What You Should Know about Knee Surgery

 

Knee replacement surgery or joint replacement surgery has become a very sophisticated form of knee surgery. Whether it’s total knee replacement surgery or partial there are now surgical advancements that can have you on your feet again very quickly.

Orthopedic knee surgery has become a common medical procedure that is performed on over 400.000 people worldwide each year. That number accounts for both major surgeries like total and partial knee replacement surgery and less invasive procedures like knee arthrothscopy.

The main aim of the orthopedic knee surgery is to increase mobility and reduce the pain associated with knee injuries and disease.

Total or partial knee replacement surgery is called knee arthroplasty and is most commonly performed in severe cases of degenerative arthritis, like osteoarthritis and other severe debilitating disabilities such as ligament and meniscus tears and cartilage defects. Arthritis knee surgery and knee replacement for the elderly is a frequently used method to help them improve mobility and reduce pain. In this procedure, the orthopedic surgeon replaces the damaged areas with specially shaped plastic or metal replacements. These replacements are now very sophisticated and have a life of up to 20 years depending on how the activeness of the recipient.

Very basically, Arthroscopy is the less invasive form of orthopedic knee surgery. The surgeon uses Arthroscopic knee surgery to remove loose bodies in the joint and to correct less severe problems like smoothing rough bone surfaces or removing debris and cleaning the area. In this procedure your orthopedic surgeon inserts a tiny camera and scope into the area. In many cases, this simpler procedure is sufficient to alleviate the symptoms.

In partial and full knee replacement surgery, like with any operation, there are risks and knee replacement problems can occur. The American Academy of Orthopedic Surgeons cites blood clots in leg veins being the most common. However, there are guidelines that your surgeon would outline for you to help prevent this complication after knee replacement surgery. Some of the measures are knee replacement post surgical rehab exercises aimed at increasing circulation, blood thinning medication and even simple items like support stockings. In rare instances the kneecap can dislocate necessitating further surgery to realign it. Sometimes full motion of the knee is not achieved and stiffness in the knee joint is sometimes felt.

What to expect after knee replacement surgery? You can expect to stay in the hospital after the operation less than one week. The length of stay depends on your level of health and on the amount of support available at home. It usually takes around 6 weeks until you are able to take your full weight on the knee with the assistance of a cane for support. Full recovery can take up to three months with some patients experiencing gradual improvement for some time after that.

What is the cost of knee replacement surgery? This depends on many factors depending on the type of implant used. Your orthopedic surgeon will be able to discuss the costs of both arthroplasty (total or partial knee replacement surgery) and Arthrothscopy (the less invasive procedure). Orthopedic knee surgery is usually covered by most insurance plans, but it would be wise to check first.

Risks of Knee Replacement Surgery
 

•  Blood clots in the leg veins are the most common complications and the preventive measures are elevation of the leg, an exercise routine, support stockings and blood thinning medications.

•  Fractures of the leg bones either during the knee replacement surgery or shortly after it. These mostly occur in older patients.

• Stiffness of the knee joint and limited range of motion. Both of these can be relieved with physical therapy.

•  Instability of the kneecap and its tendency to dislocate which may require additional surgery.

•  Loosening of the implanted components.

• Heart attack.

• Stroke.

• Nerve damage.

• Onset of infections:
      - Positive intraoperative culture is contracted during the surgery.
      - Early postoperative infection occurs within the first month after the surgery.
      - Acute hematogenous infection is spread through the bloodstream.
      - Late chronic infection sets in and hangs on for an extended period of time.
      - Periprosthetic infection is the most difficult infection to deal with but its occurrence is rare.

The Benefits of Knee Replacement Surgery

A study out of Duke University has found total knee replacement surgery improves mobility in older adults with severe arthritis.

Knee replacement surgery, or as it is also referred to as arthroplasty, is a remedial surgical course of action to alleviate the disabling pain and immobility caused most often by traumatic injuries such as the tearing or the detachment of the meniscus, cartilage or ligaments; by anatomical defects; or any one of several degenerative arthritic conditions most common of which is osteoarthritis but also the infectious or inflammatory arthritis such as Rheumatoid, Lupus or Psoriatic as well as avascular necrosis (dying bone tissue due to an obstructed blood flow).


Total Knee Replacement Surgery

You will most likely be admitted to the hospital on the day of your surgery. After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia, in which you are asleep throughout the procedure, and spinal or epidural anesthesia, in which you are awake but your legs are anesthetized. The anesthesia team will determine which type of anesthesia will be best for you with your input.

The procedure itself takes approximately 2 hours. Your orthopedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee.

 

Many different types of designs and materials are currently used in total knee replacement surgery, nearly all of which consist of three components: the femoral component (made of a highly polished strong metal), the tibial component (made of a durable plastic often held in a metal tray), and the patellar component (also plastic).

 

After surgery, you will be moved to the recovery room, where you will remain for 1 to 2 hours while your recovery from anesthesia is monitored. After you awaken, you will be taken to your hospital room.

 

Partial Knee Replacement Surgery

 

Although not as common as total knee replacement, the partial or unicompartmental knee replacement (commonly called the "uni") is a viable alternative in limited situations. The designs of the unicompartmental types of knee replacements have improved over the years, as has the sophistication of the instruments used to implant these types of artificial joints. The unicompartmental knee replacement also has smaller, less invasive incisions.

 

The unicompartmental knee replacement is used to replace a single compartment of the arthritic knee. The knee joint has three compartments: the medial (inner) compartment, the lateral (outer) compartment, and the patellofemoral (kneecap) compartment. If the damage is limited to either the medial or lateral compartment, that compartment may be replaced with the unicompartmental knee implant.

 

If two or more compartments are damaged, unicompartmental knee replacement may not be the best option. Unicompartmental knee replacement is also less desirable for a young, active person because it may not withstand the extremes of stress that high levels of activity create. It is best suited for the older, slim person with a relatively sedentary lifestyle. Only between 6 and 8 out of 100 patients with arthritic knees are good candidates for unicompartmental knee replacement.

 

Because the unicompartmental knee replacement can be inserted through a relatively small incision (approximately 3 to 4 inches long), which does not interrupt the main muscle controlling the knee, rehabilitation is faster, hospitalization is shorter, and return to normal activities is more rapid than after a total knee replacement.

However, this is still a serious surgical procedure, and has all of the same risks as total knee replacement. These risks, as well as whether you are a good candidate for unicompartmental knee replacement, should be discussed with your orthopedic surgeon.

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Minimally Invasive Knee Replacement

 

A recent advance in the performance of total knee replacement is the use of minimally invasive surgical approaches. This technique, still in its relative infancy, is more challenging than standard total knee replacement. The incisions are approximately half the size of those used in a standard approach. The smaller incisions and new techniques to expose the joint may result in short-term advantages such as a quicker rehabilitation, less pain, and a shorter hospitalization, according to some reports.

 

The minimally invasive approach to the total knee replacement is appropriate for non-obese patients who have reasonable motion without significant deformity. Hospitalization may be reduced to 1 to 3 days among these patients, and the need for an extended stay for inpatient rehabilitation may be reduced or eliminated in most patients.

 

Although some studies show shorter hospitalizations and rehabilitation periods, other studies find minimally invasive surgical techniques to be no better than standard techniques. Although the risks are not well known, they are probably comparable to those for a standard total knee replacement. Speak to your orthopedic surgeon about whether you are an appropriate candidate for this particular approach to total knee replacement.

Arthritis -- Surgical Treatment
If your arthritis does not respond to nonsurgical treatments, you may need to have surgery.
There are a number of surgical options, including the following: