and Functional Improvement

The primary goals of knee replacement surgery are to relieve pain and improve function. Studies have shown that:

• The majority of patients experience significant pain relief
• Many patients report improved ability to perform daily activities
• A large percentage of patients return to low-impact sports and exercise

Dr. Lieberman states, “Most patients experience a dramatic improvement in their quality of life after recovering from knee replacement surgery. They’re often able to return to activities they previously had to give up due to knee pain.”

Longevity of Knee Implants

Modern knee implants are designed to last for many years. According to the American Academy of Orthopaedic Surgeons:

• 90% of knee replacements are still functioning well 15 years after surgery
• Many implants continue to function effectively for 20 years or more

Dr. Heckmann adds, “While individual results can vary, the longevity of modern knee implants means that many patients can expect their replacement to last for a significant portion of their lives.”

Impact on Overall Health

Beyond improving knee function, knee replacement surgery can have positive effects on overall health:

• Increased physical activity can improve cardiovascular health
• Better mobility may lead to weight management benefits
• Reduced chronic pain can improve mental health and well-being

These long-term benefits underscore the potential value of knee replacement surgery for those suffering from severe knee arthritis. However, it’s important for patients to have realistic expectations and to discuss their individual situation with their orthopaedic surgeon.

Preparing for Knee Replacement Surgery: What Patients Should Know

Proper preparation can significantly impact the success of knee replacement surgery and the recovery process. Patients considering or scheduled for knee replacement should be aware of several important factors.

Medical Optimization

Before surgery, it’s crucial to optimize overall health. This may involve:

• Managing chronic conditions like diabetes or heart disease
• Quitting smoking, if applicable
• Achieving a healthy weight to reduce stress on the new joint
• Addressing any dental issues to reduce infection risk

Dr. Heckmann emphasizes, “The healthier a patient is going into surgery, the smoother their recovery is likely to be. We work closely with patients and their primary care physicians to optimize their health before surgery.”

Home Preparation

Preparing the home environment for post-surgery recovery is essential. This may include:

• Arranging a sleeping area on the ground floor, if possible
• Removing tripping hazards like loose rugs
• Installing safety bars in the bathroom
• Preparing meals in advance

Dr. Lieberman advises, “Having a safe, comfortable environment ready at home can make the initial recovery period much easier for patients.”

Education and Expectation Setting

Understanding the surgery process and what to expect during recovery is crucial. Patients should:

• Attend pre-operative education classes if offered
• Discuss the recovery timeline with their surgeon
• Understand post-operative pain management strategies
• Plan for assistance during the initial recovery period

By thoroughly preparing for knee replacement surgery, patients can set themselves up for a smoother recovery process and potentially better long-term outcomes. It’s important to work closely with the healthcare team to address any concerns and ensure all necessary preparations are made.

8 Signs You May Need a Knee Replacement

This common procedure can help reduce pain and restore your ability to move better. But how do you know when it’s time for surgery?

Knee replacement surgery is one of the most successful procedures in all of medicine, according to the American Academy of Orthopaedic Surgery (AAOS). It’s also very common: Over 790,000 knee replacements are performed each year in the United States. A complete knee replacement — more correctly, a resurfacing — places metal pieces to recreate the surface of the joint, with a plastic separator in between and possibly a plastic resurfacing of the inside of the kneecap (patella).

Although you’ll need a little help afterward, you should be able to begin walking again either the same day or the day after surgery. And the procedure is overwhelmingly successful: The AAOS estimates that 90% of modern total knee replacements are still working more than 15 years after surgery.

How do you know if you need a knee replacement in the first place? Deciding when it’s time is a personal decision between you and your doctor, but there are some factors that make you a more likely candidate for surgery.

1. 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.”

2. Nonsurgical treatments are no longer effective

If you have arthritis of the knee, you’ll probably start with more conservative measures such as medications, steroid injections or physical therapy to alleviate your symptoms. But at some point, they may not be enough.

“Anti-inflammatories, injections and physical therapy are temporary measures to provide pain relief, but they don’t reverse the underlying cause of pain and don’t allow cartilage to regenerate,” Heckmann says. “As time passes, these arthritic conditions tend to progress in severity, rendering these types of treatments less and less effective.”

At that point, surgery may be an option.

3. Your pain prevents you from doing normal activities or caring for yourself

If you can’t get relief from other treatments, your knee pain may start interfering with your daily life.

“In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life,” says Jay Lieberman, MD, chief of orthopaedic surgery at Keck Medicine and chair and professor of orthopaedic surgery at the Keck School. “If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery.”

4. You have severe pain even when resting, and you can’t sleep

According to Lieberman, pain while at rest that isn’t responding to other measures may make you a good candidate as well.

“In addition, if you also have consistent pain at night, this can be quite debilitating,” Lieberman says.

5. Your knee is always swollen

Swelling is another sign your knee is not responding to other treatments.

“A knee that is consistently swollen despite the use of anti-inflammatory medications, steroid injections and physical therapy suggests degeneration of the cartilage and/or instability of the knee, which can be confirmed with an X-ray,” Lieberman explains. This can make you a candidate for a total knee replacement, he says.

6. Your knee has become deformed

If your arthritis is advanced, it can affect the way you walk, which can also lead to further problems elsewhere in your body.

“As arthritis progresses, the knee may become bowed or ‘knock-kneed,’” Heckmann says. “If this type of deformity develops over time, a knee replacement may be indicated.”

In addition, people with arthritis may also lose the ability to straighten their knee, according to Heckmann. “If this occurs, you should seek an evaluation with an orthopaedic surgeon, as this loss of motion may be permanent, even after the knee has been replaced,” he adds.

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7. You’re OK with avoiding certain activities afterward

Patients should know what to expect after knee replacement surgery and understand that regular high-impact activities may not be advisable.

“Total knee replacement is quite successful in enabling patients to return to an active lifestyle — patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf,” Lieberman says. “In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear of the prosthesis.”

8. You’re of a certain age

Knee replacement is generally done in older people over 60, in part because younger people’s more active lifestyles may put too much stress on the artificial knee, causing it not to last as long; second replacement surgeries may not be as successful. But, knee replacements can be performed in people of all ages depending on your individual case, so discuss with your doctor whether you’re a good candidate.

by Tina Donvito

Do you think you may need a knee replacement? Our expert orthopaedic surgeons can help. If you are in the Los Angeles area, request an appointment online or call (800) USC-CARE (800-872-2273).

When do I need a Total Knee Replacement? (Signs and Symptoms)

If your knee joint is severely injured or damaged by a disease like arthritis, a total knee replacement (also called knee arthroplasty) may be the answer for you. But how do you know if you’re a candidate and if the time is right?

Because total knee replacement is a major surgery, orthopedists prefer to begin with non-invasive treatment options. For that reason, most patients who undergo knee arthroplasty are at “the end of the line” with non-invasive approaches. They’ve tried everything to improve mobility and reduce pain, but nothing has worked for long. 

If you’ve tried a variety of treatments for your knee pain and you’re not seeing results, it may be time to visit an orthopedist to talk about a total knee replacement.

do i need a new knee? signs and symptoms

Contrary to what many people may believe, age is not necessarily a major factor in knee arthroplasty. Juvenile arthritis can cause pain and disability to the point where a knee replacement may be recommended in children and teens.

However, most patients are adults between the ages of 50 and 80 who suffer from degenerative arthritis (osteoarthritis), a breakdown the cartilage cushion between the bones of the knee joint. In most cases, this type of arthritis is age-related.

Are you unsure about whether your knee is really that bad? Check your knee symptoms against the following list. Are you experiencing:

• morning joint stiffness lasting less than 30 minutes?
• chronic swelling or inflammation that doesn’t respond to rest or medication?
• severe to moderate pain that interferes with your daily activities?
• deformity of the knee, such as a bowing in or out?
• aching or pain after extensive standing, walking, or exercise?
• pain that increases during humid or rainy weather?
• pain that interferes with your sleep?

• pain while resting: persistent or intermittent aching without a particular cause?
• swelling or stiffness, especially after periods of rest or inactivity?
• loss of mobility (trouble bending and straightening the knee)?
• a grating or grinding feeling in the joint?
• difficulty climbing stairs or getting in and out of chairs or tubs?

If you suffer from any of the above, you may be a candidate for a total knee replacement. The next step is to visit an orthopedic surgeon to be diagnosed and evaluated.

getting diagnosed

An orthopedic surgeon can diagnose your knee condition with a thorough examination. You’ll be asked to describe your medical history, your pain, your current level of function, and any known injuries that may be contributing to your knee problems. 

Your doctor will perform physical tests to check your knee for range of motion, alignment, and strength — for example, you may be asked to walk and to bend your knee. X-rays or MRIs may be required to determine the extent of any bone damage, tissue damage, or irregularities in your knee. (If you have significant bone loss and weakness or an infection, you may not be a good candidate for the surgery.)

At the end of your visit, your orthopedist will present you with treatment options and discuss with you whether knee replacement surgery is an advisable option for improving your pain and ability to function.

What is a total KNEE replacement, exactly?

In a knee arthroplasty, your orthopedic surgeon will not give you an entirely new joint. 

Rather, the surgeon repairs your existing bone by removing damaged or diseased parts.

Your bones are then resurfaced with contoured metal or plastic implants.

The surgeon presses or cements the new components in place, using spacers to ensure that your bones will glide smoothly over each other — just like your “real” knee before it became damaged.

KNEE ARTHROPLASTY: OUTLOOK

Knee arthroplasty is a safe and effective procedure that is performed on over 600,000 people per year in the U.S. Reported complication rates are very low. 

However, all surgeries have risks. Infection, blood clots, scarring, and injuries to the blood vessels and nerves around the knee are all rare but possible complications from surgery.

Continued pain is also possible. However, most patients and surgeons report great satisfaction with knee replacement surgeries, with over 90% of patients reporting an improvement in their pain and function. 

Knee implants can wear out, however. Your orthopedic surgeon may suggest that in the future, you refrain from high-impact sports like running or basketball, as these will speed up the wear-and-tear on your implants.

