Knee replacement surgery - also called knee arthroplasty - is a procedure that can help ease pain regain function in seriously diseased knee joints. This surgery involves clipping away damaged bone and cartilage from your thigh bone, shinbone, kneecap, and substituting it with an artificial joint - composed of high-grade plastics, metal alloys, and polymers.
Many types of arthritis can affect your knee joint:
- Osteoarthritis - a degenerative joint disease that mainly affects middle-aged and older adults, can lead to the breakdown of joint cartilage and surrounding bones in the knees.
- Rheumatoid arthritis - which causes inflammation of the synovial membrane and leads to excessive synovial fluid, may cause pain and stiffness.
- Traumatic arthritis - a type of arthritis that occurs due to injury- may damage the knee cartilage.
A knee replacement surgery's key objective is to recover the parts of the knee joint that have been damaged or to ease the knee pain that cannot be managed by other treatments.
When Is A Knee Anthroplasty Required?
The doctor orders a knee replacement surgery when your knee joint is damaged or worn so much that your mobility is reduced, and you experience pain even while resting.
As we have already discussed, several types of arthritis can affect your knee joint and can be a reason for knee replacement surgery. Following are some other health conditions that can cause knee damage:
- Knee injury
- Disorders that cause unusual bone growth
- Death of bone in the knee joint after blood supply issues
- Knee deformity with pain or loss of cartilage
Who Is Given A Knee Anthrolasty Surgery?
Knee replacement surgery is major surgery, and so it's recommended only for those people who haven’t experienced pain reduction or improved mobility from physiotherapy or steroid injections.
You may be given knee replacement surgery if:
- Your knee pain is very severe and it interferes with your quality of life and sleep.
- You have intense pain, stiffness, and swelling in your knee joint, and your mobility is diminished.
- You're feeling depressed due to the pain and lack of mobility.
- Routine activities, including getting out of the bath, shopping, etc., are challenging or impossible.
- You cannot work or have a good social life.
Before recommending knee replacement surgery, your doctor will determine if you are healthy enough to deal with both major surgery and the recovery afterward.
What Are The Types Of Knee Replacement Surgery or Anthroplasty?
There are three types of knee replacement surgery. They are:
- Total Knee Replacement - In this procedure, the whole knee is replaced.
- Partial Knee Replacement - In a partial knee replacement, only the affected part of the knee is replaced with a smaller operation. Your hospital stay will be short, and the recovery time will be pretty quick.
- Bilateral Knee Replacement - In this, both knees are replaced at the same time.
Total knee replacement is a very common surgery. In the United States, surgeons perform 700,000 of them each year.
What Other Surgery Alternatives Are Available?
There are a couple of surgical alternatives to knee replacement, although their results are not very good in the long term. Your doctor will recommend the best treatment alternative for you. Other types of surgical treatment include the following:
- Arthroscopic Washout and Debridement – a tiny telescope (called an arthroscope) are inserted into the knee, which is then washed away with saline to clear any pieces of bone or cartilage.
- Osteotomy – the surgeon incisions the shin bone and restructure it so that the damaged part of the knee no longer suffers your weight
- Mosaicplasty - a keyhole surgery which involves moving plugs of hard cartilage, together with some fundamental bone from another part of your knee, to fix the damaged surface.
How To Prepare For A Knee Replacement Surgery?
Before you get into a hospital for surgery, make sure you are well informed about what’s going to happen in operation. Ideally, your hospital should provide you with all the written information along with the videos.
Stay as physically active as you can. Try exercises that can strengthen the muscles around your knee - this will support your recovery process. If you can, keep doing gentle exercise, including walking and swimming, in the weeks and months prior to your operation. You can also be referred to a physiotherapist, who will suggest some helpful exercises for you.
Recovering From A Knee Replacement Surgery
You will stay in the hospital for nearly 3 - 5 days, although recovery time can vary from person-to-person.
Once you are ready to get discharged, the hospital will provide you with advice regarding taking proper care of your knee at home. You might need to use crutches or a frame for some days. Follow the advice of your physiotherapist to perform exercises and strengthen your knee joint muscles.
Most people stop using walking aids in about six weeks of the surgery and start driving in about 6 - 8 weeks.
Full recovery may take up to 2 years as scar tissue gets better and your muscles are recovered by exercise. Only a few people will continue to experience some pain after two years.
