Health Blog


Knee Replacement

Published on 2017-08-12 15:08:49

Knee replacement surgery also known as knee arthroplasty or knee resurfacing.  Arthoplasty literally means the surgical repair of a joint. It involves the surgical reconstruction of degenerated joints using artificial body parts or prosthetics. The aim is to remove the pain and restore mobility. This procedure is commonly done for people whose knee or knees have degenerated because of osteoarthritis, rheumatoid arthritis or post traumatic arthritis when an injury damages the knee.

Osteoarthritis: this is caused by normal wear and tear of the knee joint because of aging, it usually affects people over 50 years of age, but rarely it may also affect the younger people. It is caused by inflammation breakdown and eventual loss of cartilage in the joints. Over a period of time the cartilage wears down and the bones rub together resulting in friction and pain.

arthritis, knee replacement, knee surgery,

Rheumatoid arthritis: The immune system cell from the blood into the joint sand joint lining tissues called synovium. These immune system cell create inflammation and the membrane around the knee joint becomes thick and inflamed which damages the cartilage and causes soreness and stiffness. AS the cartilage wears down the space between the bones narrows and over a period of tine the bone rub against each other resulting in pain and swelling. Sometimes it could also be due to auto immune disorder. This disease is most common in women than men.

Post Traumatic Arthritis: this is caused due to severe knee injury, where the bones around the knee breaks or ligaments tear which affects the knee cartilage

 

Knee replacement surgery is for people  who experience:

  • Severe knee pain or stiffness which affects them carrying out even daily activities like walking, climbing stairs, getting up the chair or getting in or out the car
  • Continuous knee pain even while resting 
  • Severe knee inflammation and swelling that does not improve even after medication and proper resting
  • Knee deformity where there is noticeable arch on the inside or outside the knee
  • If nay other treatment has not helped the person in reducing the pain or improvement in the condition, surgery is the best option

 

Types of Knee Replacement Surgery

  • Total Knee Replacement – surgery for replacement of both sides of the knee joint
  • Partial Knee Replacement – surgery for replacement of one side of the knee joint.
  • Kneecap Replacement: surgery for replacement only the under surface of the kneecap.

 

Medical tests and diagnosis for Knee Replacement Surgery:

  • Before the surgery complete physical examination and diagnostic tests are conducted.
  • Blood test such as hemophilia, diabetes are carried out
  • Blood pressure and pregnancy tests are done
  • History of the patient is analyzed
  • Any medications and drug allergy must be notified to the doctor
  • Notify your doctor about all the medicines that you are taking (if any)
  • Notify your doctor if you have any bleeding disorder or if you are taking anticoagulant (blood thinning) medications, aspirin or other medications that affects the blood clotting, Prior to procedure it may be necessary to stop these medications
  • Vital signs are checked to make sure heart rate, body temperature and oxygenation level are normal
  • Patients undergoing surgery should avoid smoking as long as possible prior to the surgery.
  • Your doctor will explain the procedure, ask questions to clear your doubts about the surgery and post surgery conditions
  • You will be asked to sing a consent form that gives your permission to the doctors to perform the procedure. Read the form carefully and if you are not clear, question and clarify your doubts.
  • You may meet the physiotherapist to discuss rehabilitation

 

Knee Replacement Surgery Process:

Time of procedure may vary depending upon the condition of the patient. The process is as follows:

  • Patient have to wear the hospital gown for the procedure
  • An Intravenous (IV) line may be started in your arm or hand and urinary catheter may be inserted
  • If there is excessive hair in the surgical site, it may be clipped off
  • Normally general anesthesia will be provided, it would depend on the condition of the patient which will be discussed by the anesthesiologist before the surgery
  • The Anesthesiologist will continuously monitor your heart rate, blood pressure, breathing and blood oxygen level during the surgery
  • The skin in the surgical area will be cleansed with antiseptic solution
  • The doctor will make the incision in the knee area
  • The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The knee prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis. Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a knee.
  • The prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone).
  • The incision will be closed with stitches or surgical staples.
  • A drain may be placed in the incision site to remove fluid.
  • A sterile bandage or dressing will be applied.
  • After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Knee replacement surgery usually requires an in-hospital stay of several days.

 

Some complications that may arise as a result of the surgery:

  • Bleeding
  • Infection
  • Develop DVT (deep vein thrombosis) – blood clot which can form in calf muscle and can travel upto the lungs (pulmonary thrombosis)
  • Stiffness of the knee
  • Limping
  • Hyperglycemia
  • In extreme rare cases – congestive heart or hemorrhage problems
  • Plastic lines may wear over period of time
  • Patella – knee cap may get dislocated
  • Fracture

 

Recovery after surgery:

  • The period of recovery may differ from person to person and the type of surgery carried out. For early recovery it is very important to follow doctor’s advice:
  • Right after surgery patients can begin basic movement
  • They can start walking with support by the time they leave the hospital
  • Ensure there are safety handrails in the shower or bath at home
  • Swelling will be there which is very normal and will reduce over a period of time (6 months)
  • Blood accumulation around the knee is normal which will disappear over a period of time. Avoid soaking the wound until the scar is completely healed to ensure it is not getting infected
  • Avoid stair climbing until recommended by your doctor
  • Patients can return to work after 6 to 8 weeks.
  • Not to bend own or life heavy things at least for few weeks
  • Not to stand still for long periods
  • While walking use crutches or walkers initially till the knee is strong enough to take your body weight
  • Keep your operated leg raised when sitting

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