Total knee replacement is considered one of the most successful operations ever invented and is now performed over 600,000 times annually in the US. It can offer substantial pain relief and functional improvement for patients suffering from knee arthritis.
Your total knee replacement begins with a consultation and examination. Dr. Melvin will perform a thorough history and physical exam, and review all imaging. This will allow him to fully understand your diagnosis, overall health as well as your social and support situation. If total knee replacement is determined to be the most appropriate treatment, a detailed plan for the full surgical episode, from pre-surgery preparation through the recovery, will be discussed.
Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.
Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away.
In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. All of these factors can cause pain and restricted range of motion in the joint.
Your doctor may advise total knee replacement if you have:
- Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).
- Moderate to severe pain that occurs during rest or awakens you at night.
- Chronic knee inflammation and swelling that is not relieved with rest or medications
- Failure to obtain pain relief from medications, injections, physical therapy, or other conservative treatments.
When to Consider Knee Replacement Surgery
A doctor can present knee replacement surgery as a treatment option, but whether or not to have the surgery is up to the patient. Some patients choose to have knee replacement surgery as soon as their doctors suggest it. Others want to avoid surgery or postpone it as long as possible.
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The exact cause of osteoarthritis is not known, however there are a number of factors that are commonly associated with the onset of arthritis and may include:
- Injury or trauma to the joint
- Fractures at the knee joint
- Increased body weight
- Repetitive overuse
- Joint infection
- Inflammation of the joint
- Connective tissue disorders
Your doctor will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.
X-rays typically show a narrowing of the joint space in the arthritic knee.
The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.The surgery is performed under spinal or general anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are cut at appropriate angles using specialized or custom jigs. The femoral component is attached to the end of the femur with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with or without bone cement. Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, similar to the original meniscus cartilage. The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface may also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed and a sterile dressing is placed over the incision.
There are several aspects to a healthy, safe and rapid recovery following total knee replacement
- Minimize narcotic pain medication to limit side-effects
- Maintain a healthy diet and adequate nutrition.
- Incision care - Dr. Melvin will educate you on proper incision care for the best possible recovery. Typically, a water-proof bandage will be placed over the incision and may stay in place until follow-up if it remains well sealed to the skin.
- Physical activity is important. You should perform home exercises and walk daily. Your body will need to adapt to your new prosthetic over time, so continued motion is an important factor. Physical therapy will also be prescribed.
- Follow-up appointments will be scheduled with Dr. Melvin. This will allow him to monitor the new knee and ensure that your recovery is proceeding well.
As with any major surgery, there are associated risks and complications may occur. Complications of total knee replacement can include:
- Knee stiffness
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Ligament injuries
- Patella (kneecap) dislocation or avascular necrosis
- Plastic liner wears out
- Loosening of the implant
- Heart attack, stroke, death