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Total Knee Replacement

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Total knee replacement, or knee arthroplasty, is a medical procedure that replaces the weight-bearing surfaces of the knee joint that have been damaged. Every year, more than 600,000 patients undergo knee replacement surgery in the United States. Knee replacement surgery is a safe, effective way to address debilitating knee pain and one of most successful procedures available today. People who undergo knee replacement surgery typically have a severe deformity, advanced rheumatoid arthritis, a long history of osteoarthritis, or major trauma to the knee. Arthritis of the knees can be very disruptive to quality of life, as the knees are the largest joints in the body and help support body weight and are required to perform almost all physical activities. Common symptoms for those who experience severe knee pain include difficulty performing everyday activities such as climbing stairs or inability to sleep comfortably due to persistent pain. Knee replacement surgery does not actually replace the knee joint. A more accurate description would be “knee resurfacing,” because only the surfaces of the bones are replaced. The goal of the procedure is to replace these damaged surfaces and relieve longstanding knee pain which has not been successfully resolved through nonsurgical methods. If conservative treatment methods have not effectively alleviated knee pain, you may consider exploring other more aggressive treatment options, such as total knee replacement surgery. A qualified orthopedic surgeon can utilize meticulous technique to minimize potential bone loss while maintaining soft tissue balance. Your surgeon will also guide you through an individually tailored post-op rehabilitation program.

Causes for Knee Replacement

A healthy knee joint is comprised of the femur, tibia, and the kneecap. The knee also has soft tissues, such as the smooth cartilage protecting the bones and enabling them to move easily and without friction. Shock-absorbing wedges called menisci are located between the thigh and shinbones which provide additional cushioning. The ligaments of the knees hold the bones together and provide stability, while the tendons of the area hold the thigh muscles (quadriceps and hamstrings) in place and provide strength. Other surfaces of the knee are covered by the synovial membrane, which releases fluid to lubricate the cartilage. When the tissues and bones comprising the knees do not work harmoniously due to injury, disease or an inherited condition, you may experience pain, muscle weakness and impaired knee function. When it comes to arthritis, there are three basic kinds that can affect the knee joint: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Osteoarthritis (OA) is the most common form. It is a progressive, degenerative disease that causes the joint cartilage to break down. This type of arthritis is most commonly found in older adults. Rheumatoid arthritis (RA) is a long term, chronic disease that causes inflammation in the joints and the surrounding tissue and can destroy the cartilage in the joint. RA and occur at any age and normally affects most of the joints in the body. Post-traumatic arthritis usually develops after an injury and is very similar to osteoarthritis in how it damages the body. Post-traumatic arthritis can present symptoms years after a fracture, ligament injury, or meniscus tear. Osteonecrosis can occur if the blood supply to the femur decreases, which can cause the bone to die.

Am I a Good Candidate for Total Knee Replacement?

Often, those who consider surgery to address the continual pain of their knees have tried many other nonsurgical avenues. Some medical treatments arthritic patients may have tried without lasting success include:

  • Pain medications, such as NSAIDs.
  • Corticosteroid injections to the knee joint.
  • Activity modification.
  • Mobility aids such as canes, crutches or walkers.
  • Physical therapy.
  • Weight loss to reduce pressure on knees.

Your orthopedist will take a complete medical history and review your symptoms associated with knee pain. X-rays or MRI scans will be ordered to better review the knees’ dense and soft structures. X-rays only show the bones, but a very narrow space between the thigh and shinbone and indicate arthritis and a lack of healthy cartilage separating the bones. If you have bone spurs, those will also be revealed through an x-ray. An important consideration when discussing knee replacement with your orthopedist is your expectations. Having realistic expectations is important, such as having the knowledge that even a successful operation will not allow you to do more than you could before you developed knee problems. Also, the prosthesis will eventually need to be replaced. Decades earlier, these had to be replaced approximately every 10 years, but with modern technology, knee replacement implants often last 20 years or more. After you have knee surgery, you will be able to participate in exercise more than you did before you developed knee problems. However, you will be advised to avoid high-impact activities which can put stress on the knees, such as running, jumping or contact sports, for the rest of your life. You can still participate in many other lower impact activities which are highly effective exercise, such as walking, swimming, golf, hiking, biking, elliptical use, dancing or other low-impact activities. More than 90 percent of knee replacement patients have significant symptom relief and would choose to have the surgery again if given the choice. Pre-operative planning is important so you know what to expect before, during and after knee replacement surgery.

