Joint replacement is a surgical procedure in which a worn-out or injured joint, most often the knee or hip, is replaced with a metal, ceramic, or plastic joint. This surgery has been widely used for many years with excellent results, especially with knees and hips. Other joints, such as shoulders, elbows, and knuckles, may also be replaced.
Arthritic Knee If you have severe Knee pain that limits your mobility and affects your daily functions, you may benefit from Knee replacement. The following three are the most common causes of joint damage due to arthritis:
Osteoarthritis: A disease that involves the wearing away of the normal smooth joint surfaces.
Rheumatoid Arthritis: The body’s immune system attacks and destroys the synovial lining covering the joint capsule, the protective cartilage, and the joint surface.
Trauma-related arthritis: Resulting from damage to the joint from a previous injury. It also results in joint damage, pain, and loss of mobility.
Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but sometimes procedure is performed in younger people also.
The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:
• You have daily pain.
• Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.
• You have significant stiffness of your knee.
• You have significant instability (constant giving way) of your knee.
• You have significant deformity (knock-knees or bowlegs)
Knee replacement is removing the edges of the joint that have been diseased by degeneration or trauma. Knee resurfacing is like a retread. The only part of the joint that is resurfaced is the side of the joint that is diseased.
Most of the patients with severe crippling arthritis have severe affection of both knee joints and deformities.
The advantages of replacing both knees simultaneously in one stage are :
â—‹ Single anaesthesia and hospitalisation
â—‹ One time medication and rehabilitation
â—‹ More economical
The patients who undergo simultaneous bilateral TKR must be medically fit and should not have other co morbid conditions, otherwise staged (one knee at a time) should be considered
I try to take an individualized approach to my patients. For patients who haven’t had any other treatments, I want to see them try some of the simpler things first – anti-inflammatory injections, physical therapy, maybe even arthroscopic surgery. At the same time I will follow them closely, checking them every couple of months, maybe with X-rays, to see if they are losing bone, because I can’t in general make the bone come back. If a patient comes to me who has tried other options and still has problems – they can’t walk where they need to go and have a lot of trouble getting around and doing the things they want to do – then that’s when we start looking at a joint replacement.
Some pain will accompany it as it does with any surgical procedure. Anesthesiologists and pain management specialists, also part of the Joint Replacement Centre team, work with each patient to control pain. Many factors, including your tolerance for pain, physical condition and level of activity prior to your surgery will impact the level of pain you may experience.
Major surgery on a joint may take two or three hours in the operating room. Getting full range of motion, strength and flexibility back in that joint after surgery usually takes months. That’s where pre-operative exercise and education and post-operative physiotherapy programs come in – to ensure you’re physically and emotionally prepared for surgery, and to maximize your recovery after surgery.
It’s impossible to predict how long a new joint will last, since factors such as age, weight, activity level and bone strength determine the final outcome. It’s likely that your new joint will bring you years of pain-free activity. With the new materials and components, most people have a 90 percent or greater success rate at 20 years after surgery.
If you look in the literature, generally around 95 percent of people do very well with hip or knee replacements. These are some of the more reliable procedures we do. Still, I like to try the conservative things first because there can be some complications.
If a knee component loosen or gets infected then original components are removed and new components are implanted. In case of infection, it's a staged procedure.
Any surgery has risks. There are many risks associated with knee replacement surgery. However, in the hands of a well-trained, dedicated orthopaedic surgeon, these risks should be quite low. It is fair to say that you have about a 96% chance that you will go through the operation without any significant complication occurring. The most common complication is blood clots in the legs. The most serious complication is infection. The most important long-term complication is loosening.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time.
Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics. You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.
With newer minimally invasive technologies using FIFO (fast in Fast out), post surgery you need to be in hospital for 2-3 days in single knee and 3-4 days for both knees.
It depends on your profession. If a patient has a sedentary or desk job, they may return to work in approximately 3-6 weeks. If your work is more labor intensive, patients may require up to 3 months before they can return to full duty. In some cases, more or less time is necessary.
Yes. For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. If you go directly home from the hospital, family or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required.
Using FIFO coupled with modified anaesthesia techniques and improvised pain control techniques, you will be made to walk next day after surgery in majority of cases.
Most patients require an assistive device (walker, crutches, or cane) for approximately 3 weeks after knee replacement surgery although this varies significantly from patient to patient.
You can manage stairs around a month after surgery if it’s both knees and much earlier if its single. A good rule of thumb to remember when deciding which leg to lead with is “up with the good, down with the bad.â€
This varies from patient to patient depending upon one’s comfort and confidence. Typically, patients may drive when they are using a cane comfortably and not taking narcotics. Some surgeons do not allow the patient to drive until after they have been seen in the office at 4-6 weeks after surgery.
After several months you may try to kneel or squat. It may be painful at first, but will not harm or damage your knee replacement. Much of the discomfort comes from healing on your recent incision and the healing local tissues. These activities generally become more comfortable as time passes. Avoid sitting cross legged on floor.
People can travel on an airplane six weeks after their surgery. During flying, exercise your calf muscles and ankles frequently. Check with your surgeon about taking a blood-thinner medication before flying. Wear your white anti-embolism stockings to reduce the risk of blood clots.
For a replacement operation on the right leg, it is wise to wait a four to six weeks and after you have stopped taking medications that impede your driving ability. By that time, you have control of your reflexes, making driving safe.
If your waterproof dressing has been unstained for a 24-hour period and there is no drainage, then you can shower. You should avoid immersing your incision under water. When drying the incision, pat the incision dry, do not rub it.
You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking which diminish with time.
Implants are made of metal alloys (chrome cobalt or Titanium alloy), ceramic or ceramicised material, and strong plastic parts. Up to three bone surfaces may be replaced in a total knee replacement and two surfaces in partial.
Joint replacement surgery for arthritis is considered a treatment of last resort. But even though replaced joints may not last forever, the weight, activity, and implant type have the most significant impact on how long a knee replacement will last. Some strenuous activities, including impact sports, and any activity requiring running and jumping can create stress on the implants that may lead to early failure of the implanted joint.
