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What is knee replacement? When is knee replacement advised by doctors?
Knee replacement is a surgical procedure which involves the replacement of the diseased or damaged joint surfaces of the knee with an artificial structure or prosthesis. The surgery is performed with metal or plastic components to allow the easy movement of the knee.
The knee is the largest joint of the body. It bears the body’s weight and to perform daily activities with ease, the knee joints should be healthy. Conditions like trauma or injury or age-related degeneration of the knee joint can lead to damage of the knee joints. The knee replacement surgery is often recommended when a personis suffering from one of the following symptoms:
- Difficulty in walking or performing day to day activities such as climbing chairs, getting in and out of chairs due to severe pain the need to use a walker or cane.
- Discomfort due to moderate or severe pain while resting.
- Knee gets swollen and it does not improve by rest or medications.
- Progressive deformity in knees.
- Anti-inflammatory medications, cortisone and lubricating injections, physical therapy etc. do not provide any relief in pain or discomfort in the knee joint.
How is knee replacement surgery done?
Replacement of surface of the bones in knee replacement surgeryis also known as knee resurfacing.
The four commonly performed steps in knee replacement surgery are:
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- The knee is kept in bent position so that all joints are exposed.
- Anincision of 6 to 8 inches is made and the kneecap is moved aside. The orthopedic surgeon removes the damaged cartilages at the surface of tibia and femur along with a small amount of underlying bone.
- This removed part is replaced with the artificial components which make up the surface of the joint. These artificial components can be cemented or fitted into the bone.
After that, the surface below the kneecap is cut and is resurfaced with a plastic button but this procedure varies depending on the case.
- In the end, the smooth gliding surface is created by inserting a medical grade plastic spacer between the components.
- Before the incision is sealed, the surgeon ensures the proper functioning of the knee by rotating or bending the knee.
- The knee replacement surgery lasts for about two hours.
What are the different types of knee replacement surgery/procedure options?
All of the knee replacements are not the same. Knee replacements are of different types:
- Total knee replacement: This is the most common form of surgery. Here the surfaces of the thigh bone and shin bone which connects to the knee get
- Partial knee replacement: This surgery is performed using a smaller incision as compared to total knee replacement surgery. It is usually performed when you have strong knee ligaments and only one side of knee gets affected.
- Kneecap replacement: In this surgery, only the surface below the knee gets replaced but total knee replacement is preferred due to the higher rate of success.
- Complex or revision kneecap replacement: When the patient has undergone two or three knee replacement surgeries due to severe arthritis, this type of surgery is preferred.
- High flexion knee replacement: This is considered as the leading option for joint replacements. It offers the flexibility of motion of 155° as compared to the regular motion of 125°.
What factors should be considered in selecting the ideal prosthesis or implant?
The prosthetic or artificial implants are generally made of cobalt chrome, titanium,and polyethylene (plastic). These implants can be fixed to the bone by acrylic cement or press-fit and bone grows into the implant. The factors related to patients decide prosthetic implant design, material and fixation method. The type of knee replacement best suited for the patient is selected based on the bone loss due to arthritis and quality of ligaments supporting the knee.
Factors that are considered while choosing an implant include:
- The durability of the implantwith the life-span of approximately 15-20 years.
- Ability to offerflexibility with the movement of the knee.
- The chosen implant should be biocompatible, and it should not get rejected by the body nor should it corrode due to body fluids.
What is the life-span of a knee implant?
Studies report that nearly 90% of the modern total knee replacements have a lifespan of 15 years. This has become possible due to improvement in the surgical techniques prosthetic designs, bearing surfaces and fixation methods. The final success in the surgery can be obtained by taking care of the knee replacement and general health and regularly following the instructions of an orthopedic surgeon.
What are the considerations in recovery and rehabilitation after a knee replacement surgery?
After the knee replacement surgery, the patient will be moved to a recovery room where recovery from anesthesia is monitored. After one or two hours in the recovery room, the patient is taken to the hospital room. It is likely to feel pain after the surgery and it is part of the healing process. Doctors prescribe some painkillers which help in the reduction of the pain.