Procedure

Total knee replacement surgery is an inpatient procedure, meaning it requires a hospital stay rather than allowing you to go home the same day as surgery. Before surgery begins, general anesthesia will be administered so you are asleep during the procedure. The knee will be shaved to allow better access to the structures, and small incisions will be made to gain access to the knee. In most cases the surgery consists of replacing the diseased or damaged surfaces of the joint with metal and plastic to allow the knee to continue to function as normal. This surgery is considered to be more complicated than other knee surgeries and carries a high amount of risk. Also there is a long recovery period of six weeks or more that includes substantial postoperative pain and physical rehabilitation. The operation itself can take as long as 2 hours in which doctors will remove the damaged parts of the knee and replace them with a new metal and plastic implant that will restore the alignment and function of the knee. After the procedure is finished patients will most likely have to stay in the hospital for several days before they are allowed to return home.

Risks

Knee replacement surgery is a major surgery and there are very real risks that patients need to be aware of, these risks include:

  • Continued pain: some pain is to be expected from the surgery itself, but a small percentage of patients do not get adequate relief even after they recover.
  • Infection: this rare complication is serious and requires urgent, aggressive treatment. Many infections are preventable and a course of antibiotics can prevent bacteria from entering the bloodstream and affecting the implant. After your surgery, you will have to continue taking antibiotics for any medical procedure or even colonoscopy procedures.
  • Blood clots: any surgery carries this risk of the leg veins developing clots, but you are at a slightly higher risk since the legs are directly involved in knee replacement surgery and you won’t be as mobile. These clots can be life-threatening if they travel to the lungs and cause a pulmonary embolism. Your doctor will prescribe blood thinners and have you wear compression stockings and do passive exercises while in bed to lessen this risk.
  • Fat in the bone marrow may travel through the bloodstream into the lungs, causing serious breathing problems.
  • Nerve of blood vessel damage: these risks are very low, but if you experience sudden numbness or weakness of the lower extremities, notify your doctor immediately.
  • Implant loosening/Failure: although up to 95 percent of patients have a well-functioning knee replacement implant for well over 10 years, over time the implant may start to show signs of wear or loosening. A revisional surgery may be necessary if this occurs.
  • Unattractive or physically debilitating scar tissue.
  • Need for knee manipulation procedure, where you are brought in for a second procedure requiring anesthesia which is designed to break up any excess scar tissue.

It is very important to note that patients who undergo knee replacement surgery are unable to return to their pre-injury activities because of a loss of mobility and the increased risk of re-damaging their knee.

Recovery

Once surgery is complete, you will wake up in the recovery room where you will be monitored by nurses for two to three hours before being moved again to a regular hospital room. Monitoring continues during your hospital stay, which usually lasts for three to five days. Monitoring consists of watching your vital signs, as well as changing incision dressings or the tubes that help drain fluid from those sites. Be sure to keep the incision area clean and dry and do not be alarmed by some swelling for the first three to six months. Notify your surgeon if the incision site appear very red or drains fluid. You surgeon may also prescribe a blood thinning medication to minimize the risk of a blood clot forming in the leg veins as a result of being immobile. Before the day of your surgery, make sure that your hospital discharge will be as smooth as possible. Patients who go directly home instead of an in-house rehab center are advised to have a caregiver or home health aide to attend to their needs as they recover and are largely immobile directly following surgery. Before the day of your surgery, you home should be prepared for your return, such as having a firm, straight-back chair (not a recliner), and items you frequently use should be where you can easily grab them and not have to reach or bend over. These items may include reading material, TV remote or phone.

Physical therapy actually begins at your hospital beside, with gentle movement of the leg by a therapist. The day after surgery, you will be given assistance as you are in a standing position, and a walker will help you walk with your new knee. Because weight-bearing can be stressful on the new knee, you will be monitored as you do so. Once you are further into the recovery process and the incision site has healed, you will begin more aggressive physical therapy so you can adjust to life with your new knee(s). Many patients are surprised by how quickly they are able to go back to living independently. You will be able to resume normal activities soon after surgery, but don’t overdo it. Be patient as you experience gradual improvements in pain relief and gain strength.

Another important consideration after having knee surgery is you will have to be very mindful of any possible bacterial infection. For instance, any time you have dental work, you will have to take antibiotics and inform your dentist you have a joint implant. This includes dental work such as an extraction, dental implant, periodontal work or a root canal procedure. You will be able to eat as before after a knee replacement. However, you will be instructed to keep your weight in the normal range or to lose weight if you are obese. Excess body weight puts stress on the knees, and extending the life of your prosthesis can be as simple as losing weight.

Full recovery takes time, and you will have to be dedicated to your physical therapy routine. Your therapist will go over exercises to help you regain strength and full range of motion, such as knee bends, knee exercises with resistance, stationary bicycle routines, weight-bearing, and other activities.

No matter how severe your injury, a total knee replacement can make a huge difference to your life. At West Medical, we have a number of different methods for knee replacements and are happy to assess which is best for you. Our goal is to get you feeling great and back on your feet doing what you love in no time at all. If you are interested in learning more about total knee replacement surgery in Los Angeles and throughout Southern California, please call West Medical offices at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.

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