Total Knee Replacement
Knee Arthritis
Arthritis is the swelling and tenderness of one or more of your joints. Some of the main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It is a medical condition in which the protective cartilage that cushions the ends of your bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine.
In rheumatoid arthritis, the body’s immune system attacks its own tissue, including joints. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.
Symptoms of Arthritis (associated with joints):
- Pain
- Stiffness
- Swelling
- Redness
- Reduced Range of Motion
TOTAL KNEE REPLACEMENT
Total knee replacement (TKR), also called as Total Knee Arthroplasty (TKA), is a surgical procedure performed on patients suffering from osteoarthritis of the knee joints. Osteoarthritis is a condition where the cartilage and bones of the knee are damaged leading to pain, deformity of the leg associated with difficulty in walking. Although more commonly seen in elderly patients as a result of wear and tear, a part of aging process, arthritis can also be seen in other disorders such as rheumatoid arthritis or secondary to malunited fractures of the bones forming knee joints
After a thorough clinical and radiological examination by an expert arthroplasty surgeon, a decision regarding the need for Total Knee Replacement can be taken. Depending on these examination findings and necessities of the patient, a particular design and make of implant can be chosen.
A team of exert knee replacement surgeons with a trained staff and a well-organized physiotherapy program are pre-requisites of a better outcome, speedy recovery, and early return to a more active life.
With the development of technology, like Computer Assisted Surgery (CAS), the procedure is more refined, less invasive with more accurate correction of the deformities.
How is it done?
Two most commonly used approaches while performing TKR are namely Median parapatellar and sub-vastus approaches. The difference between these two is when the vastus, the muscle present in the front of lower thigh region, is either cut in the middle as in Median parapatellar approach or reflected in sub-vastus approach. Each approach with its own advantages, are used routinely and its followers argue about superiority of one approach over the other.
Sub-vastus approach is less traumatic as muscle is reflected not cut, so physiotherapy like stair climbing can be started early in the post-operative period. However, it is skilfully demanding and cannot be performed in very stiff knees. Median parapatellar approach is relatively easy, but traumatic to muscle so stair climbing has to be delayed. However, in long term the final result achieved in terms of range of motion and the strength of muscles is similar with both the approaches.
Implants used in TKR play a crucial role in achieving a satisfactory result after the procedure on long term. So, implant selection is an important aspect we, at BIMS Hospital expect that all our patients should be aware of what type of implant is used in their body.
The type of implants that can be used in TKR can be broadly grouped in to two; depending on whether the PCL- The Posterior Crucial Ligament is retained or sacrificed. PCL is present in the knee, The function of which is to provide stability to knee joint. The first type, cruciate retaining implants are the once where PCL is saved. In the second type, Cruciate sacrificing implants, as the name suggests, PCL is sacrificed and is replaced with CAM and Post mechanism in the implant.
The types of implants that are available in these two designs are further available in two types: The fixed bearing implants namely all Poly and Metal Back. And mobile bearing implants where the insert is mobile which moves through the knee movements allowing more movement and less wear and tear. Some of these implants also come with Oxynium coating which helps in reducing wear and tear, thus increasing the life of implants.
Biological TKR
It is a TKR, performed using techniques which are more biological, less invasive and traumatic, leading to early recovery to day-to-day activities.
1) Using Sub Vastus Approach – A less invasive muscle reflecting approach instead of the one where muscle is cut, leading to early recovery and easier postoperative physio rehabilitation.
2) Using CAS (Computer Assisted Surgery) technology – Leading to less bone loss and more precise bone cuts and near normal deformity correction.
3) Using CAS (Computer Assisted Surgery) technology – Leading to less bone loss and more precise bone cuts and near normal deformity correction.
4) Using PS Implants – Using Posterior Stabilizing (PS) implants, where the PCL (Posterior Cruciate Ligament) is preserved, a less invasive soft tissue protecting approach. Using Uncemented Implants – This achieves a more biological fixation of implants, abolishes the need for cement, and thus avoids cement related complications.
GOLD KNEE
Implants used in the TKR procedure are made up of various metallic alloys which are inert, they don’t have any adverse effects on our body. Titanium or Cobalt Chromium alloys are amongst the most commonly used materials for these implants. However, all these materials are subjected to wear and tear, depending on the use and abuse of daily activities.
A new implant, called “Gold Knee”, have a Titanium Niobium Nitride coating on these alloys. This coating imparts a golden colour to the implants, hence the name. This coating decreases the wear and tear of the implants and prolongs the life of the prosthesis. Also, this coating minimizes the chances of metal allergies. Hence these implants are a boon for patients with osteoarthritis who have metal allergies.