FIGURE 3: NANDE HOSPITAL IN HOUSE PHYSIOTHERAPY CLINIC
Recovery at the hospital:
- Pain management: Short-term pain relief is often obtained through medications like opioids, non-inflammatory steroids,and anesthetics
- Blood clotting within the veins: Measures such as special support hose, blood thinners,and inflatable leg coverings are used to prevent blood clots. To keep the blood flowing in the leg, foot and ankle exercises are also recommended.
- Physical therapy: Physical therapist assists you in some exercises which will strengthen your knee for walking and normal daily activities after the surgery. A device called continuous passive motion is often used to prevent leg swelling.
- Pneumonia prevention: Some patients experience difficulty in breathing after knee replacement surgery due to anesthesia, pain medications etc. A spirometer is generally given to patients for long deep breaths.
Recovery at home:
- Wound healing: Stitches will be removed after several weeks of surgery. A suture beneath the skin in front of the knee is not required to be removed. The leg should not be soaked in warm water until it is completely dried and one can continue dressing the wound to avoid irritation.
- Diet: Loss of appetite is common after several weeks of surgery. The balanced diet supplemented with iron should be consumed on regular basis to boost up the wound healing process and restore muscle strength.
- Increase in mobility by gradually walking in and around the house.
- Getting used to other normal daily activities such as climbing stairs.
- The movement and strength of the knee can be restored by performing several exercises in a day.
Other things that should be kept in mind while you are at home:
- Reduce the usage of walking aids gradually
- Continue your exercises but avoid putting pressure on your legs
- Avoid squatting and sitting with cross legs for at least 6 weeks after surgery
- Always wear comfortable shoes
- Avoid bending over the knee until it is fully recovered
- Avoid any kind of twisting motion of the knee
Is knee replacement a good option? What are the risks associated with the procedure?
The decision to go for knee replacement surgery is to understand the pros and cons associated with this surgery.
More than 90% of patients who undergo knee replacement therapy experience reduction in knee pain and discomfort. The quality of life is found to be drastically improved in these patients.
Every knee replacement implant begins to get damaged but extensive activities such as running, jogging, jumping or other high impact sports may speed up this process and the implant can become painful. Thus, doctors generally advise not to perform such activities.
Complications during Knee replacement surgery:
- Infection: It can happen in the wound or around the implant. Antibiotics can treat minor infections but for major infections, the implant has to be removed.
- Blood clotting: The most common form of complication that occurs with knee replacement surgery is the formation of blood clots. They are dangerous if they break free.
- Implant problems: An average of 110° motion is anticipated after the surgery but sometimes implants components may loosen up.
- Neurovascular injury: Injury can occur to the nerves or blood vessels in and around the knee during surgery, but it is rare.
How does one decide which hospital to select for knee replacement surgery?
Some of the factors that can influence the choice of a hospital for knee replacement surgery include:
- One of the primary factors to be kept in mind during the availability of necessary infrastructure for conducting the surgery i.e availability of well-equipped operation theatres with necessary safety and infection control support.
- Availability of expert and skilled orthopedic surgeon too is a necessary requirement.
- The success of a knee replacement procedure is not only dependent on the expertise and infrastructure at the time of surgery, but also during the post-operative care. Thus, coordinated care by a team of doctors, physiotherapist,and other support staff is a necessary consideration.
- Availability of support services like diagnostics and pharmacy round the clock for ensuring pre and post-operative care for necessary tests and medication needs.
How do hospitals charge for knee replacement surgery?
The cost of knee replacement surgery depends on many factors, some of which include:
- Training, expertise and experience level of the operating surgeon and team.
- The type and make of the consumables being used, especially the implant.
- In usual circumstances, a patient may be required to stay in the hospital for 5-7 days after the surgery. However, in the case of poor medical health or any complications, this stay may get extended and may also require additional medical tests and medications. In such a case, the cost of treatment increases.
- Every hospital has its own norms for determining the infrastructure charges like room rent. Hence the billing policy of the hospital affects the total cost of the surgery
Disclaimer: The shared article is only for awareness and education purpose. Readers are advised to consult their doctor for proper evaluation of the condition and more information. Do not self-medicate.