Procedure

Knee Replacement- Orthopedics

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Knee replacement surgery is a surgical procedure in which an orthopedic surgeon replaces your diseased knee joint with a new prosthetic one.

Another name for knee replacement surgery is “knee arthroplasty”. The surgery is usually done to relieve the pain and limited knee mobility which develops with advancing age. The surgeon might replace all or part of your knee joint, on one or both sides depending on your specific case.

Causes

Osteoarthritis (OA) is the most common cause leading to knee replacement surgery worldwide. Osteoarthritis is a degenerative joint disease that progresses over many years. In a normal joint, the two ends of the bones are covered with a soft layer of tissue called “the cartilage”. The cartilage cushions the surfaces where your bones meet to form the joint. Advanced age, previous joint injury, obesity, and other factors can wear down cartilage and the bone ends come in direct contact and glide traumatically against each other becoming damaged. This is what doctors call osteoarthritis, and it leads to joint pain and can restrict your joint’s range of motion. Osteoarthritis can affect any joint, however, it most frequently affects the hands, knees, hips, and spine.  When the knee becomes damaged by osteoarthritis and the symptoms start interfering with your quality of life, your doctor might recommend knee replacement surgery.

Risks

Like any other surgery, knee arthroplasty can carry some possible risks:

  • Surgical site infection
  • Blood clots in your leg veins
  • Postoperative pain
  • Joint stiffness

Although all of these are possible side effects of knee replacement surgery, however, it’s uncommon for them to happen. Your doctor will give you antibiotics before surgery to reduce the risk of infection. After surgery, you will be encouraged to move your feet, wear compression stockings, and will be given blood thinners to prevent any clots from forming.

Preparing for surgery

During your initial visit to the orthopedic clinic, your doctor will start by asking you detailed questions about your symptoms. They will ask about your medical history, surgical history, home medications, and life habits. He/she will then examine your knees, flexing them and extending them in different angles to assess your range of motion, mobility, and try to stimulate any pain. They might order an X-ray of your knee to evaluate the damage in your joint.

After confirming the diagnosis, you will both agree on a suitable time for surgery. He/she will tell you if you need to stop any of your home medications (like blood thinners), and you will be asked to not eat or drink anything the night before the procedure.

Procedure

Knee replacement surgery is done using either general or spinal anesthesia after the anesthesiologist discusses the matter with you and your surgeon. If you receive general anesthesia, you will be completely asleep during the operation. If you receive spinal anesthesia, you will be awake during surgery, however, you won’t feel any pain from the waist down.

The surgery usually takes around 2 hours to complete. You will lie down on the surgical table, with your knee fixed in a bent position. The orthopedic surgeon will make a skin incision over your knee, and push away your kneecap to expose the joint. He/she will then remove the damaged bone from the joint surface in order to make room for the prosthesis (artificial joint). The prosthesis is then installed in place, and the surgeon will move your leg in different directions to test the range of motion.

After surgery

You will stay a night or two at the hospital after getting a knee prosthesis. You will receive painkillers to help control post-operative pain and antibiotics to reduce the risk of infection. You will also receive blood thinners and will be wearing compression stockings to prevent any blood clots from forming in your legs.

A physical therapist will visit you the day after surgery to show you how you can start moving and exercising your new knee. You will be instructed to follow a physical therapy program after leaving the hospital to improve recovery.

After leaving the hospital, you should expect some swelling in the leg where the joint was replaced. Some degree of pain should also be expected, however, you can ease it down with the pain killers that your doctor will prescribe you before heading home.

 Most people will be able to normally perform most of their daily activities 3 to 6 weeks after surgery. This includes shopping, driving, and performing simple chores. During this period you will be receiving your prescribed physical therapy sessions, and performing special exercises at home. After recovery, you can normally resume low-impact activities such as walking, biking, or swimming. Nevertheless, higher impact activities such as skiing and jogging should be avoided. Make sure you ask your doctor about what physical activities you can or cannot do after recovering.

Results

Knee replacement therapy has been proven to significantly reduce pain, improve mobility, and enhance the quality of life in people who receive it. Knee prostheses are usually very durable and can last over 15 years without wearing out. According to one study, 82% of prosthetic knees remain functional after 25 years of surgery.

Sources:

  • orthoinfo.aaos.org/en/treatment/total-knee-replacement/
  • arthritis-health.com/surgery/knee-surgery/what-expect-after-knee-replacement
  • https://www.uptodate.com/contents/total-knee-arthroplasty
  • jamanetwork.com/journals/jama/fullarticle/645818
  • ncbi.nlm.nih.gov/pmc/articles/PMC5859629/
About the Author:
Mersad Alimoradi is a medical doctor specializing in general surgery, with a big interest in academia. He is passionate about spreading medical knowledge and making it accessible to everyone. He has received his medical degree from the Lebanese University, in Beirut, and currently works as a physician and researcher in the country's university hospitals.
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