Also known as Knee Arthroplasty, Knee Replacement Surgery is regarded as a modern surgical technique which can accurately be described as a ‘knee resurfacing’ procedure. This surgical intervention entails restoring weight bearing facade of knee joint which is damaged or worn out, or diseased so as to relieve pain & improve movement disability. Knee joint replacement surgery is normally performed through an orthopedic implant made of plastic & metal components shaped like the joint in order to help the knee move properly. Arthroplasty basically is a field of medicine which involves total replacement & surgical reconstruction of degenerated joints with help of prosthetics (artificial body parts).
Knee Pain & Artificial Knee Implants
Whenever articular cartilage of knee wears out or becomes damaged, it becomes painful & the patient finds it extremely difficult to move the knee. Bones involved in the knee joint in this condition rub & crush one another, rather than sliding over each other with minimum of friction. For this reason, artificial knee joint prosthesis is surgically implanted which make the patient relieve pain & allow the knee joint to function properly. As of now, almost 600,000 knee replacement surgeries are carried out in United States alone, with most patients being seniors over 65 years of age.
More about Knee Joint Replacement Surgery Procedure
Knee replacement surgery results for most patients will last for at least 15 – 20 years of time, especially when it is carried out properly & subsequently not put under too much of strain. More than 90 percent of the patients who have undergone successful total knee replacement surgeries experience dramatic decrease in knee pain alongside significant improvement in performing common day-to-day activities. Total knee replacement surgery will not however allow patients to do more than normally they could before developing diseases which called for this procedure in the first place. Moreover, it has been observed that women patients tend to have more severe symptoms & worsening functions of knee prior to undergoing surgery; but women are however found to recover faster after knee replacement surgery when compared to men. Nevertheless, although men may be taking longer time to recover, they almost catch up within 12 months of time with women patients.
Common Reasons to Undergo Knee Replacement Surgery
Knee joint replacement surgery nowadays is considered to be a routine operation. The three most common reasons for people to undergo total knee replacement surgery are listed below:
- Osteoarthritis – This is one of the most common types of arthritis which is normally age related. It is caused by general long-term wear & tear of the knee joint. Majority of patients suffering from osteoarthritis are over 50 years of age. However, younger people are also sometimes found to be affected by this condition. Osteoarthritis is generally caused by breakdown, inflammation & long-term gradual loss of cartilage within the knee joint. Following which joint bones are found to rub against each other for few years before they compensate by growing thicker. However, this will eventually only result in generating more friction & more pain.
- Rheumatoid Arthritis – Also known as inflammatory arthritis, rheumatoid arthritis occurs when membrane surrounding the knee joint is thick & inflamed. This inflammation will usually become chronic & may eventually damage cartilage causing stiffness & soreness.
- Post Traumatic Arthritis – This type of arthritis is usually caused due to severe knee injuries. When ligaments around knees tear or bones break, it will usually affect the knee cartilage. In some cases surgery may be the best option to treat them.
When Should a Person Seek Knee Replacement Surgery?
Knee replacement surgery is commonly recommended for older people, though people of any age including teenagers & adults can be candidates for surgery. Body weight, gender or age of the patient is not relevant factors while considering knee joint replacement surgery. Whether or not to perform knee replacement surgery is almost always based upon the severity of pain & the degree of disability of the person seeking treatment. However, it should be noted that knee replacement surgery which is performed early in life will usually mean that the patient will require further revision surgery later on. Moreover, it is now a proven fact that when knee joint replacement surgery is performed prior to setting in of severe pain & stiffness, it usually results in better outcomes. Nevertheless, while considering option of knee replacement surgery, orthopedists would take into account a number of symptoms including the following.
- Severe Knee Pain or Stiffness – When symptoms seriously undermine ability of patients to carry out normal daily activities like walking, climbing stairs, getting up from chairs & in & out of cars.
- Moderate & Continuous Knee Pain – When this type of pain is also present when the patient is resting or sleeping.
- Chronic Knee Inflammation & Swelling – When swelling does not improve even after resting or with medications. Sometimes, even drugs can cause unpleasant side effects.
- Knee Deformity – This often refers to a noticeable arch which is found inside or on the outside of knee.
- Knee Joint Replacement Surgery as Last Resort – When symptoms fail to substantially improve even after the patient has undergone physical therapy & taken prescribed medications.
- Depression – Depression can often be a serious problem & trigger debilitating & devastating illnesses. Problems with mobility along with chronic pain can often lead to depression, especially when patients are unable to properly perform normal daily routine or social activities. Knee joint replacement surgery is an ideal procedure which can either prevent or get rid of depression in such cases.
Preparing for Knee Replacement Surgery
Knee replacement surgery is a major surgery which requires careful planning including physical evaluations, medical consultations & pre-operative preparations that usually begin about a month before the actual date of operation. For this purpose patients will have to undergo a series of diagnostic & preparatory tests which include procedures like urine examination, electrocardiograms, evaluating the patient’s capacity for blood clots & checking the blood count. Knee joint replacement surgery is usually performed under general anesthesia or under the influence of spinal or epidural anesthetic. Orthopedists in consultation with anesthesiologists will usually determine on the day of surgery as to which type of anesthetic will be more suitable for the patient. Knee arthroplasty operation normally lasts for about 1 – 2 hours of time. During this time orthopedic surgeons will remove damaged bone & cartilage & subsequently position the new plastic or metallic implant in order to restore proper alignment & practical function of knee.
