Knee replacement, or knee arthroplasty, is a surgical procedure that is commonly recommended to restore the mobility and normal function of the knee joint. There are various reasons for which the orthopedic surgeon can advise you to get knee replacement surgery, such as osteoarthritis, knee arthritis, trauma, or knee injury. It is usually oly advised to people who have become bedridden due to severe knee joint pain and/or instability.
Knee implants are prosthetics that are used in order to replace the damaged or affected knee joint. Artificial knee implants help in getting rid of mobility issues and aid you in moving freely from one place to another without any pain or discomfort.
There are three main components in a knee implant:
Femoral component : This part of the implant is directly attached to the femur and has a groove that allows the patellar component to slide while you are bending the knee joint.
Tibial component : It is a flat two-piece metal and plastic part of the implant that is attached to the tibia. The plastic part acts as a cushion between the tibial and femoral components.
Patellar component :It is a plastic dome-shaped component that is resurfaced to match the shape of the patella.
The plastic components of the implant are made of polyethylene, while the metal component is usually made of cobalt-chromium, titanium, zirconium, and nickel. Knee implants can be categorized into four categories based on what they are made of:
Metal on plastic
Ceramic on plastic
Ceramic on ceramic
Metal on metal
Diagnosis
An orthopedist specializes in diagnosing and treating bones related problems. S/he thoroughly conducts diagnosis which includes-
Physical examination, in which the doctor will assess the knee joint pain, function, symptoms, etc.
A detailed discussion of family and medical history to determine the cause of the condition
Diagnostic imaging tests such as X-ray, MRI, etc. are recommended to detect the extent of knee joint dysfunction
Procedure of knee replacement surgery
Arthroscopic knee replacement procedure takes about 1 to 3 hours and can be performed under either general or spinal anesthesia. During the surgery, the surgeon places a cut on the front of the knee to expose the kneecap. Then, they remove the damaged parts of the joint and position the knee prosthetic. Usually, a special bone, ‘cement’ and a plastic spacer, is placed between the knee implant and the bones that act as a cartilage and reduce friction during the joint movement. Then the wound is closed, using sutures or clips, and dressed. Since the surgery is minimally invasive, there is very little bleeding, and the procedure usually does not need any blood transfusions.
Knee replacement is a major treatment, so you need to prepare well before the surgery. Preparation before knee replacement surgery is done on two levels: medical and home preparation.
Medical preparation before knee replacement treatment includes :
Clearly relay your medical history to your knee replacement surgeon. Inform your orthopedic doctor about any pre-existing medical conditions you are suffering from and the medicines you are currently taking for them. If you are taking aspirin, steroids, opioids, and other similar medicines, your surgeon may ask you to limit or stop their usage before and after a week of the surgery.
You may need to completely avoid tobacco use before and after the surgery, as nicotine slows down the healing process and increases the chances of the patient developing post-surgical complications such as DVT (deep vein thrombosis).
In addition to relaying your medical history to your orthopedic doctor, you should also check with your regular doctor to ensure that you are in optimum health for the surgery.
Alcohol can counteract anesthesia and cause complications during the surgery. Therefore, you should stop consuming any alcohol for at least 2-3 days before the surgery.
In case you develop any sudden illness such as a fever, cold, flu, etc., inform your orthopedic surgeon immediately so that they can modify the procedure as needed.
There are certain factors that indicate that one requires knee replacement surgery. Some of them are-
Continuous pain and discomfort in the knee joint can not get cured through medication and other oral treatments.
The knee cap is damaged because of any trauma or degenerative disease.
Inability to walk due to extreme stiffness and pain while walking or climbing stairs
The following are a few advantages of undergoing minimally invasive knee replacement surgery compared to traditional knee replacement surgery-
Shorter incisions (mostly 3 to 4 inches)
The recovery duration is shorter
Reduces chances of excessive bleeding during knee replacement surgery
The success rate is higher than in conventional knee replacement surgery.
Minimally invasive knee replacement surgery has lesser chances of infection.
After undergoing knee replacement surgery, you will need to be cautious about how you use your knee, especially for the first few weeks after your surgery. Your doctor will encourage you to walk as soon as you can. You can begin walking with the help of walking aids or support. But in no time, most patients feel comfortable walking on their own.
Here is a typical timeline of the progress you can expect to see in the first 3 months of recovery after knee replacement surgery-
One month after your surgery - One will be able to start with low-impact daily activities like driving, walking, household chores, and daily errands.
Two month after your surgery - Around the end of the second month, most patients are allowed to start low-impact physical activities such as swimming, biking, and taking long walks again. However, depending on your recovery and well-being, your doctor may suggest you wait for a few more days or weeks before resuming such activities.
Three month after your surgery - You will probably be able to return to certain high-impact physical activities such as running or other activities that you enjoy. You will need to get your doctor’s approval before taking this step. Your orthopedic doctor will recommend you to start slow and give yourself time. Eventually, you will be able to return to the level of activity that you were used to.
Knee replacement surgery is performed with advanced and minimally invasive techniques, i.e, arthroscopy. But, like any other surgery, knee replacement surgery may also involve a few potential risks that can be discussed with your orthopedic surgeon. Some of the risks are-
Infections
Ligament damage during or post knee replacement surgery
Allergic reaction to bone cement
Nerve and artery damage around the affected knee joint
Poor reaction to administered anesthesia during knee replacement surgery
Excess scar tissue buildup
Pain and stiffness in the knee joint post-surgery
Chances of deep vein thrombosis
Total knee replacement (TKR)
During this procedure, the orthopedic surgeon replaces the damaged joint completely with an artificial or prosthetic joint. This is often recommended when the bones are severely damaged because of any injury or bone degenerative diseases.
Partial Knee Replacement
In partial knee replacement cases, only part of the knee joint is degenerated. Therefore, the surgeon recommends knee replacement for the affected side, which is known as partial knee replacement.
Revision or Complex Knee Replacement
People affected with severe arthritis may be advised knee replacement two to three times to restore complete knee function. In this procedure, the surgeon uses a modified implant in order to provide more stability to the affected knee joint.
Kneecap Replacement
This is also known as Patellofemoral arthroplasty. When the under the surface area of the kneecap is affected because of degenerative diseases, the surgeon recommends replacing the patellofemoral part of the knee joint.
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