If your knee is affected by arthrosis, it may be difficult for you to perform simple activities such as walking or climbing stairs.In advanced stages of arthrosis you may even start to feel pain while lying down (at rest).
If non-surgical treatments such as medication, physiotherapy, intra-articular infiltrations are no longer able to control the pain, then you may consider knee replacement surgery. Knee replacement surgery is a safe and effective procedure to relieve pain, correct a deformed knee and help you resume normal daily activities.
Knee replacement surgery was first performed in 1968. Since then, a multitude of improvements in surgical materials and techniques have been made to increase its efficiency. Total knee arthroplasties are one of the most successful surgical procedures in all of medicine. According to the Agency for Healthcare and Quality Research, more than 600,000 knee operations are performed each year in the United States.
Anatomy
The knee is the largest joint in the body, it consists of the distal portion of the femur, the proximal portion of the tibia and the patella (patella). The ends of these three bones that meet in the knee joint are covered with articular cartilage.
Menisci are located between the femur and tibia. These C-shaped linings act as ‘shock absorbers’, like an air cushion for the cartilage.
The cruciate ligaments, collateral ligaments, femur and tibia, together provide stability to the knee…
All of the non-cartilage-covered surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid, synovial fluid, which lubricates the cartilage, reducing friction in a healthy knee,.
Normally, all these components work in harmony. But various conditions can disrupt this harmony, leading to pain, muscle weakness and reduced knee function.
Causes
– Knee arthrosis (gonarthrosis) is an age-related “wear and tear”. It usually occurs in people over the age of 50, but can also occur in younger people. The cartilage between the knee bones becomes brittle and wears away. The bones then rub against each other, causing knee pain and joint stiffness.
– Rheumatoid arthritis. This is a disease in which the synovial membrane surrounding the joint becomes inflamed and thickened. This chronic inflammation can lead to damage to the cartilage and eventually lead to complete cartilage loss, pain and stiffness.
– Post-traumatic arthritis. This can lead to serious knee injury. Joint fractures of the proximal femur or distal tibia or injuries to the cruciate ligaments can lead to damage to the articular cartilage over time, causing knee pain and limiting knee function.
Description
A knee replacement (also called knee arthroplasty) is actually a replacement of the distal portions of the femur and tibia.
There are four basic steps to a knee replacement procedure.
– Bone preparation. The damaged cartilage surfaces at the ends of the femur and tibia are removed, along with a small amount of underlying bone.
– Positioning the metal implant. Removed cartilage and bone are replaced with metal components that recreate the joint surface. These metal components can be cemented or uncemented.
– Patella repair. The articular part of the kneecap is cut and reshaped with a plastic knob, but this is not always necessary
– Inserting a spacer. Insert a spacer made of medical grade medical plastic between the metal parts to create a smooth surface.
Is total knee arthroplasty right for you?
The decision to have knee brace surgery should be a cooperative one between you, your family, your family doctor and your orthopedist. Your family doctor can give you a referral to an orthopedist for a complete evaluation and to determine whether you may benefit from this surgery.
When this type of surgery is recommended
There are several reasons why your doctor may recommend knee replacement surgery. People who have knee replacement often have the following symptoms:
– Severe knee pain or stiffness that limits daily activities, including walking, climbing stairs and sitting/standing in a chair.
– knee pain, moderate or severe even at rest either day or night
– chronic inflammation of the knee that does not improve with rest, medication.
– knee deformity
– inability to substantially improve the pain with other treatments such as anti-inflammatory drugs, cortisone injections, injections with vascoelastic solutions, physiotherapy.
Candidates for surgery
There is no age limit or weight restrictions for knee replacement surgery.
Recommendations for surgery are based on a patient’s pain and disability, not their age. The age group that most commonly benefits from knee replacement is between 50 and 80. Total knee arthroplasties have been successfully performed in all ages, from young adolescents with juvenile arthritis to elderly patients with degenerative arthritis.
Orthopedic evaluation
An evaluation of the patient by an orthopedic doctor is composed of the following::
– a medical history.The orthopedist will gather information about the patient’s general health and will ask about the degree of pain in the knee and its ability to function.
– a physical examination. This will assess knee motion, stability, strength and changes in the axis of the lower limb
– X-rays. These images help determine the degree of damage and deformity of the knee.
– other tests. Occasionally blood tests, or advanced imaging tests such as magnetic resonance imaging (MRI), may be needed to definitive the diagnosis.
The decision to have knee replacement surgery
Realistic expectations
An important factor in deciding whether to have knee replacement surgery is understanding what the procedure can and cannot do.
More than 90% of people who have had this type of surgery have noted a great reduction in knee pain and a significant improvement in their ability to perform daily activities. But total knee replacement will not allow you to do any more than you were able to do before the onset of gonarthrosis.
The orthopedic doctor does not recommend strenuous activities after knee replacement surgery (e.g. running, jumping, etc.), also does not recommend weight gain, as it can lead to faster wear of the implant.The doctor may recommend walking, swimming, golf, driving, hiking, cycling, dancing and any sport with low impact on the implant.
Possible complications of surgery
The rate of complications in total knee replacement surgery is very low. Serious complications, such as a knee joint infection, occur in less than 2% of patients. Major medical complications such as heart attack or stroke occur very rarely.
– Infection.May occur during hospitalization or after you get home.Sometimes it can occur years later. Minor wound infections are generally treated with antibiotics. Major or deep infections may require more surgery and sometimes temporary removal of the prosthesis.
– Blood clots. Blood clots in leg veins are the most common complication of knee replacement surgery. These clots can be life-threatening if they travel to the lungs. Your orthopaedic surgeon will present you with a prevention program, which may include elevated leg positioning (on a pillow), lower limb exercises with lower intensity to stimulate blood circulation, medicated stockings and blood-thinning medication.
– Implant problems. Although we now have the most advanced implant designs and materials and the most advanced surgical techniques, problems can still occur with some components, such as loosening of the implant and contact with the bone. In addition, although there is an average movement of 115° postoperatively, sometimes retractile scars appear after surgery, which will limit movement in the operated knee.
– Pain continues. A small number of patients continue to have pain after knee replacement. This complication is rare
– Neurovascular problems. Rarely, nerve or blood vessel damage to the nerves or blood vessels in the knee can occur during surgery.
Preparing for surgery
Medical evaluation
If you decide to have knee replacement surgery, a pre-anesthetic consultation should be done beforehand. This is necessary to ensure that you are healthy enough to undergo surgery and complete the recovery process. Many patients with chronic medical conditions, such as heart disease, may also be evaluated by a heart specialist before surgery.
Tests
Several tests, such as blood and urine samples, and an electrocardiogram, may be needed preoperatively.
Medicines
Inform your orthopaedic doctor about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.
Dental assessments
Although the occurrence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as dental and periodontal extractions) should be completed before total knee replacement surgery.
Urinary evaluations
People with a history of recent or chronic urinary tract infections should have urologic testing before surgery. Older men with prostate disease should consider completing treatment before having knee replacement surgery.
Social planning
Although you will be able to walk in a crutch or cane shortly after surgery, you will need help for several weeks with routine activities such as cooking, shopping, bathing and laundry.
Planning in your home
You can make several modifications in your home to make it easier to move around and recover. The following modifications can help you in your daily activities:
– safety bars fitted to the shower or bath
– safe handrails along hallways
– a stable recovery chair with a firm cushion and a height of 18-20 cm, with a firm back, two arms and a stool to keep the leg in a raised position
– a toilet seat with arms, in case you have a small toilet
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