Total knee replacement
Total knee replacement involves the resurfacing of the worn out parts of the knee using a metal component on the end of the femur and the top of the tibia, with a plastic bearing in between. Some surgeons also put a plastic component on the back of the kneecap. The way in which a knee replacement relieves pain is simply by removing the source of the pain which is the bone grinding on bone; the knee lining is effectively resurfaced.
Reasons for Procedure
This is done if you have pain and stiffness in the knee joint that limits activities. Before surgery, other measures are tried, such as:
- Physical activity
Knee replacement surgery is most often done to:
- Ease knee pain and disability due to arthritis, or previous severe knee injury
- Correct a knee deformity (eg, knee bows in or out)
Complications are rare but no procedure is completely free of risk. If you are planning to have a knee replacement, your doctor will review a list of possible complications,
which may include:
- Blood clots
- Excessive swelling or bleeding
- Injury to nearby nerves or blood vessels
- Anesthesia-related problems
Some factors that may increase the risk of complications include:
- Pre-existing medical conditions
- Current infection
- Taking steroid medication
Be sure to discuss these risks with your doctor before the surgery
What to Expect ?
Prior to Procedure
Your doctor will likely do the following:
- Physical exam
- Blood tests
- X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones
- MRI scan —a test that uses magnetic waves to make pictures of structures inside the body Leading up to your procedure:
- If you are overweight, lose weight. This will help to decrease the amount of stress on your new joint.
- Make home modifications to help make recovery easier:
- Install equipment to help keep you safe, such as:
- Safety bars
- Raised toilet seat with arms
- Shower bench and shower hose
- Handrails on stairways and steps
- Remove items that could cause falls. These might include throw rugs and extension cords.
- Make sure you have a firm-backed arm chair and a footstool.
- Stay on the first floor. Climbing stairs will be difficult at first.
- Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners like clopidogrel (Plavix) or warfarin (Coumadin)
- If advised by your doctor, take antibiotics.
- Arrange for a ride to and from the hospital. Also, arrange for help at home.
- Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
Benefits and risks of total knee replacement
Severe pain is the main reason for having a total knee replacement. Associated problems such as deformity of the knee because of the arthritis (e.g. bow legs) and reduction in function, will improve following knee replacement but in themselves are not a reason for having the operation.
There is no operation which does not carry some risks.
The main risks of total knee replacement are:
Infection (the chances of a serious deep infection affecting a total knee replacement are approximately 1%, although up to 2-3% may develop a simple wound infection).
Deep venous thrombosis (DVT, blood clots) affecting the lower leg can occur but precautions are taken to reduce the chance of this either in the form of blood thinning tablets or injections, or special calf pumps to keep the blood flowing. Pulmonary embolism (PE) is a rare but serious complication arising when a blood clot obstructs some of the veins in the lungs.
Nerve damage can occur, but this is usually seen in the form of a numb patch of skin to one side of the scar. It is extremely rare to have nerve damage from a knee replacement causing weakness in the leg or foot.
Stiffness: sometimes despite having a technically successful operation, the knee can be stiffer than hoped for which can result in aching and general dissatisfaction. It is not always possible to work out a reason for this.
The above are some of the major and more commonly occurring early risks from knee replacement but your surgeon or physiotherapist will discuss and answer any more specific questions with you.
On average, you have approximately a 95% chance of getting a good result from a knee replacement, giving you pain relief for at least 10 years. It may eventually fail by wearing out or loosening, amongst other things.
Uni-compartment knee replacement (UKR)
If your knee arthritis affects only one of the three major compartments of the knee you may be suitable for a uni-compartment, sometimes called a half knee replacement. The most usual site for this is the medial (inner) compartment of the knee. Mobile bearing knee replacements
In either TKR or UKR, the plastic bearing which sits between the two metal components may be fixed (a fixed bearing knee replacement) or mobile. A mobile bearing means that the plastic is not fixed rigidly to the tibial component, and can move around in a number of planes. Depending on the actual implant used this movement may take place backwards and forwards, sideways, rotation or a combination.
Minimally invasive total knee replacement
Whether you have a TKR or UKR, the smallest possible incision will be used which allows safe and satisfactory implantation of the knee replacement.
You maybe aware of minimally invasive total knee replacements, put in through small incisions using special instruments. This type of operation is available for selected patients. There may be a short term benefit with less post operative pain and quicker recovery. There is no proof yet that it is a better procedure in the long term. It is technically more difficult and there may be some increased risks. Studies are being undertaken at the moment to answer some of the questions.
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- Install equipment to help keep you safe, such as: