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 and the soft cartilage on the ends of the femur and tibia (articular cartilage), serve as a cushion and help absorb shock during activities. Arthritis (inflammation of the joint), 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 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. Itmost often effects older people.
In a normal joint, articular cartilage allows smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or is completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. All of 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.
- A bow- legged knee deformity
The exact cause of osteoarthritis is not known, however there are a number of factors that are commonly associated with the onset of arthritis and may include:
- Injury or trauma to the joint
- Fractures within the knee joint
- Increased body weight
- Repetitive overuse
- Joint infection
- Inflammation of the joint
- Connective tissue disorders... Read More
Your doctor will diagnose osteoarthritis based on your medical history, physical examination, and X-rays. Occasionally a MRI is needed to help with the diagnosis.
X-rays typically show a narrowing of the joint space in the arthritic knee
The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.
The surgery is performed under spinal or general anaesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are removed at appropriate angles using specialized instruments. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) . This removes the deformed part of the bone and any bony spurs, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws. The femoral component is attached to the end of the femur with or without bone cement. Your surgeon will place 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. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also usually prepared to receive a plastic component. 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 incision is carefully closed and a sterile dressing is placed over the incision.
Rehabilitation begins immediately following the surgery. A physiotherapist will teach you specific exercises to strengthen your leg and restore knee movement. You will be able to walk with crutches or a walker. Your physiotherapist will also provide you with a home exercise program to strengthen your thigh and calf muscles.
Risks and complications
Although uncommon, 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
- Plastic liner wears
- Loosening of the implants
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