• Total Hip Replacement
  • Anterior Hip Replacement
  • Total Knee Replacement
  • MAKO plasty® Partial Knee Replacement
  • Revision Knee & Hip Replacement
  • Knee Arthroscopy

Total Knee Replacement

Introduction

A Total Knee Replacement (TKR) or Total Knee Arthroplasty is a surgery where the joint surfaces is replaced with a metal prosthesis and a new plastic liner that serves as the bearing surface.

The procedure is usually recommended for patients who suffer from pain and loss of function from arthritis and have failed results from other conservative methods of therapy.

The typical knee replacement replaces the surface of the femur (thigh bone) and tibia (shin bone) with a metal prosthesis, and a plastic liner is inserted between them as well as on the back of the patella (knee cap).

Arthritis

Arthritis is a general term covering numerous conditions where the joint surface (cartilage) wears out. The cartilage provides a smooth cushion that allows pain free movement in the joint. This surface can wear out for a number of reasons, often the definite cause is not known. When the articular cartilage wears out, pain can develop. There are numerous conditions that can cause arthritis and often the exact cause is never known. In general, but not always, it affects people as they get older (Osteoarthritis).

Other causes include

  • Trauma (fracture)
  • Increased stress e.g., overuse, overweight, etc.
  • Infection
  • Connective tissue disorders
  • Inactive lifestyle e.g., Obesity, as additional weight puts extra force through your joints which can lead to arthritis over a period of time
  • Inflammation e.g., Rheumatoid arthritis

In an Arthritic Knee

  • The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.
  • The capsule of the arthritic knee is swollen
  • The joint space is narrowed and irregular; this can be seen in an x-ray image
  • Bone spurs or excessive bone can also build up around the edges of the joint
  • The combinations of these factors make the arthritic knee stiff and limit activities due to pain or fatigue.

Diagnosis

The diagnosis of osteoarthritis is made on history, physical examination & x-rays.

Indications

Prior to surgery you will usually have tried some simple treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, assistive devices (cane, walking sticks, crutches, walker), or physical therapy.

Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, canes, or physical therapy. Once these have failed, it is time to consider surgery.

You should consider a knee replacement when you have

  • Arthritis confirmed on X-ray
  • Pain not responding to analgesics or anti-inflammatories
  • Limitations of activities of daily living including your leisure activities and work
  • Pain keeping you awake at night
  • Stiffness in the knee making mobility difficult

Benefits

The benefits following surgery are relief of symptoms of arthritis. These include

  • Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
  • Pain waking you at night
  • Deformity- either bowleg or knock knees
  • Stiffness

Pre-Operation

  • Your surgeon will send you to your primary care physicain for routine blood tests and other tests (EKG, urine test, chest x-ray)
  • You should have any other medical, surgical or dental problems attended to prior to your surgery (We recommend that dental work be completed at least 30 days prior to surgery)
  • Make arrangements around the house prior to surgery
  • Stop aspirin or anti-inflammatory medications 10 days prior to surgery as they can cause bleeding
  • Stop any naturopathic or herbal medications 10 days before surgery
  • Stop smoking as long as possible prior to surgery
  • Shower with chlorhexidine soap for 3 days prior to surgery

Day of your surgery

  • You will be admitted to hospital usually on the day of your surgery
  • You will meet the nurses and answer some questions for the hospital records
  • You will meet your anaesthetist who will review the anesthesia options (In most cases, spinal anesthesia and a regional nerve block is preferred)
  • Approximately 30 mins prior to surgery, you will be transferred to the operating room Surgical Procedure

Once in the operating room, the surgical site is shaved and cleaned.

Prophylactic antibiotics are administered through an I.V.

Each knee is individual and knee replacements take this into account by having different sizes for your knee.

You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes approximately two hours.

The surgeon cuts down to the bone to expose the bones of the knee joint.

The damaged portions of the femur and tibia are then cut at the appropriate angles using specialized jigs. Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. Usually, a plastic component is also placed on the surface of the patella (knee cap).

The real components are then inserted with cement and the knee is again checked to make sure things are working properly. The knee is then carefully closed and a drain is usually inserted, and the knee dressed and bandaged.

In anticipation of your surgery please review the links below for some helpful exercises to improve your sugical outcome.

Surgical Procedure

Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added.

Surgery is performed under sterile conditions in the operating room under spinal or general anesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. Surgery takes approximately two hours.

The surgeon cuts down to the bone to expose the bones of the knee joint.

The damaged portions of the femur and tibia are then cut at the appropriate angles using specialized jigs. Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components. The patella (knee cap) may be replaced depending on a number of factors and depending on the surgeon’s choice.

