Total Knee Replacement

Introduction

A painful knee can several affect your ability to a lead a full active life.  Over the last 25 years, major advancement in artificial knee replacement has greatly improved the outcome of surgery.  Artificial knee replacement surgery is becoming more and more common as the population of the world begins to age.

What does the surgeon hope to achieve?

The main reason for replacing any arthritic joint with an artificial joint is to stop the bones from rubbing cause pain. Replacing the painful and arthritic joint with an artificial joint gives the joint a new surface which moves smoothly and without causing pain. The goal is to help people return to many of their activities with less pain and with greater freedom of movement.

Preparation

How should I prepare for surgery?

The decision to proceed with surgery should be made jointly by you and your surgeon. The decision should only be made after you feel that you understand as much about the procedure as possible.

Once you decide to proceed with surgery, several things may need to be done. You orthopedic surgeon may suggest a complete physical examination by your regular doctor. This is to ensure that your are in the best possible condition to undergo the operation. You may also need to second time with the physical therapist who will be managing you rehabilitation after the surgery.

Causes for knee joint replacement

There are many conditions that result in degeneration of the knee joint. Osteoarthritis is the most common cause for patients who have knee replacement surgery. Once the sick protective surface of the articular cartilage is worn away, the result is bone rubbing against hour. Bone rubbing against bone is painful. Fracture of the knee, born cartilage and bone ligaments can cause the knee joint to function abnormality. This abnormal function can lead to excessive wear and tear of the joint many years after the injury just like an out of balance give can wear out too soon.

Symptoms

The symptoms of a degenerative knee joint usually begin as pain while bearing weight on the affected knee, such as when walking.

The knee may become swollen with fluid.

The range of motion of the affected knee can be affected.

Diagnosis

 

The diagnosis of a degenerative knee joint starts with a complete history and physical examination by your surgeon.

X-rays are required to determine the how had your knee joint has become. X-ray may help suggest a cause for the degeneration in your knee.

Other test may be required it your surgeon thinks that other condition may be adding to me degenerative process.

Blood test can rule out systemic arthritis, such as rheumatoid arthritis or as infection in the knee.

Medical treatment

Not all degenerative knee conditions require a knee replacement as a first treatment. Your doctor may suggest several alternative treatments in put off replacing the knee as long as possible.

Anti-inflammatory medicines may reduce the inflammation from the arthritis and reduce pain.

Surgery

Most degenerative problem will eventually require replacement of the painful knee with an artificial knee joint, called prosthesis. The decision to proceed with surgery should be made by you, your family and your doctor and only after your feel that your understand as much as possible about the surgery and recovery process.

Once the decision to have surgery is made, there are several things that may need to be done.

The Artificial knee joint, called a prosthesis

There are two main types of artificial knee replacement.

1. Cemented prosthesis

2. Uncemented prosthesi

both type are widely used, in many cases, a combination of the two type are used. The kneecap, or patellar portion of the prosthesis is usually cemented into place. The choice to use a cemented (or) uncemented prosthesis is usually made by the surgeon based on your age and lifestyles and your surgeon’s experience.

Each prosthesis has four parts

* The tibial component replaces the end of the tibia. The tibia is commonly called the shinebone.

* The femoral component replaces the end of the femur, the groove where the kneecap slides.  The femur is commonly called the thighbone.

* The patellar component replaces the surface on bottom of the patella.

The femoral component is made of metal. The tibial component is usually made of two parts a metal tray that fitted directly onto the bone and a plastic spacer that provide a bearing surface.

A cemented prosthesis is held in place using epoxy type cement that attaches the metal to the hour

An uncemented prosthesis has a fine mesh of holes on the surface that allow the hour to grow into the mesh and attaches the prosthesis to the bone

The operation

Post operative details:

The patient is recovered and usually observed for a 24 hour period in a high dependency ward.

Drains are usually removed with in 24 hours, and the patient is encouraged to walk on the second post operative day. Continual improvement is generally observed, and discharges occur in 5-14 days.

Discharge is only recommended once wound healing is satisfactory 1 knee flexion of 90 degree has been achieved the patient considered to be safe and supported in the home environment.