For the best results, try low-impact activities instead. Sports like swimming, walking, kayaking, golf, and biking are kinder on your joints and will help your “new knee” perform well for many years.

SHOULD YOU CONSIDER a knee replacement?

The answer depends on many factors, including your age, health history, lifestyle, and medications you may be taking. Give Coastal Orthopedics located in Corpus Christi a call 361.994.1166  to find out if arthroplasty may be the right choice for treating your knee pain.

By Rob S Williams, MD

7 Signs You’re Ready for Knee Replacement

If you’re thinking about having knee replacement surgery, you’re in good company. Every year, more than a half-million Americans opt for the procedure. 

Many people have knee replacements (also called knee arthroplasty) because they have osteoarthritis. This condition occurs when the cartilage (tissue) that cushions the knee joint wears away. As a result, bone rubs against bone, which is quite painful. Other people may need a new knee because they have rheumatoid arthritis, a disease that causes chronic joint inflammation. Still others may have had an injury causing knee pain and limiting function. These conditions are known to cause gradual worsening of knee pain over a long period of time. It’s not always easy to know when knee replacement surgery is necessary. You and your doctor will take several factors into account in deciding if (or when) joint replacement is right for you. These factors include your X-ray or MRI results, pain level, physical function, personal health history, and weight. 

Here are high-level guidelines that can help you prepare for a conversation with your doctor about moving forward with knee replacement. 

Why You Might Say “Now’s the Time” 

Here are seven signs that the time might be right for a knee replacement:

1. Medications—even stronger anti-inflammatory drugs—don’t help, or no longer help ease your pain. 
2. Other less invasive treatment options don’t effectively reduce your pain and inflammation. These may include cortisone injections, lubricating injections, rest, and physical therapy. 
3. You have lots of difficulty and pain performing everyday tasks, such dressing, bathing, getting out of bed or a chair, or climbing stairs.
4. You need the aid of a cane or walker to get around. 
5. Your pain is severe day and night. The pain is there even when you’re not using your knee, such as when you’re sitting still or lying down. 
6. Your knee has become deformed from injury or arthritis. It bows in or out. (However, in some cases, severe deformity can make surgery more difficult. If you start to feel severe deformity, talk with your doctor sooner than later.) 
7. You are between 50 and 80 years old. Most people who get knees replaced are in this age range. (However, age is not necessarily a deciding factor. Surgeons successfully perform knee replacements on patients of all ages.)

Why You Might Say “Not Yet” 

Here are a five reasons knee replacement might not be right for you—at least for now:

1. You still have time to give more conservative treatments a chance to work. These options include rest, ice, heat, muscle-strengthening exercises, and pain medications. 
2. Your pain is bearable, and medications are helping. 
3. You can still get around and do your normal activities without much difficulty. 
4. You have weak thigh muscles that wouldn’t be able to support a new knee joint. Or, you have open sores or ulcers in the area that could easily become infected after surgery. 
5. You are very overweight. Extra weight puts more pressure on your knees, and may move parts of the artificial knee joint. This can lead to pain or further surgery.

Have a Conversation With Your Doctor 

Before you make up your mind about having your knee replaced, talk with your doctor about the possible risks of surgery. These can include infection, loosening of the knee replacement parts, and movement limitations. Also, talk about any health conditions you might have that could make the operation and your recovery more difficult. 

It’s also important to have realistic expectations for how quickly you will recover from the surgery. It can take several weeks to several months to feel back to normal after a knee replacement. You’ll also need to commit to physical therapy and exercise. Your doctor can talk through the factors that can speed up or slow down recovery, and help you decide if the timing is right. 

Under the right circumstances, a knee replacement can significantly boost your quality of life. More than 90% of people who get new knees are able to resume their normal activities shortly afterward and are happy with the results, according to the American Academy of Orthopaedic Surgeons. And pinpointing a good time to have a knee replacement is a key part of having success with the procedure.

Total Knee Replacement Surgery Information

Overview

The procedure: total knee replacement surgery.

What is knee replacement surgery?

Knee replacement surgery removes damaged or diseased parts of the knee joint and replaces them with metal or plastic parts. Also called knee arthroplasty, it’s a safe, effective procedure that can help you feel better and move better.

How does partial knee replacement differ from total knee replacement?

Most arthroplasties target the entire knee joint, an operation called a total knee replacement. But some people choose to have a partial knee replacement.

To understand the difference, it helps to know the knee’s compartments, or sections. It has three:

• Inside (medial).
• Outside (lateral).
• Under the kneecap (patellofemoral/anterior).

The partial approach fixes a single section. So healthcare providers call it unicompartmental replacement. A total knee replacement addresses all three sections. Generally, only younger adults with symptoms in one knee section benefit from partial replacement.

Who gets knee replacement surgery?

You may consider knee replacement surgery if:

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

What the alternatives to knee replacement?

A healthcare provider may recommend knee replacement surgery after other treatments for knee pain don’t help anymore. These earlier options may include:

• Exercise or physical therapy to strengthen the muscles around the joint which will provide stability.
• Knee arthroscopy for mechanical issues.
• Medications such as NSAIDs and cortisone shots.
• Walking aids or supports (for example, a cane or walker) and bracing.

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 it’s also become popular in middle age, as people want to stay active.

Procedure Details

How do I determine if I need a knee replacement?

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

Your orthopedic surgeon will:

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

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

What happens before knee arthroplasty?

If you and your surgeon decide to move forward with knee replacement, you may need:

• Blood tests.
• Dental exam to help lessen the risk of infection from surgery.
• Electrocardiogram to make sure your heart is strong enough for surgery.
• Physical exam to make sure you’re healthy enough for surgery.

What happens during knee arthroplasty?

The day of surgery, you will receive anesthesia to prevent pain during the operation. You will have either a regional (spinal block) or general anesthetic. Your anesthesia team will decide what type of anesthesia is right for you.

Knee arthroplasty takes about an hour or two. The surgical team will:

• Make an incision (cut) in the knee area.
• Remove any damaged cartilage and bone.
• Place the knee implant and position it properly.
• Secure the implant into place using cement or without cement.
• Insert a piece of polyethylene (plastic) that creates a smooth, gliding surface between the metal parts of the implant.
• Close the incision.

What happens after knee arthroplasty?

After surgery, you will get moved to a recovery room. The healthcare team will watch you for a short time to make sure you wake up from the anesthesia without complications. They’ll also monitor your vital signs and pain level.

Occasionally, people who have knee replacement surgery go home the same day. If you need to stay in the hospital, it will likely be for one day. Additional time spent in the hospital is based on medical necessity.

Will I need any treatments after knee replacement?

Your healthcare team will prescribe medications to help you manage pain after surgery, such as:

• Acetaminophen.
• Opioids. (Provided for limited time following surgery.)
• NSAIDs.

To prevent blood clots and control swelling, your healthcare team might also recommend:

• Blood thinners, such as aspirin or injectable Enoxaparin based on individual risk of blood clot formation.
• Compression devices, usually used while hospitalized. These are mechanical devises which provide intermittent compression.
• Special support hose.

Your team will ask you to move your foot and ankle around frequently to maintain blood flow at home. They’ll also show you special exercises to help strengthen your knee and restore motion. Exercises are very important to the success of your knee replacement. Initially, physical therapy will be in the home. Arrangements for this in home PT are made at the time of discharge from the hospital.

Risks / Benefits

What are the advantages of knee replacement?

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

What are the risks or possible complications with knee replacement surgery?

Although knee arthroplasty is a very safe procedure, rare complications may occur:

• Blood clots.
• Infection.
• Injury to the nerves or blood vessels around the knee.
• Problems with the implant, such as the device wearing down too soon or loosening.
• Scar tissue inside the knee.

Recovery and Outlook

When can I get back to my everyday activities after knee arthroplasty?

Your doctor will give you specific instructions. But many people can get back to their everyday activities three to six weeks after surgery.

Your healthcare provider will give you specific instructions about recovery. You will gradually increase activity, starting with a slow walking program. You will be encouraged to stand, climb stairs and perform other normal household activities as soon as possible.

How long does a knee implant last?

Most modern knee implants last 15 years or longer after surgery. Eventually, with normal activity, the plastic implant may begin to wear down or loosen.

Younger people who have knee arthroplasty sometimes need a second knee replacement later in life.

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.
• Cleaning and doing laundry.
• Cooking.
• Shopping.

Plan ahead to have a friend or loved one help you after surgery, or tell your healthcare provider if you’ll 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.

When to Call the Doctor

When should I seek medical attention after knee replacement?

After you go home, call your healthcare provider right away if you develop any of the following symptoms:

• Chest pain and/or shortness of breath.
• Fever higher than 101 degrees Fahrenheit (fluctuations in body temperature are to be expected following surgery).
• Incision problems, like bleeding, leaking, swelling, redness or odor.
• Pain in your calf, ankle or foot that is new and gets worse.

A note from Cleveland Clinic

If you have severe knee pain but medications and therapy aren’t helping, knee replacement may provide the answer. This common and effective surgery can reduce pain and get you back to everyday activities. Talk to your healthcare provider or an orthopedic provider about whether knee arthroplasty is a good option for you.

Knee Osteoarthritis: When to Consider Surgery

Knee osteoarthritis (OA) can affect your every move: walking, climbing stairs, even sitting or lying down. Surgery can help bring relief, but doctors almost always advise trying other treatment options first. These include:

Medications you take by mouth. Over-the-counter options include acetaminophen (Tylenol) as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve). NSAIDs fight inflammation. Stronger NSAIDs are available by prescription.

Creams or ointments you rub onto the skin. Different forms are sold over the counter. You can get stronger versions with a prescription.

Medications injected into the joint. Corticosteroid injections, also called cortisone shots, fight inflammation and can offer fast pain relief that may last up to several months. Injections of hyaluronic acid boost the natural joint fluid that keeps knees moving smoothly. They may take up to a couple of months to have their full effect but can last up to 6 months or more.

Exercise and physical therapy. Exercise strengthens the muscles that support your knee. Physical therapy also helps. A physical therapist can design the program for you and see if you need supportive braces, splints, or canes. If you need to lose weight, diet and exercise can help you shed some pounds and take some of the pressure off your knees.

