Knee Replacement Surgery
What is Knee Replacement Surgery?
Knee replacement surgery (knee arthroplasty) is a procedure that involves removing diseased or damaged bone and cartilage of a knee joint and replacing them with artificial joint (prosthesis) made of metal, polymers or high-grade plastic parts.
It is an effective, safe procedure that can help relieve pain, feel better, move better and restore function in severely diseased knee joints.
While many patients can be managed with the help of medicines, physical therapy or injections, some do not get any relief with these treatments. In such patients with advanced condition, knee replacement surgery, also called knee arthroplasty, is suggested. In this surgery, weight-bearing portion of the knee joint is replaced by an artificial structure. Today, knee replacement surgery is one of the most common bone surgeries performed around the world.
Types of Knee Replacement Surgery
Knee replacement surgeries are of two types the choice of which is decided by the degree of dysfunction of the joint.
- Total Knee Replacement Surgery (TKR)
- Partial Knee Replacement Surgery (PKR)
Total Knee Replacement Surgery (TKR)
In this procedure, the complete knee joint is replaced with an artificial joint, made of metal and plastic components. The procedure may be chosen for obese patients and those who have a severe joint dysfunction.
Partial Knee Replacement Surgery (PKR)
If only one side of the knee is damaged, a partial knee replacement (PKR) may be recommended. PKR is a less extensive operation, with a smaller incision, and involves less bone being removed.
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Benefits of Knee Replacement Surgery
A knee replacement may make it easier for you to get regular exercise. This can help manage or prevent obesity, cardiovascular disease, diabetes, osteoporosis, and many other health conditions. Strong knees also offer more support and stability, so there is less chance of having a fall.
1. Reduced knee pain
The most common cause of issues with the knee joint is arthritis, and this condition can lead to joint damage and lots of pain. Using minimally invasive techniques, surgeons can complete a knee replacement procedure that can reduce the amount of knee pain you feel after surgery. This is one of the biggest benefits you can expect after your knee replacement surgery.
2. Faster recovery
Another benefit you can expect after minimally invasive knee replacement surgery is a faster recovery time. In traditional knee replacement procedures, 8-to-10-inch incisions were necessary, and many times knee muscles and other soft tissue were cut during the procedure.
With minimally invasive techniques, less soft tissue damage is done. Also, a smaller 4-inch incision is typically all that’s required for this type of surgery. This means your body will have less healing to do after surgery, and this can decrease your recovery time significantly.
3. Improved ability to perform daily activities
Possibly the most important benefit you can expect after minimally invasive knee replacement surgery is an improved ability to do normal daily tasks. After all, the knee is vital to performing daily tasks like walking and standing. It’s also critical to other activities such as jumping and running.
The pain of knee arthritis may have reduced your ability to do such things, but all that can change after a minimally invasive knee replacement. You may find that you’re not only able to do normal tasks with less difficulty, you may also be able to recapture your independence, too.
Knee Implant Types
Thinking about a total knee replacement? There are a few different kinds of knee implants that are used in this procedure. The different types are categorized by the materials that rub against each other when you flex your knee:
Metal on plastic.
This is the most common type of implant. It features a metal femoral component that rides on a polyethylene plastic spacer attached to the tibial component. The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant life span. However, one problem that can happen with plastic implants is an immune reaction triggered by tiny particles that wear away from the spacer. This can cause bone to break down, leading to loosening and failure of the implant. Advances in manufacturing have greatly reduced the rate of wear in the plastic.
Ceramic on plastic.
This type uses a ceramic femoral component instead of metal (or a metal component with a ceramic coating). It also rides on a plastic spacer. People who are sensitive to the nickel used in metal implants might get the ceramic type. Plastic particles from this type of implant also can lead to an immune reaction.
Ceramic on ceramic.
The femoral and tibial components are both made of ceramic. Ceramic parts are the least likely to react with the body. However, ceramic joint prostheses can make a squeaking noise when you walk. In rare cases, they can shatter under heavy pressure into pieces that must be removed by surgery.
Metal on metal.
The femoral and tibial components are both made of metal. Metal-on-metal implants have been used much less often in recent years because of concerns over traces of metal leaking into the bloodstream. The metal comes from the chemical breakdown of the implant hardware. All metal implants originally were developed to provide longer-lasting joint replacements for younger people.But the traces of metal can cause inflammation, pain, and possibly organ damage. Metal-on-metal implants may be considered only for young, active men, because they may last longer than other materials. Women of childbearing age can’t receive these implants because the effects on a fetus are not known.
Risks & Complications
The vast majority of total knee replacement surgeries are successful; however, complications can occur.
Below is a list of some potential complications. In rare instances, these complications are life-threatening. A small percentage of patients will require a second, revision surgery.
Complications tend to be higher in patients who use tobacco and who are older or obese.
Complications Involving Anesthesia
Like any major surgery involving general anesthesia, there is a low risk of strokes, heart attacks, pneumonia, and blood clots.
Blood clots occurring in deep veins, or deep vein thrombosis (DVT), are a potential complication of knee replacement surgery. Left untreated, a blood clot can break free from the vein wall, a life-threatening condition known as pulmonary embolism. When caught in time, pulmonary embolism is treatable with anti-clotting medication. Devices that can be wrapped around the affected leg to provide intermittent pneumatic compression can minimize the risk of DVT.
Infection
Antibiotics are routinely given at the time of surgery to reduce the risk of infection. Despite this precaution, infection affects 2% to 3% of knee replacement patients. In many cases, the infection can be treated with additional antibiotics. However, in other cases, infection can result in the removal of the replacement joint and can even be life-threatening if it spreads throughout the body.
While the risk of infection decreases as the surgical wounds heal, it never completely goes away. People who receive joint replacements are advised to tell their dentists before any dental procedure. Bacterial infections contracted during dental procedures can affect implants. Antibiotics can be given to prevent this from happening.
Aside from risks associated with anesthesia and infection, there are other potential complications:
- A prosthesis component can become loose or dislocate if it does not seal to the bone well or is misaligned.
- Legs may be slightly different lengths after surgery. In some cases, a shoe insert can remedy this problem.
- The new knee may be stiff. Most people who have undergone knee replacement surgery can bend their knees at least 115 degrees. However, some people develop scar tissue that hinders flexibility. This limited flexibility is more common in people who had limited flexibility before surgery.
- An allergic reaction to the prosthesis or bone cement can occur. In these cases, the bone cement and prosthesis must be removed.
- Damage can occur to the knee’s patella (knee cap) and/or the soft tissue (muscles, ligaments and tendons) that support the joint between the patella and the femur.
- In rare cases there is damage to surrounding arteries, veins, and/or nerves.
For the most part, complications can be treated. A surgery followed by complications may still be considered successful if pain is alleviated and function improves over the long term.
Before Knee Replacement
- Blood tests.
- Dental exam to help lessen the risk of infection from surgery.
- Electrocardiogram to make sure your heart is strong enough for surgery.
- Physical exam to make sure you’re healthy enough for surgery.
During Knee Replacement
- Make an incision (cut) in the knee area.
- Remove any damaged cartilage and bone.
- Place the knee implant and position it properly.
- Secure the implant into place using cement or without cement.
After Knee Replacement
After surgery, you will get moved to a recovery room. The healthcare team will watch you for a short time to make sure you wake up from the anesthesia without complications. They’ll also monitor your vital signs and pain level.
Occasionally, people who have knee replacement surgery go home the same day. If you need to stay in the hospital, it will likely be for one day. Additional time spent in the hospital is based on medical necessity.