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Painful knees are a common problem in the middle-aged and elderly populations, and the most common cause of pain in this population is knee arthritis. There are a number of treatments for early knee arthritis that can help alleviate pain, and return people to their daily activities.
As some point, knee arthritis begins to interfere with quality of life to such a point that something has to change. When treatments such as anti-inflammatory medications, cortisone injections, and physical therapy fail to improve the situation, total knee replacement could be an option.
Once the diagnosis of severe knee arthritis is made, you will need to decide with your physician the optimal treatment course. There are signs to look for to decide if the time is right for a knee replacement. If conservative treatments fail to help, then total knee replacement may be an option. There are many types of knee replacements available on the market, but they all share the most basic characteristics.
Most knee replacements last more than 20 years and many will last much longer. However, it is important to understand that there are potential complications of knee replacement surgery that can decrease the life span of the implant. Because of this, knee replacement should be reserved for older patients with significant symptoms of their arthritis.
When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create exact surfaces to accommodate the implant. A metal and plastic knee replacement implant is then placed to function as a new knee joint. Depending on the condition of the cartilage on the undersurface of the kneecap, the kneecap may also be replaced.
Prior to total knee replacement surgery you should have a very thoughtful discussion with your doctor, and have your questions answered. You should understand the potential risks of knee replacement surgery. These include:
Knee replacement surgery is outstanding--the results have been excellent and the outcome of most patients is wonderful. However, there are risks to this surgery, and it is important to understand these before you proceed.
Important, Before You Fly:
Please advise us if you are taking aspirins, as we need to make sure that you have at least two clear weeks of not taking them, before any operation.
When choosing your operation date, please make sure that the start date of your period does not commence on date of operation. The operation will be cancelled, and we cannot be held responsible for any costs associated with rebooking of flights etc., - around new date(s) offered. Please note: It does not matter if your period starts immediately after the operation. If in doubt, please select dates which you can be sure about, or see your local GP, as they can offer tablets/medication to delay your period.
Last update: 14th November 08
Total Knee Replacement
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As some point, knee arthritis begins to interfere with quality of life to such a point that something has to change. When treatments such as anti-inflammatory medications, cortisone injections, and physical therapy fail to improve the situation, total knee replacement could be an option.
Who needs knee replacement surgery?
The most common reason for needing total knee replacement surgery is knee osteoarthritis, or degenerative joint disease. This is often referred to as 'wear and tear' arthritis, although these days we are beginning to understand that osteoarthritis is more than simply a condition of joint aging. As the cartilage surface on the ends of the bones is worn away, the normal mechanics of the knee joint are altered. The knee becomes inflamed and irritated, and the damaged cartilage, inflamed tissues, and exposed bone can cause pain.How do I know when I'm ready for knee replacement surgery?
Common symptoms of severe arthritis of the knee joint include:- Swelling of the joint
- Knee pain
- Bow-legged or knock-kneed deformity
- Loss of motion
- Feeling of the knee 'giving-way'
Once the diagnosis of severe knee arthritis is made, you will need to decide with your physician the optimal treatment course. There are signs to look for to decide if the time is right for a knee replacement. If conservative treatments fail to help, then total knee replacement may be an option. There are many types of knee replacements available on the market, but they all share the most basic characteristics.
How long will a knee replacement last?
Knee replacement implants can wear out over time. The implant is made of metal and plastic, and while these implants are designed to last many years, they all will eventually wear out. Studies have consistently shown knee replacement implants are functioning well in 90-95% of patients between 10 and 15 years after surgery.Most knee replacements last more than 20 years and many will last much longer. However, it is important to understand that there are potential complications of knee replacement surgery that can decrease the life span of the implant. Because of this, knee replacement should be reserved for older patients with significant symptoms of their arthritis.
How young is too young to have a knee replacement?