Weight loss. Every pound you gain puts an extra 3 pounds of pressure on your knees. If you eventually need knee replacement surgery, your chances of success are much greater if you first lose extra weight.

Nutritional supplements. Some people take glucosamine and chondroitin for OA. Studies on how well they work have had mixed results. Another supplement, called SAMe, has been shown to work as well as nonprescription pain relievers and may have fewer side effects. It takes longer to work, though. Before you start taking any supplements, even if they’re natural, tell your doctor so they can check for any side effects.

These treatment options may provide enough relief to keep you moving comfortably. If they don’t, they become less effective over time, or you can’t tolerate them, your doctor may suggest considering surgery. The two types of surgery most often recommended for knee OA are arthroscopic surgery and knee replacement surgery.

Arthroscopic Surgery

In this type of surgery, the surgeon inserts a thin tube with a tiny camera on the end through a small opening in your skin to view the inside of your knee. The surgeon can then remove damaged cartilage — the smooth covering that protects the bones in the joint. Your knee can be cleaned or flushed to remove loose bone or cartilage pieces that may be causing pain.

Most people can get back to their usual activities a few days later. The recovery usually isn’t painful.

Arthroscopic surgery may provide short-term relief from pain and possibly delay more complex surgery.

Knee Replacement Surgery

If you have tried all other osteoarthritis treatment options and still have knee pain, your doctor may suggest knee replacement. It can help reduce your pain and improve your ability to move.

Knee replacement surgery involves removing all or part of the knee joint and replacing the damaged parts with an artificial joint. These are made of metals and plastics. In some cases, the surgery can be done robotocally.

It may take months to recover fully, but the relief can last many years or even a lifetime.

It may be time to have knee replacement surgery if you have:

• Severe knee pain that limits your everyday activities
• Moderate or severe knee pain while resting, day or night
• Long-lasting knee inflammation and swelling that doesn’t get better with rest or medications
• A bowing in or out of your leg
• No pain relief from NSAIDs or can’t tolerate them

4 signs you need a knee replacement

Knee osteoarthritis develops over time and can sneak up on you. When you do begin to experience symptoms, much of the damage may already be done. Here are some signs you shouldn’t ignore.

1. Pain points

Pain with activity.

Knee pain manifests in many ways. Pain that comes on with activity and limits what you can do is a clear signal to seek help.

Delayed pain.

Pain doesn’t have to stop you in your tracks to be serious. Pain that comes on after activity, also known as ‘payback pain’, can be a warning that your knee isn’t performing as it should.

Pain that interrupts sleep.

If you find knee pain prevents you from falling asleep or you wake up because of pain caused by your movements during sleep – talk to someone about it.

2. Visual changes

The way your knee looks can be just as important as the way it feels. Changes in the appearance of your knee can be a sign of inflammation. If your leg swells, or looks markedly different from the other then it may be time to speak with a specialist.

3. Limited movement

Difficulty sitting down in a low seat such as in a car or cinema because your knee refuses to bend is a common sign of osteoarthritis. Seizing or catching of the joint during movement can also indicate advanced deterioration or that a loose bone fragment has become lodged in the joint.

4. Lifestyle limitations

It doesn’t matter if you want to climb a mountain or simply prune the garden – any symptom that prevents or limits your ability to do the things you love is cause for concern. With a little help, a bad knee doesn’t have to impact your quality of life.

Most knee problems don’t require a full knee replacement. There are a number of treatments available, including physiotherapy and medication, which may better address your symptoms.

Last updated Tuesday 15 December 2020

First published on Friday 5 February 2016

Knee Replacement Complications | Problems After Knee Surgery

If the more common side effects of a knee replacement occur, they generally begin immediately after surgery. These include swelling, stiffness and pain. If any of these persist beyond a few months, they may be a sign of a more serious complication.

The American Academy of Orthopedic Surgeons (AAOS) says serious knee replacement complications are rare. Less than 2 percent of patients will experience them.

Complications may result from the knee surgery, or patients may develop physical complications related to the device, such as implant rejection.

Other knee replacement complications, such as loosening, may be due to mechanical problems or defects with the implant. More serious complications need revision surgery to correct.

The risk of death from total knee replacement surgery, also known as total knee arthroplasty (TKA), is very low. A 2017 study in the Journal of Bone and Joint Surgery, American volume, found the leading cause of death within 90 days of total joint replacement surgery was ischemic heart disease.

Mechanical Complications

Most implants should last 20 years or longer, but some may fail sooner or at higher-than-expected rates. This can lead to recalls or to patients suing the manufacturer.

The American Association of Hip and Knee Surgeons says there is a 0.5 to 1 percent chance each year that a patient’s knee implant will fail. The association calculates that 90 to 95 percent of knee replacements will last 10 years and 80 to 85 percent will last at least 20 years.

Though they are extremely rare, mechanical complications — such as loosening, instability, dislocation, misalignment and device failure — can result from manufacturing defects, poorly fitted implants or problems during surgery.

Unfortunately, these types of problems may not become apparent for many years. Between 2007 and 2014, Smith & Nephew sold more than 42,000 of its Journey I BCS Knee implants. But it wasn’t until 2018 that the company announced it was recalling the devices because revision rates were 1.5 times higher than with comparable devices.

Knee Implant Loosening

Loosening is one of the most common complications of total knee replacement surgery. Patients usually need revision surgery to fix it.

There are several causes for loosening. Infection is one of the most likely causes. Faulty design, product defects, or wear and tear on implant parts can also cause loosening.

Lawsuits have claimed DePuy Attune implants loosened because cement used to connect the device to bone failed.

There is little research into loosening problems with the Attune knee. However, a 2017 study in The Journal of Knee Surgery evaluated “clinical, radiographic and intraoperative findings” of patients who received the Attune knee and required revision surgery.

The study’s authors reviewed three hospital databases for patients who had total knee replacement revision surgery for tibial loosening at the “implant-cement interface,” which is the point where the cement is supposed to connect the implant to the bone. They identified 15 cases in which patients received an Attune knee. The authors found loosening of the tibial components in two of the 15 knees.

Though the researchers only looked at 15 cases, they also checked adverse event reports filed with the U.S. Food and Drug Administration.

“There were 21 reports of tibial loosening at the implant–cement interface in MAUDE database in the past 2 months alone,” Peter M. Bonutti and the other authors wrote. “Numerous other tibial failures were reported; however, the mechanisms of failures were not specified.”

In a letter to Drugwatch, DePuy stressed that this study looked at only 15 cases and that there is no evidence that this result is replicable across the general population. The company said the Attune knee has not been recalled due to loosening complications.

People also reported loosening with Zimmer NexGen uncemented implants. Between 2010 and 2014, Zimmer recalled 108,000 of the knees due to a risk of loosening.

Zimmer attributed the first recall of 68,000 devices to a problem with instructions to doctors on how to properly implant the devices. The company attributed the second recall in 2014 to a problem with threads that did not properly fit screws that connected the implant to the bone.

People who filed adverse event reports with the FDA, and lawsuits against Zimmer, claimed those screws sometimes failed.

Pain and Other Physical Complications

Knee replacement surgery can result in physical complications ranging from pain and swelling to implant rejection, infection and bone fractures.

Pain may be the most common complication following knee replacement surgery. It’s normal for patients to experience some degree of pain up to six months after surgery. But if pain persists past six months after the procedure, it’s generally considered to be long-term, or chronic, pain.

Several studies have looked at the frequency of chronic pain among total knee replacement patients. Findings suggest anywhere from 16 percent to 44 percent of patients are reporting this side effect.

“It is also possible that the true prevalence of chronic pain after TKA is even higher than estimated in research studies, as some patients may be reluctant to report that they have pain,” authors of a 2018 article published in EFFORT Open Reviews wrote.

Knee Replacement Loosening Symptoms

Pain

Swelling

Instability

Limited range of motion

Instability and Dislocation

Authors of a 2016 study in The Bone and Joint Journal said instability is a chief reason for revision surgery. It accounted for as many as one in five revision surgeries described in medical literature, according to the study.

Instability can cause excessive wear on implant parts. It can also cause patients to fall, resulting in further injuries including fractures. In the worst cases, instability can cause the implant to dislocate.

Authors of a 2018 study in the journal Orthopaedic Proceedings called TKA dislocation “an unusual but dramatic” complication. The researchers looked at roughly 31,000 TKAs performed at a single hospital since 1970. Their study estimated dislocations occurred in 1.87 of every 1,000 arthroplasties. It also found that revision surgery was successful in repairing dislocated prosthetics in 89 percent of cases.

A 2014 case report and literature review in the Journal of Orthopaedics found that dislocation tends to happen from both “high and low energy” traumas. The authors concluded prosthetic knees and natural knees dislocated for similar reasons, including overextending the joint.

Knee Replacement Instability and Dislocation Symptoms

Pain

Swelling

Wobbly sensation in the knee

Unable to put weight on the knee

Misalignment and Failure

Components in an artificial knee have to be precisely aligned to work. If they do not line up, they can wear out too soon. Or the implant can fail without warning.

Symptoms of misalignment and failure include instability, pain and swelling. Other signs include reduced range of motions and warmth or heat around the joint. Patients almost always need revision surgery to fix misalignment problems.

A 2017 study in Bone Joint Research said misalignment, or malalignment, was “associated with several important clinical complications.” The study said alignment of TKA components can dramatically affect wear on the device, stability of the patient’s ligaments and how long the prosthetic will last.

Excessive weight can cause components in a knee replacement to move out of their proper position and increase the risk of failure. A 2017 study in the Journal of Healthcare Engineering used computer models to look at possible results. The authors found overweight patients were at risk of wearing out polyethylene components prematurely.

Timeline of Recent Chronic Pain Studies

• 2012

  A study in BMJ Open compared the prevalence of chronic pain between people who had total hip replacements to those who had total knee arthroplasty. Only about 9 percent of hip patients reported long-term pain compared to 20 percent of knee patients.

• 2014

  A review of studies and literature published as a chapter in the book Chronic Postsurgical Pain found the frequency of chronic pain after total knee replacement ranged from 24 percent to 44 percent.