Are There Any Risks?
Knee replacement surgery is very common, and most people do not experience any complications. Although, as with any surgery, there are some risks of complications, which are listed below:
- Infection of the wound
- Stiffness of the knee
- Unexpected bleeding into the knee joint
- Persistent pain in the knee
- Infection of the joint replacement, requiring further surgery
- Deep vein thrombosis (DVT)
- A break in the bone surrounding the knee replacement during or after the operation
- Artery, nerve, or ligament damage in the area close to the knee joint
In certain cases, the new knee joint is not completely stable. In such a case, the patient needs to undergo further surgery to correct it.
How Is The Knee Replacement Surgery Done?
Usually, knee replacement surgery is performed under:
- General anesthesia: which keeps you asleep throughout the procedure
- Spinal anesthesia or Epidural: keeps you awake, but you will experience no feeling down the waist
The worn or damaged ends in your knee joint are removed and replaced with metal and plastic components that have been measured to fit correctly.
You can either have a total knee replacement or partial knee replacement, depending upon how damaged your knee is.
Total Knee Replacement
- In a total knee replacement, the full knee is replaced, and this procedure usually takes about 1 - 3 hours. Consider the following points to understand what happens during the procedure.
- The surgeon will make a cut down the front of your knee to reveal your kneecap. This is then shifted to the side so that the surgeon can make it to the knee joint behind it.
- The damaged ends of your shinbone and thigh bone are cut away. The ends are accurately measured and shaped to fit the prosthetic replacement. A dummy joint is placed to check that the joint is working appropriately. Adjustments are made, the bone extremities are cleaned, and the final prosthesis is fitted.
- A curved part of metal replaces your thigh bone's extremities, and a flat metal plate replaces the end of your shin bone. These are fixed using special bone called 'cement' or are treated to encourage your bone to fuse with the replacement parts. A plastic spacer is inserted between the pieces of metal. This works like cartilage, minimizing friction as your joint moves.
- Depending upon the reasons for replacement, the back of the knee cap can also be replaced.
- The wound is closed with either clips or stitches, and a dressing is done to the wound. A splint is utilized to keep your leg immobile in exceptional cases, but you are generally encouraged to try moving your knee as early as possible.
You may face difficulty moving after the operation, particularly bending your knee. Kneeling can also be challenging for you due to the operation scar.
Partial Knee Replacement
- If only one part of your knee is damaged, your doctor may recommend a partial knee replacement for you. This is a simpler surgery, which involves smaller incisions and less bone being removed. It’s suitable only for about one in four people with osteoarthritis.
- The pros of partial knee replacement include a comparatively shorter hospital stay and recovery time. Blood transfusions are also often required. This type of knee replacement generally results in the more natural movement in the knee, and you might be able to be more active than after a total knee replacement.
Talk to your doctor regarding the best type of surgery and why they consider it the best treatment alternative.
How Long Can A Replacement Knee Last?
Your replacement knee might not last forever due to wear and tear through everyday use. Some people may require further surgery to correct it.
Research says that about 01 in 20 people who have had a knee replacement will require further surgery after nearly twelve years. Again, this depends upon the type of knee replacement. Total knee replacements usually last longer than partial knee replacements.
Tips For Looking After Your New Knee
Consider the following tips to look after your new knee:
- Use your walking aids but aim to eventually decrease the amount you rely on them as your leg feels stronger
- Continue to take any prescribed painkillers or anti-inflammatories to help manage any pain and swelling
- Do not sit with your legs crossed for the first six weeks after your operation
- Keep up your exercises to help prevent stiffness, but do not force your knee
- Avoid twisting at your knee
- Do not place a pillow underneath your knee while sleeping as this can lead to a permanently bent knee
- Wear supportive shoes outdoors
- Lift your leg while sitting and apply an ice pack wrapped in a tea towel for about 20 minutes every 3 or 4 hours to reduce any swelling
- Do not kneel on your operated knee until your surgeon says you can
Graduate in biotechnology, Maria Brown has a huge appreciation for books and writing. Apart from talking about classic literature with people around (which is her favourite thing to do), she provides editorial assistance to the team. Maria always has something to talk about on any topic because of her vast knowledge on a plethora of subjects.