The joints in our body are under constant stress and strain. As we get older, it is not uncommon for the joint surfaces to get worn out and pain to start occurring within them.
One such joint that is often affected is the knee joint. While in the initial stages of knee pain painkillers are very helpful, as the knee joint gets more and more degenerated, knee replacement surgery may be required.
We shall take a brief look at knee replacement surgery, discussing the procedure itself and any side-effects and complications that may occur from them.
The knee joint
The knee joint is composed of the lower end of the femur bone, and upper end of the tibia and fibula. The patella is present in front of the joint. It contains within it cartilage and joint fluid.
When is knee replacement surgery performed?
If the knee joint is severely affected by degenerative disease such as osteoarthritis, then knee replacement surgery may be advised. Patients will experience stiffness and pain in the knee joint and may find it difficult to mobilise at home and perform day-to-day activities.
Knee replacement surgery may also be performed in the event of extreme trauma to the knee. Other conditions that may warrant knee replacement surgery include haemophilia, rheumatoid arthritis and gout.
Types of knee replacement surgery
Broadly classified, there are two different types of knee replacement surgery. A total knee replacement involves replacement of the entire knee joint while a partial knee replacement only involves one half of the knee joint being replaced.
In addition to the above two, sometimes only the knee cap may be replaced. This is known as patellofemoral arthroplasty. Knee replacement surgery may be also performed as a revision procedure to previous surgery on the knee.
How is knee replacement surgery performed?
Knee replacement surgery required admission to hospital. Prior to the procedure, the patient may be asked to stop any blood thinning medications that they may be taking a few days before. The procedure will be explained and consent is obtained from the patient to undergo the operation.
The video below explains how it is performed:
Most cases of knee replacement surgery are performed under general anaesthesia. Spinal epidural anaesthesia may also be used. When performing a total knee replacement, the surgeon will make an incision on the knee joint to expose the knee cap and femur, tibia and fibula. The joint is inspected for any damage by arthritis and the damaged areas are removed.
The bones are shaped so that the knee prosthesis can be placed snugly in the area. Once the knee replacement prosthesis is placed in position, special cement is used to hold it in place. The wound is then closed and is dressed with a sterile dressing. The procedure can take a few hours to perform. The prosthesis usually lasts for up to 20 years.
This video demonstrates total knee replacement:
A partial knee replacement involves only one half of the knee joint being removed. The incision is smaller and a small portion of the joint is taken out.
The advantage above total knee replacement is that partial knee replacement only requires a short stay in hospital and not a lot of blood needs to be transfused during the procedure. However, patients may obtain the same relief that they do when compared to totally replacement.
This video demonstrates partial knee replacement:
New techniques have emerged where very small incisions are made in the knee joint and special equipment is manoeuvred around within the joint to help replace it. This is called mini incision surgery and is still in the early stages of development.
Benefits of knee replacement surgery
The primary benefit of knee replacement surgery is the reduction of pain. Patients find that their knee movements are significantly better than before and that they are able to mobilise a lot more freely. This in turn has a positive impact on their quality of life.
Complications of knee replacement surgery
Knee replacement surgery is a very common procedure performed in surgical practice and is accompanied by very few complications. The common complications that may occur are the development of small blood clots and bleeding within the joint. Infection may occur and require antibiotics.
Damage may occur to the nearby bone tissue, ligaments and nerves which can cause pain and numbness.
One of the disadvantages of undergoing knee replacement surgery is the feeling that the new knee joint is not as good as the natural knee joint that is present before the surgery. Over time, patients do get used to this. Some patients may notice a ‘clicking’ sensation when they move the knee, but this is normal and is nothing to worry about.
Following knee replacement surgery, it can take up to 2 years before patients get completely used to the new knee and feel like they have recovered totally. In order to allow the new knee to heal, patients may be asked to perform gentle exercises by physical therapists and their doctor.
This will help strengthen the muscles around the knee joint and really get rid of symptoms such as pain and stiffness. A good exercise that can help strengthen the muscles around the knee joint is cycling and gentle walking. Exercises such as brisk walking and running are not recommended early on as these can place a fair amount of stress on the knee joint. Looking after the wound is also important and patients are requested to ensure that it remains clean so that infection does not develop.
This video discusses this further:
For the first few weeks following the procedure, patients may be offered crutches to walk around at home. This will avoid any stress that is placed on the knee joint and will help with healing. New research is being conducted into performing knee joint replacement surgery by robots. Surgery is that the not involve the use of cement are also being studied. The future looks exciting and outcomes look extremely positive.
Knee replacement surgery is one of the most commonly performed surgical procedures. It is usually indicated for conditions such as osteoarthritis though there are other reasons why it may be performed.
The procedure is fairly straightforward and is accompanied by minimal complications. Long-term outcomes are excellent and the knee replacement prosthesis often last for up to 20 years. Patients notice a significant improvement in their mobility and their quality of life as a result.
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