• 2016

  A study in the journal Osteoarthritis and Cartilage found as many as 20 percent of patients experience long-term pain and dissatisfaction after surgery.

• 2018

  An article in EFFORT Open Reviews said more recent studies have found 16 percent to 33 percent of patients reported chronic pain after their surgery. “This equates to a high number of patients experiencing this adverse outcome after surgery,” the authors wrote.

The exact cause of pain can be difficult to diagnose because it can accompany almost any other complication. When swelling and joint pain happen together, it can be a sign of infection. The combination may also be a sign that there is a mechanical problem with the implant.

“It is also possible that the true prevalence of chronic pain after TKA is even higher than estimated in research studies, as some patients may be reluctant to report that they have pain.”

Infection

Infections are a serious complication that threatens a patient’s overall health. They are also a leading cause of implant failure. They can damage muscle or bone, weakening the implant.

A 2017 review in the journal Arthroplasty Today looked at six national arthroplasty registries around the world and concluded infection rates increased over time.

Researchers examined data from 2010 to 2015 and found that on average just over 1 percent of patients developed infections requiring surgery. The rate of infection was lower in 2010 and 2011 than in the later years.

“Despite global efforts to reduce postoperative infection, infection burden has actually increased in the selected registries over time,” the authors wrote.

Infection can come from bacteria living on the implant, or bacteria may enter the surgical wound during surgery. Symptoms of infection include pain, sudden stiffness, swelling, and warmth, heat or redness around the joint. An infection can also cause fatigue, drainage, fever, chills and night sweats.

Doctors can sometimes treat infection with antibiotics. Left untreated, infections may require surgery to remove the device and infected muscle or other tissue. In rare cases, infections may lead to amputation.

Bair Hugger Devices and Arthroplasty-Related Infections

Thousands of people blame Bair Hugger devices for infection complications following knee replacement surgery. The surgical devices stabilize patients’ body temperature during the procedure.

Studies suggest Bair Huggers may stir up particles on operating room floors. Some researchers believe air currents could carry bacteria to the open surgery site. But the studies relied on simulations rather than actual surgeries.

The device’s manufacturer, 3M, says the studies prove nothing and that Bair Huggers have been used safely in more than 20 million surgeries. But Bair Hugger lawsuits claim some patients needed amputations to stop infections.

Madris Tomes, former FDA program manager, says allergic reactions and infections are the knee implant adverse events she sees most often.

Implant Rejection

Knee implant rejection is extremely rare. People may confuse it with infection, but the two are different complications.

Implant rejection, or metal hypersensitivity, happens when metal in the implant triggers a reaction in the patient’s body. This can be an allergic reaction or an autoimmune response. Patients who suffer implant rejection may need revision surgery to remove and replace the device.

Authors of a 2017 study in the Journal of the American Academy of Orthopaedic Surgeons called metal sensitivity issues in TKA surgeries “a controversial topic.” They wrote that it was “quite rare” and difficult to diagnose.

The authors said doctors should consider metal hypersensitivity as a possible complication after eliminating other potential causes of pain or swelling. They said revision surgery should be a last resort.

According to the study, there is no widespread test or procedure in place to gauge a patient’s risk for metal hypersensitivity prior to surgery.

The Arthritis Foundation says because metal hypersensitivity is rare, testing before surgery is not routinely recommended for all patients. The foundation says people should ask their doctor if they should have an allergy test before surgery. Anyone who has had a reaction to metal jewelry probably should be tested, according to the foundation.

Knee Replacement Rejection Symptoms

Pain spreading throughout the body

Weakness

Fatigue

Fractures

Bone fractures after a knee replacement can happen in the thighbone, the kneecap or the tibia (one of the two bones in the lower leg). These are more likely to happen in older patients and those with low bone density issues such as osteoporosis.

Loose components and malalignment or malposition of implants can cause bone fractures. This is a medical emergency and needs immediate treatment.

A 2015 study in the journal Knee Surgery & Related Research said the supracondylar area of the thighbone is the most likely place fractures occur. That area is where the thighbone, or femur, joins the knee.

Even so, the authors wrote that these fractures were seen in less than a half percent to 2.5 percent of TKA patients. They mostly happened within two to four years after surgery.

Fractures to the lower leg bones or kneecap tended to be even rarer.

Medscape reported in 2017 that supracondylar fractures have become more common with an aging population. According to the article by Dr. Steven I. Rabin, the best results for repairing these fractures require surgery. This often entails using a metal plate and screws to connect the broken bone fragments so they can grow back together.

Patients should be aware of the signs of a bone fracture. These include pain and swelling or bruising around the fracture or joint. The leg may appear deformed, or it may be unable to support weight.

Surgery Risks

Knee replacement surgery shares risks with other types of surgeries. These include anesthesia reactions, blood clots, heart attack and stroke.

There are also some risks specific to the procedure, such as nerve damage and nerve block complications. Patients should ask their doctor about what signs and symptoms to watch out for following surgery and during recovery.

Nerve Damage from Surgery

Nerve damage can happen during surgery, but it usually goes away within six months.

Surgeons must cut and stretch skin and muscle during surgery. The American Academy of Orthopaedic Surgeons says “pressure, stretching or cutting” can damage nerves in the leg or around the joint.

Knee surgery may involve special tourniquets to restrict blood flow in the leg. According to a 2013 study in the journal Acta Orthopaedica, these devices may put damaging pressure on nerves.

Symptoms of nerve damage include radiating pain, “tingling” sensation in the leg, and numbness in the leg or foot.

Nerve Block Complications

Some total knee replacement patients may experience nerve block complications. A nerve block is an anesthetic that surgeons inject close to the nerves around a surgical site to relieve pain following surgery.

A 2009 study in The Journal of Arthroplasty found complications of nerve blocks can sometimes delay recovery. The researchers said these complications were rare in their study – they occurred only in 1.3 percent of patients — but they categorized them as “major complications” when they did occur.

The study involved 1,190 patients who underwent knee replacement surgery between January 2004 and July 1, 2007 and received a nerve block. Eight patients suffered femoral nerve palsies – when a patient can’t move or feel part of the leg – and eight suffered serious falls resulting in injuries.

Clicking or Popping

Clicking or popping sounds after surgery are a normal knee replacement side effect. This is not necessarily a complication.

“Most people also feel or hear some clicking of the metal and plastic with knee bending or walking,” according to the American Academy of Orthopaedic Surgeons.

The noise may be from the metal or plastic parts adjusting inside the leg, or it may be tendons adjusting to the new implant.

The sounds usually decrease or even go away after several months. Clicking by itself is not a serious problem, but patients should let their doctor know if they experience pain, swelling or other noises along with the clicking.

“Most people also feel or hear some clicking of the metal and plastic with knee bending or walking.”

90,000 what you need to know? – symptoms, diagnosis, treatment at the Central Clinical Hospital of the Russian Academy of Sciences

Knee arthroplasty is an effective and often the only way to restore lost limb function. Total, i.e. replacement of all components of the joint, arthroplasty is the method of choice in the treatment of:

• degenerative – dystrophic diseases (arthrosis-arthritis)
• rheumatoid arthritis
• post-traumatic arthrosis
• incorrectly fused intra-articular fractures of one or both articular surfaces
• bones that make up the knee joint
• damaged ligamentous apparatus of the knee joint with pronounced articular changes
• ends of bones

What should a patient know about arthroplasty surgery?

This is a very precise surgical procedure, the goal of which is to return you to a movable, painless joint, allowing you to return to your normal life.

The development of technical progress has led to the emergence of materials that can replace a worn out joint with an artificial one. Just like a regular knee joint, an artificial one exactly repeats the elements of a normal joint, allowing the necessary range of motion to be carried out. The implantation of an artificial knee joint does not require extensive bone resection and during the operation the own ligamentous apparatus of the knee joint is preserved, except for cases when the ligamentous apparatus is damaged and its restoration is required.The appropriate prosthesis is selected for each specific case.

Consultation

During the consultation, the doctor will determine the indications and contraindications for arthroplasty, conduct the necessary research and select the appropriate prosthesis. X-ray examination will allow to find out the degree of deterioration of the joint, to make the necessary measurements. You will be sure to be warned about the possible risks and complications of the operation. The complications of the operation include the following:

• infection in the area of ​​operation
• blood loss during or after surgery
• thromboembolism (blockage of a vessel by a thrombus)

Before surgery

Before the operation, the patient undergoes a complete clinical examination (delivery of tests, specialist consultations, examination by an anesthesiologist).Hospitalization of the patient 1-2 days before the operation.

Operation

In standard cases, implantation of an artificial joint lasts 2-3 hours. During the operation, measures are taken to prevent infectious complications, if necessary, replenishment of blood loss, drainage of the wound in order to prevent blood accumulation.

After operation

In the postoperative period, the administration of antibiotics, painkillers, symptomatic treatment continues.

Rehabilitation treatment in a hospital

Activation in bed is allowed already on the 1st day after the operation. From the second day, you can sit down in bed, start static exercises for the muscles of the limb, and perform breathing exercises. Walking with a dosed load on the operated limb and additional support (crutches, playpen) is possible already from 3 days. The stitches are removed for 10-12 days.

Extract home

Discharge is made 10-12 days after the operation.Rehabilitation measures should be continued, strictly following the recommendations of the operating surgeon. If necessary, hospitalization in a rehabilitation center for recovery is possible under the guidance of specialists – rehabilitation therapists. Restrictions in physical activity on the operated limb should be observed within 6 weeks from the operation, during which time it is recommended to use additional support.

City Clinical Hospital No. 31 – Knee arthroplasty

For endoprostheses, the chemical composition of all its components is extremely important.After all, an implanted artificial joint will have to serve a person for many years. Today there are many different models of endoprostheses: cemented, cementless, with various options for the heads and cups of the joint (ceramics, plastic, metal). Only an experienced orthopedic surgeon can decide which prosthesis is suitable for a patient.

Endoprosthetics is an extremely complex and high-tech operation that lasts about two hours and requires the highest professionalism from the doctor. The surgeon uses about 80 different instruments during the operation.With cement fixation, the prosthesis is glued to the patient’s bone; with cementless fixation, the bone will grow into it over time. The period of rehabilitation treatment of patients after arthroplasty is especially important. It should only be supervised by experienced physical therapists and physiotherapists. Of course, you will have to walk on crutches for several weeks after the operation. But haste is not appropriate here.

