Knee Replacement Surgery, Procedure, Risks, Preparation and Results
Knee replacement surgery — also known as knee arthroplasty — can help relieve pain and restore function in severely diseased knee joints. The knee replacement surgery procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers.
In determining whether a knee replacement surgery is right for you, an orthopedic surgeon assesses your knee's range of motion, stability and strength. X-rays help determine the extent of damage.
Your doctor can choose from a variety of knee replacement surgery prostheses and surgical techniques, considering your age, weight, activity level, knee size and shape, and overall health.
If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Knee replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Knee replacement surgery is one of the most successful procedures in all of medicine. Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this article will help you understand more about this valuable procedure.
The reason behind knee replacement surgery:
The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have knee pain at rest.
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
Knee replacement surgery procedure:
A knee replacement surgery (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are replaced.
There are four basic steps to a knee replacement procedure:
- Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.
- Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
- Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
Risks of knee replacement surgery:
Knee replacement surgery, like any surgery, carries risks. They include:
- Blood clots in the leg vein or lungs
- Heart attack
- Nerve damage
- Another risk of knee replacement surgery is failure of the artificial joint. Daily use wears on even the strongest metal and plastic parts. Joint failure risk is higher if you stress the joint with high-impact activities or excessive weight.
Signs of infection after knee replacement surgery:
Notify your doctor immediately if you notice any of the below after knee replacement surgery:
- Fever greater than 100 F (37.8 C)
- Shaking chills
- Drainage from the surgical site
- Increasing redness, tenderness, swelling and pain in the knee
An infected knee after knee replacement surgery usually requires surgery to remove the artificial parts and antibiotics to kill the bacteria. After the infection is cleared, another knee replacement surgery is performed to install a new knee.
When knee replacement surgery is recommended:
The decision to have total knee replacement surgery should be a cooperative one between you, your family, your primary care doctor, and your orthopedic surgeon. Your doctor may refer you to an orthopedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.
There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from knee replacement surgery often have:
- Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
- Moderate or severe knee pain while resting, either day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications
- Knee deformity — a bowing in or out of the knee
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
Candidates for knee replacement surgery:
There are no absolute age or weight restrictions for total knee replacement surgery.
Recommendations for knee replacement surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement surgery are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total knee replacement surgery has been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
How you should prepare of knee replacement surgery:
- Food and medications before knee replacement surgery
Your doctor or anesthesiologist might advise you to stop taking certain medications and dietary supplements before your knee replacement surgery. You'll likely be instructed not to eat anything after midnight the day of your knee replacement surgery.
Prepare for your recovery after knee replacement surgery
For several weeks after the procedure of knee replacement surgery, you might need to use crutches or a walker, so arrange for them before your knee replacement surgery. Make sure you have a ride home from the hospital and help with everyday tasks, such as cooking, bathing and doing laundry. If you live alone, your surgeon's staff or hospital discharge planner can suggest a temporary caretaker.
To make your home safer and easier to navigate during recovery after knee replacement surgery, consider doing the following:
- Create a living space on one floor since climbing stairs can be difficult.
- Install safety bars or a secure handrail in your shower or bath.
- Secure stairway handrails.
- Get a stable chair with a firm seat cushion and back, and a footstool to elevate your leg.
- Arrange for a toilet-seat riser with arms if you have a low toilet.
- Get a stable bench or chair for your shower.
- Remove loose rugs and cords.
Results of knee replacement surgery:
For most people, knee replacement surgery provides pain relief, improved mobility and a better quality of life. And knee replacement surgery can be expected to last more than 15 years.
Improvement of knee motion is a goal of knee replacement surgery, but restoration of full motion is uncommon after knee replacement surgery. The motion of your knee replacement after knee replacement surgery can be predicted by the range of motion you have in your knee before knee replacement surgery. Most patients of knee replacement surgery can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.
Most people feel some numbness in the skin around your incision of knee replacement surgery. You also may feel some stiffness, particularly with excessive bending activities.
Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is normal. These differences often diminish with time and most patients of knee replacement surgery find them to be tolerable when compared with the pain and limited function they experienced prior to knee replacement surgery.
Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement surgery if the alarm is activated.
Three to six weeks after knee replacement surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car, if you have enough muscle control to operate the brakes and accelerator, and if you're not still taking narcotic pain medications.
After recovery of knee replacement surgery, you can engage in various low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations after knee replacement surgery.
After knee replacement surgery, make sure you also do the following:
- Participate in regular light exercise programs to maintain proper strength and mobility of your new knee after knee replacement surgery.
- Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery after knee replacement surgery.
- Make sure your dentist knows that you had a knee replacement surgery. Talk with your orthopedic surgeon about whether you need to take antibiotics prior to dental procedures.
- See your orthopedic surgeon periodically for a routine follow-up examination and x-rays after knee replacement surgery. Your surgeon will talk with you about the frequency and timing of these visits.
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