Why is Golden Knee Replacement Better?
Regular knee implants, made of chromium or cobalt tend to release metal ions in the body. In patients who have metal allergy, these metal ions can cause inflammation in the knee area and eventually cause complications like infection, pus formation and severe knee pain. Hence, for such patients, a Golden Knee Surgery is generally suggested. The implant used for this surgery has a gold-coloured Titanium-Nitride/Zirconium nitride coating. Not only does the golden knee implant prevents any allergic reaction with the body, but also, is more durable and has a longer life.
Who should undergo Golden Knee Replacement?
Even though any patient who is a candidate can opt for Golden knee replacement. It is preferably advisable for patient who have any kind of metal allergy.
What Are the Most Common Types of Knee Replacement Surgery?
There are two most common types of knee replacement surgery which include:
Total Knee Replacement
Partial Knee Replacement or Unicompartmental Replacement
Most knee replacement surgeries target the whole knee joint, called a total knee replacement. But some people opt for a partial knee replacement.
In order to understand the difference, we should first know the three compartments or sections of the knee:
Medial (Inside)
Lateral (Outside)
Patellofemoral/anterior (Under the kneecap)
While a total knee replacement addresses all three sections, the partial knee replacement fixes a single section. Usually, only young adults with symptoms in just one knee section opt for a partial replacement.
Considering the condition of the knee and the patient’s general health, an orthopaedic surgeon will help in choosing the best option.
Who Should Get Knee Replacement Surgery?
People suffering from the following conditions should get a knee replacement surgery:
A knee injury or arthritis in the knee that has badly damaged the mating surfaces of the joint.
Swelling and inflammation that does go away with rest and medicines. If the knee is deformed, such as not shaped normally or looking swollen.
Pain and stiffness which gives trouble doing routine activities like getting in and out of car or walking up or down the stairs.
What Happens Before Knee Replacement Surgery?
Once the patient and surgeon decide to go ahead with knee replacement surgery, they may require:
Blood tests
Physical examination to ensure that the patient is healthy enough for surgery
Dental exam to help reduce infection risk from surgery
ECG (Electrocardiogram) to ensure that the patient’s heart is strong enough for the surgery
What Happens During Knee Replacement Surgery?
On the day of operation, the patient will receive anaesthesia to prevent pain during the surgery. It will be either a general anaesthetic or a regional (spinal block). The anaesthesia team will decide what type of anaesthesia suits the patient.
Knee replacement operation takes close to an hour or two. During the surgery the surgical team will:
Make a cut (an incision) in the knee area
Remove any damaged bone and cartilage
Place a knee implant and position it accurately
Secure the implant into the place by using cement, or without cement, as well
Insert a piece of polyethylene (thermoplastic polymer) which creates a smooth, gliding surface between metal parts of the implant
Close the cut/incision.
What Happens After the Knee Replacement Surgery?
After knee arthroplasty, the patient will be moved to a recovery room. The healthcare team at the hospital will watch the patient for a while to make sure they wake up from the anaesthesia without any complications. The team will also monitor the vital signs and pain level of the patient.
During the hospital stay, the healthcare team will encourage the patient to move your foot and ankle that will increase the blood flow to the leg muscles and help prevent swelling and blood clots.
Rarely, people who get knee replacement surgery go home the same day. If a patient has to stay in the hospital, it will most likely be for one more day. The time spent in the hospital is based on medical needs.
Will I Need Any Treatments After Knee Replacement?
Medicines prescribed by the doctor may help control and relieve pain. The patient will most likely receive blood thinners and wear a support hose or compression boots to protect further against clotting and swelling.
The patient will also be asked to perform frequent breathing exercises and gradually increase the activity level.
The day after surgery, a physiotherapist will the patient to exercise the new knee. After leaving the hospital, patients continue physiotherapy at home. Patients have to perform these exercises regularly, as instructed.
What Are the Risks of Knee Replacement Surgery?
Although knee replacement surgery is a very safe procedure, some rare complications may occur which include:
Infection
Blood clots
Injury to nerves or the blood vessels around the knee
Problems with the implant like the device loosening or wearing down very soon
Scar tissue inside knee
When To Seek Medical Attention After Knee Replacement Surgery?
After going home, the patient should call their doctor immediately if they develop any of these symptoms:
Shortness of breath and/or chest pain
Fever greater than 101 degrees Fahrenheit (fluctuations in body temperature are expected following surgery)
Cut/incision problems, such as leaking, bleeding, redness, swelling, or odor
Pain in the foot, calf, or ankle that is new and gets worse