Knee arthroplasty

Knee arthroplasty involves replacing some or all of the joint structures with an artificial prosthesis in order to repair pain-causing damaged bearing surfaces.Total knee arthroplasty involves replacing all three parts of the affected joint. With partial arthroplasty, one or two parts of the joint are replaced while maintaining intact structures.

There are a number of invasive and non-invasive techniques that exclude joint arthroplasty, but the effect of such interventions in most cases is short-term. In the overwhelming majority of cases of degenerative lesions of the knee joint, it is arthroplasty that allows achieving a long-term effect.Overall, knee replacement surgery provides two main benefits: (1) pain relief and (2) increased range of motion. Among all the surgical interventions presented to date, total knee arthroplasty is the most conducive to improving the quality of life of patients. The results of this intervention are in most cases successful. In order to decide whether to undergo knee arthroplasty, the patient should learn more about the benefits of different types of prostheses and about the operation itself.

How do I know if I need knee replacement surgery?

Osteoarthritis is the most common cause of pain leading to replacement of the affected joint. Restriction of the patient’s daily activity with pain or discomfort in the knee joint may be an indication that he suffers from some form of arthritis. If this is the case, then the difficulty experienced in bending the legs, doing squats, standing on the knees and walking may indicate the need to contact the surgeon in order to discuss the possibility of performing knee arthroplasty.The main age category for this type of surgery is 60-80-year-old patients, however, in some cases, total knee arthroplasty may be required at a younger age, for example, with traumatic injuries of the knee joint.

Patients suffering from arthritis of the knee joint are characterized by staging in the development of pain syndrome. At first, pain of low intensity develops, gradually progressing over several years.Under the influence of the functional load, pain in the knee joint affected by arthritis increases. Gradually, difficulties begin to be noted when lifting from a chair, toilet, moving up and down stairs.

Pain syndrome also develops at night, which necessitates taking analgesics for its relief. The second stage requires a decrease in daily activity to reduce the manifestations of pain in the knee joint. For example, the patient begins to move less, it becomes difficult for him to work in the garden, to clean the house, to make purchases.He also begins to avoid using stairs and attending recreational activities. In other words, if you have difficulty performing daily tasks, you may need a knee replacement. In the third stage, in order to relieve recurrent episodes of discomfort in the knee joint, the patient resorts to taking analgesics. At any of the indicated stages of the development of pain syndrome, an appointment with a doctor is required. They will be given an X-ray of the knee to assess any existing damage.Depending on the degree of joint damage, the doctor may recommend preliminary conservative treatment before deciding to perform surgery.

Conservative treatments include medication, injection, bandage, and physical therapy. In case of ineffectiveness of these measures to restore the function of the knee joint, knee arthroplasty (partial or total) may be the method of choice.

Reasons for performing knee arthroplasty

There are a number of conditions that can lead to the need for knee arthroplasty, among which gonarthrosis (osteoarthritis, rheumatoid arthritis or post-traumatic arthritis) is the most common.There are also a number of factors that contribute to the development of joint damage, including genetic, developmental abnormalities, repeated trauma, obesity.

The knee joint is the largest, most complex and, accordingly, the most frequently affected joint in the body. It is the complexity of the structure and stress noted above that lead to the development of arthrosis. Knee arthroplasty – partial or total – is an effective way to treat degenerative arthrosis.

Why is knee replacement performed?

As a result of knee arthroplasty, most patients have:

• pain relief;
• increased mobility;
• increased ability to perform daily tasks;
• improving the quality of life.

Types of gonarthrosis that may require knee arthroplasty

Osteoarthritis develops when the contact surfaces of the articular cartilage are destroyed, which leads to the development of pain and stiffness of movements. With the complete destruction of the articular cartilage, direct contact and friction of the bony surfaces of the joint occurs, which results in limitation of mobility and the development of chronic pain syndrome.Osteoarthritis most often develops in people over the age of 50, but it is also common among patients with a family history of the disease, as well as among people whose lifestyle causes constant stress on the joints, such as athletes and workers.

Rheumatoid arthritis is an autoimmune disease, which is based on the auto-aggression of the immune system against the synovial membranes, leading to their inflammation and increased production of synovial fluid (a liquid substance that acts as a lubricant in the joint).Of prime importance is the fact that this process also causes damage and wear to the articular cartilage.

Post-traumatic arthritis develops as a result of serious injury to the knee, such as a fracture, injury to the ligamentous apparatus, or rupture of the meniscus. Traumatic effects also lead to the occurrence of microtraumas of the articular cartilage, eventually leading to the development of osteoarthritis, which causes pain and stiffness in the knee joint.

Degenerative changes in the knee joint may also be associated with a condition known as avascular necrosis (AVN) (the correct medical name is osteochondritis dissecans).This condition mainly occurs in adolescents and young people and is characterized by the presence of lesions on the articular surfaces, mainly on the condylar surface of the femur (condyles are rounded protrusions on the distal portions of the femur). Areas of bone become thinner, and they can detach and form sequesters in the joint cavity. These fragments can vary in size from very small to large, which can lead to pain, instability and even blockage of the joint.

There are techniques for influencing individual lesions, however, in general, this condition progresses as the patient grows older. Nevertheless, if large surfaces are involved in the pathological process, the development of arthritis is possible at any age – from adolescence to senile.

Anomalies of development or displacement of structures of the knee joint can lead to an increase in the load on the joint, which mediates the development of degenerative changes in it.Such lateral displacements in the knee joint, also referred to as varus or hallux valgus, are characterized by the formation of an unnatural angle between the femur and tibia in the projection of the knee joint. Over time, there is a gradual and uneven destruction of the articular cartilage.

How effective is knee replacement surgery?

Knee arthroplasty has become the most common form of joint replacement surgery.In 2010, more than 721,000 such transactions were carried out in the United States. Between 1991 and 2010, the incidence of knee replacement surgeries increased by more than 161%, which is partly due to advances in knee prostheses, surgeons’ qualifications, and the growing number of patients requiring this kind of surgery. … Endoprosthetics of the knee joint is characterized by the highest proportion of successful surgical results in comparison with other surgical interventions, and in general, patients’ attitude towards it remains positive, despite negative press reports and anti-advertising.

Frequency of successful surgical intervention

The rate of successful knee arthroplasty, as well as the degree of improvement in the quality of life of patients after this surgical intervention, is reliably very high. 9 out of 10 patients after this operation notice an instant disappearance of pain in the knee joint area, 95% of patients are satisfied with the results of the surgery. The service life of 90% of the prostheses is 10 years, and 80% of the prostheses demonstrate a service life of 20 years or more, depending on the patient’s health and physical activity.Surgery outcomes vary from patient to patient.

Rehabilitation as a component of successful treatment

While the rate of successful knee arthroplasty is very high, the success of the procedure as a whole largely determines the period of postoperative rehabilitation. The success of knee arthroplasty largely depends on the patient’s participation in the rehabilitation process. The importance of this stage of treatment cannot be overemphasized!

Rehabilitation after knee arthroplasty begins almost immediately.In the postoperative period, a physiotherapist starts working with the patient. In the early stages of rehabilitation, the emphasis is on maintaining motor activity in the prosthetic joint and on achieving confidence in the patient’s safe movement. As a result of the operation, new scar tissue is formed, therefore, in order to avoid irreversible loss of motor function due to insufficient exercise of flexion and extension of the limb in the knee joint, the patient should follow the recommendations of his attending physician and physiotherapist.

The physiotherapist develops a plan of rehabilitation measures for the outpatient phase of treatment, including exercises at home and in the gym. During the recovery and rehabilitation period, it is also important to follow the instructions of the physiotherapist and not to expose the prosthetic joint, as well as the surrounding tissues, to excessive stress while they are healing.

What to expect from a prosthetic knee joint?

After a successful knee replacement surgery, the patient does not experience pain, but this does not mean that the knee joint is fully restored.Most patients do not feel painful. However, a number of patients periodically develop pain syndrome and a feeling of “foreignness” of the joint. Most will be able to return to their previous level of physical activity, but vigorous exercise and running are not recommended. During the first 6-8 weeks, the patient needs to be especially careful not to allow rotational movements in the joint, as well as to keep the joint as extended as possible when lying down. During the same period, one should refrain from kneeling and squatting.

Knee arthroplasty

Knee arthroplasty is a complex surgical procedure that involves replacing a severely damaged or worn-out joint with an artificial one in order to restore the lost limb function and return the patient to a normal life without pain.

Anatomy

The knee joint is the largest in the human body, it takes on a colossal part of the load when moving (walking, running) and other active activities.

The joint is formed by the distal end of the femur and the proximal end of the tibia, covered with hyaline cartilage and reinforced with many ligaments and tendons that provide joint stability. The patella is adjacent to the distal end of the femur.

The structure of the knee allows not only flexion and extension of the lower leg, but also inward rotation (pronation) and outward movement (supination).

However, at the same time, the complex anatomical structure of the knee joint and the heavy loads that it takes on daily, make it one of the most vulnerable.

Indications for knee arthroplasty

In a healthy joint, muscle tension, ligaments of the joint capsule are balanced. Smooth and even cartilage ensures smooth sliding of bones relative to each other. With pathological changes in the joint, accompanied by severe pain and the lack of effectiveness of conservative treatment, patients are shown surgical intervention.

The most common indications for endoprosthetics are the following conditions / diseases:

• arthrosis of the knee joint (gonarthrosis, post-traumatic arthrosis)

• rheumatoid arthritis

• Incorrectly fused intra-articular fractures of the articular surfaces of the bones that make up the knee joint

• damage to the ligamentous apparatus of the knee joint with pronounced changes in the articular surfaces of the bones

• aseptic or avascular necrosis

• bone tumors, etc.

During a face-to-face consultation, an ECSTO orthopedic surgeon assesses the degree of deterioration of the joint and, based on the studies and functional tests carried out, makes a decision on the need for surgical intervention in a particular case.

