Total Knee Replacement
Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.
Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It often affects older people.
In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. These factors can cause pain and restricted range of motion in the joint.
Your doctor may advise total knee replacement if you have:
- Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).
- Moderate to severe pain that occurs during rest or awakens you at night.
- Chronic knee inflammation and swelling that is not relieved with rest or medications
- Failure to obtain pain relief from medications, injections, physical therapy, or other conservative treatments.
- Deformity of the knee (bow-leg or knock-knee deformity)
The exact cause of osteoarthritis is not known, however, there are several factors that are commonly associated with the onset of arthritis and may include:
- Injury or trauma to the joint
- Fractures at the knee joint
- Increased body weight
- Repetitive overuse
- Joint infection
- Inflammation of the joint
- Connective tissue disorders
The diagnosis is made by obtaining a complete medical history, performing a thorough physical examination and finally by reviewing x-rays. X-rays will typically demonstrate narrowing of the joint space. An MRI is usually not necessary, but can also confirm the diagnosis.
The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.
The surgery is most often performed under spinal anaesthesia. When a spinal anaesthetic is used, patients are still sedated during the operation, but are able to breathe on their own and do not require a ventilator (breathing machine). On rare occasions, general anaesthesia may be recommended.
Your surgeon will make an incision in the skin over the affected knee, followed by an incision in the joint capsule, to expose the knee joint. Then the damaged portions of the femur and tibia bone are cut at appropriate angles, removing a precise amount of bone to be replaced by the prosthesis, using specialized instruments. After using trial implants to verify the function of the joint, the femoral, tibial, and patellar components are attached with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. A plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, like the original meniscus cartilage. The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. On some occasions, the surgeon may elect to not resurface the patella is the cartilage remains in good condition. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The capsule and incision are carefully closed and a sterile dressing is placed over the incision.
Rehabilitation begins immediately following the surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Knee immobilizers are used to stabilize the knee only for ambulation is you are unable to perform a straight leg raise. Remember, if a knee immobilized is recommended, it is usually only for ambulation and should be removed at all other times to encourage a range of motion of the knee. You will be able to walk with crutches or a walker. Your physical therapist will also provide you with a home exercise program to strengthen thigh and calf muscles.
Risks and complications
As with any major surgery, possible risks and complications associated with total knee replacement surgery include:
- Knee stiffness
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Ligament injuries, instability
- Patella (kneecap) dislocation
- Plastic liner wears out
- Loosening of the implant
- Failure to relieve pain
- Scar formation
- Pressure sores
- Medical compositions (Stroke, heart attack, pulmonary embolism)
If you find difficulty in performing simple activities such as walking or climbing stairs because of your severe arthritic knee pain, then total knee replacement may be an option for you. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume your normal activities of daily living.