A. If you have knee deformities or severe
X-ray changes, or advanced symptoms of arthritis, you require a total knee
replacement surgery.
Symptoms of advanced knee arthritis are pain, crepitus, stiffness, limping, muscle weakness, limitation of motion, and swelling. Total Knee replacement surgery is generally delayed by the doctors in favor of less invasive procedures. But, if you have difficulty walking or performing everyday activities such as getting dressed, you do require knee replacement surgery. Total knee replacement surgery offers great relief from pain and it restores normal activities in life.
Q. How common is
total knee replacement surgery?
A. Knee replacement is a routine surgery
performed on over 650,000 people worldwide each year. Over 90% of people who
have had Total Knee Replacement experience an improvement in knee pain and
function.
Q. How old is the
average patient for knee joint replacement surgery?
A. The average knee joint replacement
patient is around 65-70 years old; however patients of all ages have received
knee implants.
Q. What is a total
knee replacement surgery?
A. The total knee replacement surgery
involves resurfacing the parts of the bones of the knee that rub together with
metal and plastic implants. Using special, precision instruments, the surgeon
will remove the damaged surfaces of all three bones. The replacement surfaces
will then be fixed into place.
The surface
of the femur is replaced with a rounded metal component that comes very close
to matching the curve of the natural bone. The surface of the tibia is replaced
with a smooth plastic component. This flat metal component holds a smooth
plastic piece made of ultra-high-molecular-weight polyethylene plastic that
serves as the cartilage. The undersurface of the kneecap may also be replaced
with an implant made of the same polyethylene plastic.
Q. Are all knee
joint replacements the same?
A. No, there are six different types of
knee replacements:
- · Uni-compartmental
- Posterior cruciate ligament (PCL) retaining
- Posterior cruciate ligament (PCL) substituting
- Rotating platform
- Stabilized
- · Hinge
These
different prostheses can be made of cobalt chrome, titanium, and polyethylene
(plastic), and can be fixed to the bone with acrylic cement or can be
press-fit, which allows bone to grow into the implant. Use of a particular
implant design, material, and fixation method depends on many factors related
to each individual patient.
Q. Which knee
replacement is ideal for me?
A. The type of knee replacement and implant
best suited for depends on your age, the degree of involvement of each of the
three compartments of your knee, choice of your orthopedic surgeon and your
level of activity. This would be discussed with you and analyzed by your
surgeon before you choose to come here for the surgery.
Usually,
total knee replacements are ideal for severe osteoarthritis affecting all the
three compartments of your knee and rheumatoid arthritis.
Q. How is the knee
replacement surgery done?
A. The knee replacement surgery starts with
an incision over the knee that exposes the joint. The special precision guides
and instruments are used to remove the damaged surfaces and shape the ends of
the bones to accept the implants.
The implants
are then secured to the bones. When the surgeon is satisfied with the fit and
function of the implants, the incision is closed. The surgery takes two to tree
hours to complete, which varies from patient to patient.
A bandage is
applied and a special drain is usually inserted into the wound to drain the
fluid that naturally develops at the surgical site. You would then be taken to
the recovery room, where you would be closely monitored. When you regain
consciousness, you would be taken to the hospital room, where a nurse would be
with you. You would also be given pain killers and the knee might remain
swollen for a few days.
Q. How is the knee
rehabilitation done?
A. A total knee replacement rehabilitation
program is begun after the surgery.
To help
regain strength, balance and range of movement in your knee, a specifically
designed rehabilitation programme is started when you are back in the hospital
room. The physical therapist will help you perform appropriate exercises. About
24 hours after surgery, you will probably be asked to stand.
Within the
next 24 hours, you will probably begin to walk a few steps with the help of a
walker. You can expect to stay in the hospital for about five to six days after
your surgery. You may or may not be transferred to a rehabilitation facility
for a few more days, as determined by your surgeon. Your bandages and sutures
will usually be removed before you leave the hospital. At home, you will need
to continue your exercises.
A. Most patients start walking with the
cane within six weeks of the surgery. Few patients also start driving within
seven to eight weeks after surgery.
But, there
are some precautions to be taken even after you have fully recovered. One
should not put excessive strain on the knee like jogging, skiing, high impact
aerobics and other sports which put strain on the knee joint.
A. Though this is not an exhaustive list of the precautions, these are the general guidelines to be followed after the surgery. The surgeon and the physical therapist will guide you in details about the do's and don'ts after the surgery
·
Avoid heavy
lifting and excessive stair climbing
·
Maintain
appropriate weight
·
Avoid
"impact loading" sports such as jogging, downhill skiing and high
impact aerobics, twisting or impact stresses.
·
Consult your
surgeon before beginning any new sport or activity
·
excessive
bending when weight bearing, like climbing steep stairs
·
not lift or
push heavy objects
·
Do not kneel
·
Avoid low
seating surfaces and chairs.
Q. What is the
life of a replaced knee?
A. The longevity of the prosthetic varies
with every patient depending upon physical condition, activity level, weight as
well as the accuracy of implant placement during surgery.
Though total
knee replacement has become a common and predictable surgery, with very high
success rates, it should be kept in mind that there is no guarantee that a
prosthetic joint will last the rest of patient's life.
As with any
mechanical joint, the knee components move against each other. Natural fluid in
the joint space, called synovial fluid, helps to lubricate the implants just as
it lubricates the bones and cartilage in a natural joint. Still, the prosthetic
components do wear as they roll and slide against each other during movement.
As with car tires or brake pads, the rate of wear depends partly on how the
knee joint is used. Activities that place a lot of stress on the joint
implants, as may be the case with heavier and more active patients, may reduce
the service life of the prosthesis. Implant loosening and wear on the plastic
portions of the implant can lead to the necessity for revision surgery to
replace the worn components, or all of the components.
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