Our specialist determines the indications / contraindications for the operation, discusses in detail with the patient all the nuances of the upcoming treatment, selects the required type of endoprosthesis, taking into account the state of the bone tissue and the anatomical features of the knee.

Preparation for surgery

When determining the indications for the operation, our orthopedists take into account many factors, including the age and weight of the patient, the condition and shape of the bones of the knee joint, the condition of the muscles and ligaments of the leg, the expected degree of physical activity of the patient, etc.

At the ECSTO European Clinic for Traumatology and Orthopedics, you can undergo a complete preoperative clinical examination, including conducting research and visiting the necessary specialists within a few hours.After the examination, the anesthesiologist selects the optimal type of anesthesia, which guarantees the patient no pain during the operation. Our specialist also takes into account the individual characteristics of the patient’s body, such as the presence / absence of chronic diseases, age, etc.

On average, the endoprosthetics procedure takes from one to several hours and is performed under general or regional (spinal, epidural) anesthesia.

Operation

Knee arthroplasty is a technically very difficult procedure.Only a competent surgeon with extensive experience in performing such operations can correctly install a knee endoprosthesis.

If only one area of ​​the knee joint is affected, the patient undergoes unipolar arthroplasty, in which only the damaged part of the knee joint is replaced with an artificial implant. If it is necessary to replace all components of the joint, complete (total) arthroplasty is performed.

During the operation, the orthopedic surgeon removes damaged bone fragments and remnants of the destroyed cartilage of the knee joint and replaces them with components of the endoprosthesis.

Correctly selected and installed modern endoprosthesis gives the patient the opportunity to live a full life without pain for many years.

Rehabilitation after knee arthroplasty

Postoperative pain in patients is usually moderate, which allows rehabilitation to begin the very next day after surgery: ECSTO patients begin to walk with full load on the operated leg under the supervision of a rehabilitation physician and are engaged in passive joint development with the Arthromot apparatus, which contributes to early recovery range of motion.

By the time of discharge from the clinic (6-7 days), ECSTO patients in most cases walk independently with or without additional support, can go up / down stairs.

Subject to the recommendations of an orthopedic surgeon and a rehabilitation doctor, the patient will soon be able to return to a normal, full-fledged lifestyle.

Cost of knee arthroplasty

The cost of the operation can be specified by calling the clinic or in the price list in the section “Traumatological and orthopedic operations”.

Prosthetics with knee replacement in Germany

Sven Rogmans, traumatologist, orthopedist

Specializes in the following areas: orthopedics, traumatology, specialized accident surgery, treatment of various types of especially severe injuries.

More about the specialist →

A knee joint prosthesis is a complete or partial replacement of a natural one, in cases of severe arthrosis or trauma, with plastic or metal elements.Artificial parts allow the patient to regain mobility, performance and, to a certain extent, the ability to play sports. Special recommendations in this case are given by the doctor during treatment in Germany in the clinic “Nordwest” at the department of orthopedics. For partial or complete replacement of the knee joint, various types of prosthetics, types of prostheses themselves and their fixation are used.

Types of knee joint replacement

Partial joint prosthesis replaces only part of it.Areas in which the cartilage surfaces are intact are preserved. Thus, the implantation of a total endoprosthesis can be postponed by 15-20 years. When implanting total prosthesis knee joint , both surfaces, the areas of the femur and tibia, are replaced with artificial ones. This is necessary in case of complete wear of the articular surfaces, accompanied by severe pain and impaired mobility.

Modern knee joint prostheses are called superficial: only the worn out surfaces of the cartilage are removed and the bone is preserved.The lateral and posterior cruciate ligaments are also preserved. Thanks to modern technology, such prostheses allow for maximum mobility and rotational movements. This makes it possible to shorten the duration of rehabilitation after prosthetics or knee arthroplasty in Germany and to restore the patient’s mobility much earlier.

Recently, the design of implants has been improved, an individual selection is used with the maximum preservation of intact surfaces, special types of prostheses are used for women, allergy sufferers, athletes or specially made prostheses for a special size of the knee joint.

The main function of the prosthesis and its composition

Knee endoprosthesis is an “artificial joint”, which in structure must correspond to the natural knee in order to perform its tasks. It should replace the surfaces of the knee joint cartilage and restore the patient’s ability to move. This requires the implantation of artificial sliding surfaces. For their production, metal and polyethylene are used. The metal parts are usually made of an alloy of chromium, cobalt and molybdenum.Such an alloy may contain nickel, however, if the patient is allergic to nickel, a titanium prosthesis is made.

Knee Endoprosthesis Components

In the clinic “Nordwest” during the prosthetics operation, depending on the task, various elements are used, which allow replacing partially or completely worn-out areas of natural cartilage or bone tissues.

• Femoral component
  Consists of metal, covers the lower end of the femur and must strictly follow the paired cylindrical shape of the end of the femur ( condyles ).
• Tibial component
  Covers the head of the tibia, along which the femur slides in the knee joint. The cruciate ligaments and menisci anchor and support the knee joint. The tibial component is also usually made of metal. To form a sliding pair with the metal thigh component, it is covered with an elastic, resistant polyethylene layer.
• Artificial knee caps
  Used quite rarely.If the back of the patella is damaged by arthrosis, an artificial polyethylene plate is used to replace the worn back of the patella.

All components are installed in such a way that the metal surface slides over the plastic surface. This makes the artificial joint resistant and does not allow it to wear out quickly.

Types of prostheses

Depending on the degree of development of arthrosis, different types of prostheses are used.The standard is a total endoprosthesis that completely covers both articular surfaces, femoral and tibial. However, if arthrosis of the knee joint affects only a certain limited area of ​​it, implantation of a partial prosthesis is possible.

Partial

In this case, we are talking about single-sided unilateral sliding prosthesis , with the help of which only one of the two condyles of the femur is changed. By replacing one portion of the knee, they preserve most of the joint with limited cartilage damage.With partial knee prostheses, as with total arthroplasty, the femur component is made of metal. It is positioned in such a way that it covers only one part of the femur. On the side of the tibia, a metal part is placed, on which a polyethylene insert is located. The metal part slides over the liner like sled runners.

Total:

• double-sided sliding prosthesis;
• axially stabilized prosthesis.

The most commonly used is the double-sided superficial sliding prosthesis . In this case, all parts of the knee are replaced: the surfaces of the femur, the tibia, and sometimes the back of the patella. When installing such a prosthesis, the connecting ligaments of the knee are preserved.

If, in addition to cartilage and bone, the ligamentous apparatus of the joint is damaged, the only possibility of prosthetics is prosthesis with axial stabilization , the so-called pedicle prosthesis.It fixes the joint along the longitudinal axis, which prevents lateral displacement of the lower leg in relation to the femur. In this case, the interconnected parts of the prosthesis act as a hinge.

Surgery to install a knee joint prosthesis

Only one skin incision is made to open the knee joint. The surgeon then removes the damaged cartilage and bone tissue. The important ligaments of the joint are preserved and the knee after implantation has the necessary stability and mobility. Replacement of the surfaces of the femur and tibia is performed with maximum bone preservation.

Next, special clamps are installed to check the mobility and determine the size of the prosthesis. Finally, the implant can be anchored in the bones of the thigh and lower leg.

In all cases, doctors try to preserve the existing knee joint and ligamentous apparatus as much as possible, most often preserving the internal and external, as well as the posterior cruciate ligaments.

The anterior cruciate ligament should be removed during the installation of a total knee prosthesis due to its geometric structure and the way of its installation.However, a knee prosthesis replaces her function. When installing a partial prosthesis, the anterior cruciate ligament is not removed and thus the natural movement of the knee is preserved.

Fixation types

There are various methods of fixation of the knee joint prosthesis:

• Cemented
  In most cases, the components of the prosthesis are fixed with bone cement. Bone cement is a fast hardening plastic ( polymethyl acrylate ).
• Cementless
  With this type of fixation, the prosthesis is pressed against the bone in a special way. Bone trabeculae are connected to the rough surface of the reverse side of the prosthesis and provide, after a while, a firm fixation of the implant.
• Hybrid
  In this case, the femoral component of the prosthesis is usually cemented and the tibial component is pressed into the shin bone. The kneecap component is also cemented with this type of fixation.

Potential risks and complications of knee replacement

Implantation can be associated with certain risks and complications. The most common of these are infection, thrombosis, bleeding, and scarring ( arthrofibrosis ).

• Periprosthetic infection
  In case of infection after knee replacement in the area of ​​the prosthesis, antibiotic treatment is performed. If it is unsuccessful, the infected prosthesis is removed and after a while a new one is installed.
• Arthrofibrosis of the knee joint
  Excessive scarring and inflammation after prosthesis placement. Arthrofibrosis begins with knee pain, severe reduced knee mobility, and signs of inflammation. Swelling and redness are very common. The knee joint becomes less and less mobile. The cause of complaints in arthrofibrosis is growths and scar tissue, which arise due to violations of the biochemical balance in the knee joint. As a treatment, the joint is immobilized under anesthesia to remove the scars.

Loose knee prosthesis

In case of loosening of the knee joint prosthesis in the places of attachment to the bone, its duration is reduced. A loose prosthesis cannot perform its functions when walking, standing, or any movements. In this case, the prosthesis must be removed and replaced with a new implant. It is possible to determine the causes and degree of loosening during diagnostics in Germany. The sooner the problem is identified, the more efficiently it will be solved.

• Prosthesis infection – septic loosening
  One of the causes of prosthesis loosening is infection.If bacterial plaque builds up on the implant after the prosthesis is placed, this can trigger an immune response in the body and lead to osteolysis ( bone loss ). In this case, an urgent use of antibiotics is required to debride the implant. If treatment is unsuccessful, replacement of the prosthesis may be required.
• Osteolysis due to plastic separation
  The next reason is aseptic osteolysis. This kind of loosening is not bacterial. Instead, the polyethylene particles are separated from the denture insert.In some susceptible patients, this can provoke an immune response. At the same time, the released phagocytes cannot eliminate plastic, the immune reaction does not stop and can lead to osteolysis of the surrounding bones, which destroys the attachment of the prosthesis in the bone, and the prosthesis is weakened.

