FAQs On Total Knee Replacement
by PRIYANSHU SAXENA Medi MarcomQ- What is TOTAL KNEE REPLACEMENT?
Ans- Total
knee replacement is a surgical procedure whereby the diseased knee joint is
replaced with artificial material. The knee is a hinge joint which provides
motion at the point where the thigh meets the lower leg. The thigh bone (or
femur) abuts the large bone of the lower leg (tibia) at the knee joint. During
a total knee replacement, the end of the femur bone is removed and replaced
with a metal shell. The end of the lower leg bone (tibia) is also removed and
replaced with a channeled plastic piece with a metal stem. Depending on the
condition of the kneecap portion of the knee joint, a plastic
"button" may also be added under the kneecap surface.
Cause
The most common cause of chronic
knee pain and disability is arthritis (Osteoarthritis,rheumatoid arthritis, and
traumatic arthritis ).
Osteoarthritis usually occurs in people of 50 years of age and older and
often in individuals with a family history of arthritis. The cartilage that
cushions the bones of the knee softens and wears away. The bones then rub
against one another, causing knee pain and stiffness.
Rheumatoid
arthritis is a
disease in which the membrane around the joint becomes thickened and inflamed,
producing too much fluid that overfills the joint space. This chronic
inflammation can damage the cartilage and eventually cause cartilage loss,
pain, and stiffness.
Traumatic
arthritis can
follow a serious knee injury. A knee fracture or severe tears of the knee
ligaments may damage the cartilage over time, causing knee pain and limiting
knee function.
Q-How does this surgery benefit the patient?
Ans- Severe knee pain that limits everyday activities, including
walking, climbingstairs, and getting in and out of chairs.
Moderate
or severe knee pain while resting, either day or night
Chronic
knee inflammation and swelling that does not improve with rest or medications
Knee
deformity: a bowing in or out of your knee
Knee
stiffness: inability to bend and straighten your knee
Failure
to obtain pain relief inspite of using anti-inflammatory drugs. Failure to
substantially improve with other treatments such as cortisone injections,
physical therapy, or other surgeries
Preoperative
Evaluation
Before
surgery, joints adjacent to the diseased knee are carefully evaluated. This is
important to ensure optimal outcome from the surgery.
Blood
thinning medications such as Aspirin, may have to be adjusted or discontinued
prior to surgery.
Routine
blood tests of liver and kidney function, and urine tests are evaluated for
signs of anemia, infection or abnormal metabolism. Chest x-ray and ECG are
performed to exclude significant heart and lung disease which may preclude
surgery or anesthesia.
Surgery
Procedure
After admission in the hospital, you
will be evaluated by a member of the anesthesia team. The most common types of
anesthesia are general anesthesia, in which you are asleep throughout the
procedure, and spinal or epidural anesthesia, in which you are awake but your
legs are anesthetized. The anesthesia team will determine which type of
anesthesia will be best for you with your input.
The procedure itself takes
approximately 2 hours. Your orthopedic surgeon will remove the damaged
cartilage and bone and then position the new metal and plastic joint surfaces
to restore the alignment and function of your knee.
After surgery, you will be moved
to the recovery room, where you will remain for 1 to 2 hours while your
recovery from anesthesia is monitored. After you awaken, you will be taken to ward.
A recent advance in the
performance of total knee replacement is the use of minimally invasive surgical
approaches which has many advantages like the incisions are approximately half
the size of those used in a standard approach which results in quicker
rehabilitation, less pain, and a shorter hospitalization.
Postoperative
Period
After surgery, patients are taken
to a recovery room and are kept under observation. When stabilized, they are
shifted to ward.
Passage of urine can be difficult
in the immediate postoperative period, and this condition can be aggravated by
pain medications. A catheter inserted into the urethra (a foley’s catheter)
allows free passage of urine until the patient becomes more mobile. Physical
therapy is an extremely important part of rehabilitation and requires full
participation by the patient for optimal outcome. Patients can begin physical
therapy forty-eight hours after surgery. Some degree of pain, discomfort, and
stiffness can be expected during the early days of physical therapy. Knee
immobilizers are used in order to stabilize the knee while undergoing physical
therapy, walking, and sleeping. A unique device that can help speed recovery is
the continuous passive motion (CPM) machine. The CPM machine is first attached
to the operated leg. The machine then constantly moves the knee through various
degrees of range of motion for hours while the patient relaxes.
Patients will start walking using
a walker and crutches. Eventually, patients will learn to walk and climb
stairs. A number of home exercises are given to strengthen thigh and calf
muscles.
Recovery
It is important for patients to
continue in an outpatient physical therapy program along with home exercises
for optimal outcome of total knee replacement surgery. The wound will be
monitored by your surgeon for healing. Patients also should watch for warning
signs of infection including abnormal redness, increasing warmth, swelling, or
unusual pain. It is important to report any injury to the joint to the doctor
immediately. Future activities are generally limited to those that do not risk
injuring the replaced joint. Sports that involve running or contact are
avoided, in favor of leisure sports, such as golf, and swimming. Swimming is
the ideal form of exercise, since the sport improves muscle strength and
endurance without exerting any pressure or stress on the replaced joint.
These joints are at risk for
infection by bacteria introduced by any invasive procedures such as surgery,
dental or gum work, urological and endoscopic procedures, as well as from
infections elsewhere in the body. Patients are recommended to take antibiotics
before, during, and immediately after any elective procedures in order to
prevent infection of the replaced joint.
Q- What
are the complications involved?
Ans- Blood clots in the leg veins are the most common complication. Your
orthopaedic surgeon will outline a prevention program, which may include
periodic elevation of your legs, lower leg exercises to increase circulation, support
stockings, and medication to thin your blood.
Infection of
the replaced joint can occur, though rare.
Although
implant designs and materials as well as surgical techniques have been
optimized, wear of the bearing surfaces or loosening of the components may
occur.
Additionally,
scarring of the knee can occasionally occur, and motion may be more limited,
particularly in patients with limited motion before surgery.
Finally,
although rare, injury to the nerves or blood vessels around the knee can occur during
surgery.
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