Types of Knee Replacement Surgeries
- TKR or Total Knee Replacement Surgery – TKR surgery involves replacement of both sides of knee joints. It is one of the most common knee procedures performed, TKR surgery usually lasts anywhere between 1 – 3 hours of time. Artificial implants which are placed through surgical interventions usually last anywhere between 15 – 20 years for most patients. There will be scar tissue following TKR surgery despite having better mobility & much less pain in knee. Although, TKR surgery is a more reliable long-term knee procedure, there may always be some difficulty in moving or bending knees.
- PKR or Partial Knee Replacement Surgery – PKR surgery is usually performed only when one side of the knee joint is required to be replaced. However, PKR surgery may not last as long as TKR procedure would. Nevertheless, less bone is removed in this operation & therefore incisions are also smaller in size. PKR surgery is found to be suitable in among 25 percent of the patients with osteoarthritis. PKR surgery generally requires shorter stays at the hospital along with shorter recovery periods. It also involves simpler postoperative rehabilitation with lesser blood loss alongside lower risk of blood clots & infection. Moreover, PKR surgery is found to result in more natural movement of the knee & most patients are able to get up & move about more rapidly after operations than TKR surgery patients can do.
Alternative Surgical Options to Knee Replacement Surgery
There are a number of surgical alternatives which can be considered to knee joint replacement surgery in some cases, largely depending upon the severity of wear & tear in individuals. However, it is knee joint replacement surgery which tends to provide better long-term results.
- Kneecap Replacement – Medically known as patellofemoral joint arthroplasty, this procedure can be performed when it is only the kneecap which is damaged. This is a short surgical procedure which requires a shorter time for recovery.
- MIS – Mini-Incision Surgery – Most commonly used in PKR surgery, MIS is still considered as a new surgical technique. The only difference in this type of surgical intervention is that orthopedists operate through a very small incision which is made in front of knee rather than making the traditional larger opening for operation. New specialized surgical instruments are inserted through these minimally invasive small openings in order to maneuver around tissues, rather than cutting through them. Recovery time is also much quicker & less painful with this procedure as it is less harmful to the joint.
- Image Guided Surgery – Though this surgical technique is considered a highly accurate alternative procedure in positioning the new artificial knee joint, it is still not commonly utilized. In fact, image guided surgery is applied in only 1 percent of knee replacement procedures which are performed. During this procedure, orthopedists utilize computerized images & infrared beacons to perform surgery while sitting in a separate room from the operation theater.
- Arthroscopic Washout & Debridement – Arthroscope basically is a tiny telescope which is inserted through small incisions made in the knee for purpose of operation. The knee joint is subsequently washed out with saline solution in order to clear away tiny bits of bones. This procedure is therefore not advisable for patients having severe arthritis.
- Osteotomy – Osteotomy is basically an open operation which involves cutting the shin bone & realigning so that body weight of the patient no longer bears down on one portion of the knee. Sometimes, this procedure is utilized for young patients with limited arthritis in order to enable postponing knee replacement surgery. Patients undergoing osteotomy should be frankly informed that they may eventually be required to undergo knee joint replacement surgery at a later date.
- ACI – Autologous Chondrocyte Implantation – ACI procedure involves extraction of new cartilage from the patient’s own cells & then subsequently artificially matured within a test tube in order to be introduced in the damaged area at a later stage. This is a common procedure which is utilized when patients have injured knees in an accident. ACI procedure is normally utilized for patients with accidental injuries than those with arthritis.
Risks & Complications Associated with Knee Replacement Surgery
Orthopedists suggest that knee joint replacement surgery is having extremely low rates of complications which are found to occur in fewer than 2 percent of the patients. However, complications when they arise include heart attack, infection in knee joint, DVT or Deep Vein Thrombosis & stroke. Damage to nerve is found to occur in among 1 – 2 percent of the patients. Moreover, stiffness or persistent pain in joints is found to happen in 8 – 23 percent of the patients. About one in every 50 knee replacement surgery patients are found to experience failure of prosthesis within 5 years following operation. Other complications are also found to occur in about one out of every 20 surgeries, but most of these are however minor & therefore can be successfully treated. Some of these most common complications include the following.
- Continuous pain following knee replacement surgery.
- Allergic reactions to bone cement.
- Excessive bone formation around artificial knee joint implant which is restricting movement of knee.
- Excessive scar tissue restricting movement of knee.
- Infection of wound during healing.
- Fracture in bone around artificial joint implant during or after surgery.
- Instability of kneecap resulting in pain & dislocation on the outer side of knee.
- Nerve, artery or ligament damage in areas around knee joint.
- Stiffness & loss of motion in knee joint.
- Numbness in area around incision scar.
- Dislocation of the kneecap.
- Unforeseen bleeding within knee joint.
- Wearing down of implant surfaces due to loosening of components.
Recovery at Hospital Following Knee Replacement Surgery
Knee wound resulting from incision following total knee replacement surgery will finally be closed with staples. Although, patients may feel pain following the operation, it is extremely important that a physical rehabilitation program is strictly adhered to. Hospital staff will possibly try to encourage patients to get up & try walking a day after the operation, with help of a walking aid. Physical therapy sessions are normally aimed at strengthening the knee. It may however hurt at first, but these sessions are crucial because they can significantly reduce risk of future complications. Knee replacement surgery patients can also utilize a passive motion machine in order to restore movement in knee & leg. Patients undergoing knee replacement surgery are usually hospitalized for 5 – 10 days of time following operation. Duration of stay at the hospital will depend upon how well the patient is responding to rehabilitation. Patients not having adequate help at home are advised to stay at the hospital for longer periods of time.