Knee replacement surgery

The surgery to replace the knee joint prosthesis is much more complicated than the initial prosthesis installation. The amount of bone tissue required to strengthen the implant is significantly less.Therefore, replacement of the prosthesis requires special experience from the operating surgeon.

Rehabilitation and Life with Knee Prosthesis

Already on the first day after the operation, they begin to carefully perform passive joint movements using an electric bus. On the second day, intensive physiotherapy is connected: the patient is taught to move with the help of crutches. On the 4th-5th day, it is possible to walk up the stairs and to be discharged home. Upon completion of inpatient treatment in the Nordwest clinic, three to four weeks of rehabilitation follows, either on an outpatient basis or in a rehabilitation clinic.

Duration of the knee joint prosthesis

Modern knee joint prostheses last 15 – 25 years.

Duration of use of the prosthesis depends on:

• Patient weights
  The lighter the weight, the longer the prosthesis will last.
• Activities
  The more physical activity the patient experiences, the higher the risk of wear and loosening of the prosthesis. Sports with the least stress on the knee joint, such as swimming or cycling, are ideal.
• Bone quality of the patient
  The higher the bone density, the more firmly the prosthesis is anchored. In patients with osteoporosis, the prosthesis lasts less than in patients with high bone density.

How the service life of a knee joint prosthesis can be increased

1. Perform gymnastic exercises after the end of the rehabilitation period to prevent the development of joint stiffness.
2. Wear flat shoes with soft insoles.
3. In the event of purulent infections (and in other parts of the body), pay the doctor’s attention to the presence of a prosthesis and take prescribed antibiotics.
4. Avoid bending the joint more than 90 degrees.
5. Do not lift or carry heavy objects.
6. Avoid strenuous physical work.
7. Prefer sports with the least stress on the knee joints, such as swimming, gymnastics or cycling.
8. Avoid contact and traumatic sports such as football, tennis, running or equestrian sports.

Cost of knee replacement surgery in Germany

Prices for an operation to install a knee endoprosthesis, as well as to replace a worn-out prosthesis, the cost of prosthetics at the Nordwest clinic depends on the degree of complexity of bone and cartilage tissue damage, the patient’s age and individual preferences. How much does a partial or total knee joint replacement cost? , taking into account consultations, examinations and diagnostics, as well as the cost of recovery after an operation, you can clarify when you first contact the clinic by phone, by mail or through the feedback form.In addition, you can familiarize yourself with the prices for orthopedic treatment in the “Prices” section.

90,000 What is Knee Replacement?

The knee is one of the most vulnerable parts of the body and plays an important role in your daily life. With a healthy knee, you can walk, run, sit, stand and climb stairs. While your knees can support your weight, a slight bump or illness can damage your knees and cause serious problems.Sometimes pain and injury in the knee due to various reasons, such as osteoarthritis, cannot be treated in any way. Knee replacement is the most effective way to relieve pain in these conditions. What is Knee Replacement? Knee replacement is a surgical procedure in which a damaged knee joint is replaced with an artificial joint.

This is a complex and slightly complex procedure that requires surgical skills and experience, as well as special postoperative care.This article will talk about the knee replacement procedure, as well as pre- and postoperative procedures, side effects, and cost.

Types of Knee Replacement Surgery And How They Are Performed

Surgeons perform two types of knee replacement surgeries, depending on the severity of the knee injury: total knee arthroplasty and partial knee arthroplasty.

Total Knee Replacement or Replacement is suitable for people whose knee joint is completely worn out and / or damaged due to osteoarthritis, rheumatoid arthritis or other diseases.In this operation, both sides of the worn ends of the knee joints are replaced with prostheses. Total knee arthroplasty is the most common method performed on people between the ages of 60 and 80. During surgery, the doctor cuts off the worn ends of the femur and tibia and replaces them with a curved piece of metal and a flat metal plate, respectively. Then, to prevent friction, a plastic spacer is inserted between the metal parts; in fact, this plastic plate serves as cartilage.Finally, the doctor will suture the wound and you should stay in the hospital for 3-5 days.

Partial Knee Replacement is the simplest method and is suitable for patients whose knee joints have been injured on one side. Since the knee joint on one side has been replaced with a prosthesis, the wound will be minor and fewer bones will be cut in this situation. Doctors prescribe this method to 1 in 4 people with osteoarthritis, and it has a shorter hospital stay and recovery period than the previous method.Another benefit of a partial knee replacement is that you can bend your knee more naturally than a complete knee replacement.

Some of the most popular questions patients ask about knee replacement surgery are: What are knee replacement materials? Which method is best for me? In answer to the first question, the artificial knee joint consists of metal and high-quality, wear-resistant plastic. Cobalt-chromium and titanium alloys are used as metals.Which method is right for you depends on your doctor’s diagnosis and the degree of joint damage. However, keep in mind that knee replacement surgery is an important procedure that should only be considered as the last choice for patients whose pain is not relieved with physiotherapy and steroid injections .

Who Are The Best Candidates For Knee Replacement Surgery?

Endoprosthetics is the last option for people with limited mobility and pain even at rest.Over time, you may wonder what is causing the damage to your knee joints. Osteoarthritis is the main cause of knee bone damage over time, and symptoms appear with age. In addition to this, other diseases such as hemophilia , knee injury , Gout and Rheumatoid arthritis can injure the knee.

In this case, after a while, people will experience severe knee pain, which will affect their daily and daily activities and reduce their quality of life.You can try various treatments to relieve pain during this period, but when your knee joint is completely worn out, your only choice is knee replacement. There are some signs that you are ready for a knee replacement, some of which include:

• Swelling and stiffness in the knee joint
• Moderate or severe knee pain, even at rest
• Severe pain that disrupts your privacy and sleep
• Everyday tasks such as shopping and getting out of the bath become impossible.
• Pain in the knee with deformity and deviation of the knee
• Pain is not relieved even with anti-inflammatory drugs
• You are depressed due to pain and lack of mobility
• You cannot work or have a public life
• Severe knee pain restricts daily activities such as walking, climbing stairs, sitting, and getting up from a chair.

These options indicate that you need to have this operation to get back to normal. The risks and recovery times may scare you, but don’t worry; if you choose a professional surgeon, you will have no postoperative problems. In addition, preoperative preparation is required to carry out simple surgery with minimal side effects.

Before And After Knee Replacement Surgery

Before any operation, you must be mentally and physically prepared.Get more accurate and reliable information about endoprosthetics and familiarize yourself with the procedure. You can do this by reading informative articles on various websites or by asking people who have had arthroplasty to share their experiences with you. To have a short recovery period, strengthen the muscles around the knee by doing special strengthening exercises several weeks or months before the procedure. Doctors recommend light exercise, such as walking or swimming, before knee replacement surgery.To familiarize yourself with all the steps in the procedure, here are the steps to take before, during, and after your surgery.

Before Operation

• Before your procedure, you will sign a consent form, read it carefully, and ask your doctor any questions you may have.
• Your doctor may order a number of tests, such as a blood test, to make sure you are in good health before having surgery.
• Be sure to talk to your doctor about all medications, chemical and herbal supplements you are taking.
• Tell your doctor if you are allergic to any medication, anesthesia, or metal; otherwise, it could pose a serious risk to you.
• If you have a history of bleeding problems or are taking anticoagulants such as aspirin, tell your doctor.
• Avoid drinking and smoking about two weeks before surgery; otherwise, the risk of dangerous bleeding will increase on the day of surgery.
• You must fast for eight hours before the procedure.

These are some general advice that is almost the same for all patients, but the doctor may prescribe other special drugs for them depending on the patient’s physical condition and health.

Day of Operation

• Your anesthesiologist will put you to sleep with general anesthesia to make the operation easier for you.
• A urinary catheter can be inserted after you are placed on the surgical table.
• The surgeon will make small incisions at the knee surgery site.
• The worn end of the knee joint is then replaced with an artificial joint made of plastic and metal.
• Finally, stitches or staples will be used to close the incision.
• You will then be taken to the recovery room to check your vital signs.

You will not notice or feel any of the above steps.But don’t worry; the anesthesiologist and all members of the surgical team will regularly monitor your general condition and vital signs. You will be transferred to the surgical department and postoperative treatment will begin as soon as your general condition stabilizes and you come to your senses.

Post-operation

• You will be prescribed pain relievers to relieve pain
• A drain can be inserted to drain the fluid from the incision.
• 12 or 24 hours after surgery, you must stand up and walk with the assistance of

staff

• While you are in the hospital, a physical therapist will teach you certain exercises to strengthen your knee
• The day after surgery, you can slowly start to exercise

Generally, you should stay in the hospital for 3-5 days, but this can be reduced to 1-3 days, depending on your general condition.The main part of your recovery period will take place at home and you must be very careful with your new knee.

Actions Required To Care For The New Knee

There are many steps you can take to care for your new knee, but strengthening exercises are an important part of your recovery plan. Do these exercises regularly under the supervision of a physical therapist so that you can quickly resume your daily life. The following steps will also help you take care of your knee replacement:

• To reduce swelling, lift your leg while seated and apply an ice pack to the operated area every three to four hours for 20 minutes.
• For the first six weeks after surgery, do not sit cross-legged.
• Avoid physical activity that causes twisting of the knee.
• Do gentle exercise and light walking to relieve knee stiffness.
• Never place a pillow under your knee while sitting or sleeping.
• Do not drive for 6-8 weeks after surgery and always consult a doctor to resume driving.
• For the first three months, do not do heavy work at all, such as vacuuming or moving furniture. You can only do simple things like dusting and washing.
• Do not have sex for 6-8 weeks after surgery.

What Do You Expect After Knee Replacement Surgery?

Before undertaking a knee replacement, you should consider how much it will affect your return to normalcy.Most people expect this surgery to completely solve their problem, but this is an unrealistic expectation. Arthroplasty significantly reduces pain, improves mobility and improves quality of life. About 8 weeks after surgery, you can engage in activities such as walking, swimming, cycling, driving, and climbing stairs. However, keep in mind that an artificial joint will never act like a healthy knee for you and you must take great care of it.Activities such as running, jumping, hiking, skiing, tennis and lifting heavy objects can pose a serious threat to the survival of a knee prosthesis. However, this surgery will significantly reduce the pain caused by a knee abrasion, and for people who experience pain even at rest, this may be the only thing they expect from the surgery. However, in order to have a comfortable life after surgery, you need to take care of your artificial knee for many years.