The real components are then inserted with or without cement and the knee is again checked to make sure things are working properly. The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.

In anticipation of your surgery please review the links below for some helpful exercises to improve your sugical outcome.

Post operative

You will wake up in the recovery room with a number of monitors to record your vitals. (Blood pressure, Pulse, Oxygen saturation, temperature, etc.) You will have a dressing on your hip.

Post-operative X-rays will be performed in recovery.

Once you are stable and awake you will be transferred to the orthopedic floor.

You will receive fluid through an I.V.

To avoid lung congestion, it is important to breathe deeply and use the incentive spirometer that the nurses will provide.

The goal is to walk with physical therapy on the day of surgery.

Pain is normal but if you are in a lot of pain, inform your nurse. We us “multi-modal” pain management. You will receive various medication which control pain through different mechanisms ion the body. These include acetaminophen, anti-inflammatories, nerve medication, muscle relaxers, and narcotic pain medication.

You will be able to put all your weight on your knee and your physical therapist will help you with the post-op knee exercises.

To minimize blood clots in your legs, compression stockings and sequential compression devices will be placed. You will also be placed on a blood thinner medication, such as aspirin.

Most patients can be discharge home after one or two nights in the hospital.

A waterproof bandage is place in the hospital and patients can begin showering two days after surgery.

Sutures are usually dissolvable, so most of the time there are no staples to remove.

A post-operative visit will be arranged prior to your discharge. You will usually have a 2 week and 6 week check up with your surgeon who will assess your progress. You should continue to see your surgeon for the rest of your life to check your knee and take X-rays. This is important as sometimes your knee can feel excellent but there can be a problem only recognized on x-ray.

A lot of the long term results of knee replacements depend on how much work you put into it following your operation.

Bending your knee is variable, but by 2-3 weeks should bend to 90 degrees. The goal is to obtain 120 degrees of movement.

More physical activities, such as sports previously discussed, may take 3 months to do comfortably.

Post-op precautions

Remember this is an artificial knee and must be treated with care.

  • An elevated toilet seat may be helpful initially.
  • You can shower after 48 hours with the waterproof dressing in place. The waterproof dressing is removed in 7 days, and then you may shower with the incision exposed.
  • You can apply Vitamin E or moisturizing cream into the wound once the wound has healed.
  • If you have increasing redness or swelling in the wound or temperatures over 100.5° you should call your doctor.
  • If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent infection in your new prosthesis. Consult your surgeon for details.
  • Your knee replacement may go off in a metal detector at the airport. A knee replacement identification card will be provided at your first post-op appointment.

Risks and Complications

  • As with any major surgery, there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages
  • It is important that you are informed of these risks before the surgery takes place
  • Complications can be medical (general) or local complications specific to the knee

The risks of surgery include, but are not limited to, bleeding, infection, damage to the nerves or blood vessels, persistent pain, stiffness, fracture, loosening or the prothesis, bearing surface wear, dislocation, blood clots, pulmonary embolism, stroke, heart attack, and death.

Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete.

Specific complications include:

Infection

Infection can occur with any operation. In the knee this can be superficial or deep. Infection rates vary. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your new knee may need to be removed to eradicate infection.

Blood Clots (Deep Venous Thrombosis)

These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your doctor.

Stiffness in the Knee

Ideally your knee should bend beyond 100 degrees but on occasion, the knee may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you and under anesthetic.

Wear

The plastic liner may eventually wears out over time. There is excellent survival at 15-20 years.

Wound irritation or breakdown

The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this.

Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.

Cosmetic Appearance

The knee may look different than it was because it is put into the correct alignment to allow proper function.

Dislocation

An extremely rare condition where the ends of the knee joint lose contact with each other or the plastic insert can lose contact with the tibia (shinbone) or the femur (thigh bone).

Patella problems

Patella (knee cap) can dislocate. This means it moves out of place and it can break or loosen.

Ligament injuries

There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem.

Damage to Nerves and Blood Vessels

Rarely these can be damaged at the time of surgery. If recognized they are repaired, but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.

Fractures or breaks in the bone can occur during surgery or afterwards if you fall. To repair these, you may require surgery.

Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.

Summary

Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan—it may help to restore function to your damaged joints as well as relieve pain.

TKR is one of the most successful operations available today. It is an excellent procedure to improve the quality of life, take away pain and improve function. In general 90-95% of knee replacements survive 15 years, depending on age and activity level.

Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and medical practitioner.

Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.

Location One

1860 Town Center Drive, Ste. 300
Reston, VA 20190
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Location One

6201 Centreville Road, Ste. 600
Centreville, VA 20121
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