How Long Does a Knee Replacement Last?

The complete recovery process after surgery takes about two years; during this time, you can speed up the recovery of the muscles around the knee with strengthening exercises. A common misconception among people who have knee replacements is that they think a prosthesis will last forever. However, this is not the case, wear and tear with daily use over time leads to damage to the plastic part of the artificial joint.According to the National Joint Register (NJR), one in 20 people who undergo surgery will need reoperation after 12 years, depending on the type of knee replacement surgery. This shows that these prostheses are not permanent and this period can be shorter if you do not take proper care of them.

Side Effects of Knee Replacement Surgery

All surgeries have side effects that can be mild or severe, depending on the patient’s condition.In addition to the patient’s condition, this may depend on the skill and experience of the surgeon. According to statistics, patients who choose professional and experienced surgeons for knee replacement experience minor postoperative complications. Arthroplasty can also cause moderate to severe side effects, which doctors report occurring in 1 in 20 cases. Fortunately, most of these side effects are minor and will go away over time. Here are some common side effects of knee replacement surgery:

• Side effects associated with anesthesia include sore throat, aches and pains, drowsiness, vomiting, trembling and shortness of breath.Side effects associated with anesthesia are rare but common in people who are allergic to anesthetic drugs.
• Deep vein thrombosis (DVT) refers to the formation of a blood clot in a vein deep within the body, which is one of the most dangerous and common side effects of orthopedic surgery. This blood clot can enter the heart and lungs through the bloodstream and can be life-threatening if left untreated.
• Unexpected bleeding inside the joint usually occurs due to the use of anticoagulants, which are prescribed to patients after surgery.
• Infection is one of the most serious and rare side effects of knee replacement surgery. According to statistics, about 1.5% of patients experience joint and wound infection within three months after surgery.

And other complications such as:

• Wound complication
• Continuing pain or stiffness
• Weakening and fracture of the implant
• Allergy To Artificial Metal Joints
• Loss of Motion
• Complications of the popliteal artery
• Nerve damage
• Death

Alternatives to Knee Replacement Surgery

The fear of surgery, especially knee replacement, is one of the main reasons why patients are always looking for alternative treatments.They usually worry about side effects, recovery, and most importantly, they don’t want to lose their knees. Currently, doctors usually offer other alternative treatments to patients. These methods include:

Mini Slit Method

Mini-incision surgery is one of the most demanded methods that the surgeon often uses for partial knee arthroplasty. In this method, the surgical team makes a smaller incision than the standard incision method and uses a special instrument to maneuver around the tissue.Shorter recovery times and no additional incision are the advantages of the mini incision surgery.

Patellofemoral replacement

Another name for patellofemoral surgery is kneecap replacement surgery, which is the best option for those with kneecap injury. Thus, thanks to this simple operation, it is no longer necessary to perform a complete or partial knee replacement surgery for a knee cap injury.

Imaging surgery

This is a modern method of endoprosthetics without incisions and postoperative complications. The surgeon uses computerized images, obtained by attaching infrared pointers to parts of your leg and surgical instruments, to perform image-based surgery.

Patient-Specific Endoprosthetics

As the name suggests, this method of arthroplasty is a specific procedure for each patient.In this method, each prosthesis is made specifically for each patient in order to ultimately be suitable for him. Patient-specific arthroplasty is an advanced type of knee replacement, and doctors believe it may last longer than a standard prosthesis.

How Much Does Knee Replacement Cost?

Artificial knee joints are usually expensive as they are made of special high quality metal and plastic.Knee replacement surgery is usually a complex and complex operation that requires high precision. Reports state that the average cost of a total knee replacement in the United States is $ 50,000, and the average cost of a partial knee replacement is 10-20% less than a total knee replacement.

And The Last Word …

If medication, changes in daily activities, and physical therapy do not help relieve the patient’s problems, knee replacement is the last choice.Before surgery, try to learn more about the procedure, side effects and recovery time. You can do this by consulting your doctor and asking him to show you a knee replacement before and after pictures, or by reading scientific articles on reputable websites. If you are one of the people who did this, record your experience for other users.

Total Knee Replacement Surgery | MRMC

Diagnosis and indications for surgery

This is a complete replacement of the articular surfaces of the knee bones with an artificial endoprosthesis with soft tissue reconstruction, consisting of a femoral and tibial component made of titanium or cobalt-chromium alloy, with a polyethylene gasket between them.The components are anchored to the bone with acrylic bone cement. Indications for surgery: arthrosis of the knee joint of various causes (primary, secondary due to systemic diseases or trauma), dysfunction of the knee joint, severe pain syndrome

Cost of the operation

Free according to the system of compulsory medical insurance quotas for High-tech medical care

Options operations

• With preservation of the posterior cruciate ligament
• Without preservation

Stages of hospitalization

Indications for surgery are determined by an orthopedic traumatologist at an outpatient appointment.For this you need:

1. Make an appointment and come to the doctor’s appointment MRMC

   If total arthroplasty is necessary, the doctor will assess the general condition of the patient, if there are no contraindications to the operation (purulent-septic wounds, obesity, vascular and nerve pathologies), he will give a list of necessary diagnostic procedures and analyzes for preparation and appoint the date of the appointment of the anesthesiologist to determine the date of the operation.

2. On the day of surgery

   The patient arrives in the morning, medical records are entered on him, after which he is taken to the preoperative ward.The operation takes 35 to 90 minutes, after which the patient is observed in intensive care for a day. After that, the patient is transferred to the department of traumatology and orthopedics, where he sits down and learns to walk with support on a walker or crutches, learns the orthopedic and therapeutic regimen, which the patient must observe from 3-6 months, on the 4th day of treatment, the patient is discharged, he receives hands an extract indicating recommendations for further treatment.

Approximate standard list of tests

• General urine test
• Clinical detailed blood test with ESR
• Coagulogram
• Biochemical blood test (creatinine, urea, total cholesterol, ALS, glucose )
• Tests for HIV, syphilis, hepatitis B and C
• Blood group and Rh factor
• ECG results
• Echocardiography (ultrasound of the heart)
• Duplex scanning of the veins of the lower extremities
  9000 Examination of an ENT doctor, therapist, cardiologist, dentist
• In case of presence or detection of pathology – consultation of a specialized specialist.

Knee arthroplasty – Clinics of Belarus

Knee arthroplasty

Knee arthroplasty is a surgical operation that consists in replacing the affected surfaces of the knee joint with artificial components that resemble normal articular surfaces in their shape.

Why is knee replacement surgery performed?

Knee arthroplasty performed with the aim of :

• elimination of joint pain,

• increasing the range of motion in the joint,

• elimination of deformity of the lower limb,

• restoration of the function of the lower limb.

The need for arthroplasty of the knee arises due to a number of diseases leading to damage to the knee joint:

• rheumatoid arthritis,

• degenerative-dystrophic diseases (arthrosis),

• post-traumatic arthrosis,

• damage to the ligamentous apparatus of the joint, leading to deformation of the articular surfaces.

Patients are worried about joint pain, limitation of range of motion, impaired support function of the limb, and its deformity.

Knee arthroplasty – a reliable way to get rid of unbearable pain and restore movement in the joint!

Knee endoprosthesis includes a femoral and tibial components made of metal and a plastic insert between them, consisting of high-polymer polyethylene.

There are knee arthroplasty to replace only the affected part of the joint (unicompartmental endoprostheses) and to replace the entire affected joint (total endoprostheses).In the case of functional insufficiency of the ligamentous apparatus of the knee joint, posterior stabilized and rotationally linked models of endoprostheses are used. Endoprostheses are fixed using bone cement.

Traumatologists-orthopedists of the Republic of Belarus use implants for knee arthroplasty only from the world’s leading manufacturers Waldemar Link, DePuy, Covision, Biomet.

How is the operation performed?

The operation is performed under general or local anesthesia.During the operation, the patient is in the supine position. The joint is accessed along its anterior surface. During the surgical intervention, the altered articular surfaces are filing according to special templates and guides. Then the endoprosthesis is implanted, as a rule, on bone cement, which ensures fast and strong fixation of the implant.

The duration of the operation is 1 hour 30 minutes.

On the first day after the operation, the patient is in the intensive care unit, and then transferred to the ward.

The total length of hospital stay is 15 days.

Indications and contraindications for knee replacement surgery.

The decision to perform knee arthroplasty is made by a traumatologist-orthopedist on the basis of complaints, clinical examination of the patient, data of X-ray examination of the knee joint, and, if necessary, other auxiliary examination methods. The type and size of the knee joint replacement is individually selected for each patient based on a thorough examination and preoperative planning.

The main contraindications of to the operation are:

• allergy to materials of which the prosthesis is made,

• pathology of the blood coagulation and anticoagulation system,

• severe stage of somatic pathology (cardiovascular morbidity, pulmonary, renal failure),

• presence of an acute infectious disease,

• age up to 25 years,

• presence of malignant neoplasms,

• obesity stage 3-4,

• endocrine diseases in which the metabolism of bone tissue is impaired.

Postoperative period.

In the postoperative period, the patient is prescribed the necessary medication and physiotherapy treatment. As a rule, a dosed load on the operated limb is recommended, walking with support on crutches for a certain period of time. Particular attention is paid to the restoration of the function of the limb muscles and the development of movements in the operated joint.

As with any surgery, after knee arthroplasty, in rare cases, the development of complications can be observed, the main of which are thromboembolic complications, blood loss, and infectious complications in the joint area.

A correctly installed knee endoprosthesis can last up to 15 years. If the implant is worn out, surgery may be necessary to replace it.

Why choose Belarus?

Traumatologists-orthopedists of Belarus have accumulated significant experience in performing knee arthroplasty operations. So, in the Republican Scientific and Practical Center of Traumatology and Orthopedics, the Minsk Regional Clinical Hospital, the 6th City Clinical Hospital, more than 1000 such operations are performed annually.