There is no rule that limits the age of a patient who needs a knee replacement, but surgery should be carefully considered in patients younger than 60 years of age. Before this age, there is a high probability that the knee replacement will wear out in the patient's lifetime. If a knee replacement wears out, then a repeat knee replacement, called revision knee replacement, will be performed. The revision knee replacement surgery is generally not as successful as the first knee replacement, and the rehabilitation is often more difficult. If you are under the age of 60, and considering knee replacement, you should understand the possible problems of performing knee replacement in young patients. Furthermore, you should ensure you have exhausted the conservative treatments for knee arthritis.When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create exact surfaces to accommodate the implant. A metal and plastic knee replacement implant is then placed to function as a new knee joint. Depending on the condition of the cartilage on the undersurface of the kneecap, the kneecap may also be replaced.
Selecting the Type of Knee Replacement Implant
Different companies manufacture different types of knee replacement implants. Your doctor will select a particular implant for your knee replacement. There are two basic types of implants:- Cemented Knee Replacements
The most commonly used knee replacements are cemented into the bone. Cemented implants fit tightly into position, and are immediately solidly fixed into the bone.
- Press-Fit Knee Replacements
Press-fit implants are designed with a rough surface that bone can grow into. Over time the surrounding bone grows into the implant holding it solidly in position.
What is the knee replacement implant made of?
There are four parts to most knee replacements. The components are:- Femoral Component
Fits on the end of the thigh bone, made of metal.
- Tibial Component
Fits on top of the shin bone, usually made of metal.
- Patellar Component
Replaces the cartilage on the undersurface of the kneecap, made of plastic.
- Plastic Insert
Fits between the femoral and tibial components.
How long does it take to perform a knee replacement?
Knee replacement surgery itself takes about 90 minutes, but time in the operating room may be longer. You are left with about an eight inch incision over the front of the knee. The incision is most commonly closed with metal clips called 'staples.' These clips remain in the skin for about two weeks and are then removed in the office. Removal of the metal clips is almost pain-free.What type of anesthesia is used for knee replacement surgery?
The surgery can be performed with general anesthesia, epidural or spinal anesthesia, or a regional nerve block. The advantage of epidural and regional blocks are that pain medicine can be administered by these routes post-operatively. Most patients are given pain medicine for the first day or two following surgery.Is there anything else I need to know about surgery?
There are some important considerations to think about prior to undergoing a knee replacement surgery. It is important to understand that this is major surgery. The decision to have a knee replacement needs to be taken seriously, with careful consideration of alternatives. If the alternative--living with your own knees--is no longer possible because of pain, then you may be the right patient for total knee replacement surgery.Prior to total knee replacement surgery you should have a very thoughtful discussion with your doctor, and have your questions answered. You should understand the potential risks of knee replacement surgery. These include:
- Blood Clots
Blood clots in the large veins (deep venous thrombosis, or DVT) of the leg and pelvis are common after knee replacement surgery. To minimize the risk of developing blood clots, your doctor will start you on blood thinning medication which will continue for several weeks following total knee replacement surgery. In addition, you will be given compression stockings to keep the blood in the legs circulating. Early mobilization after the surgery will also help prevent blood clot formation.
The concern is that if a blood clot develops, it is possible that the clot can travel to the lungs (called a pulmonary embolism), which can be potentially fatal. If your doctor finds evidence of blood clot formation, you will likely be given a higher dose of blood thinning medication for a longer period of time.
- Infections
Infection of a knee replacement is a very serious complication, and may necessitate removal of the knee replacement implant. Infections sometime occur in the days and weeks following surgery (early infection), or years down the road (late infection). An attempt to surgically clear the infection, and leave the implants in place, is sometimes made, especially in the early infections. However, some infections require removal of the implants, followed by weeks of IV antibiotics. To reduce the risk of this being a problem, once you have a joint replacement you should take antibiotics when invasive procedures (such as dental work or colonoscopies) are performed.
- Stiffness
When surgery is performed, you body's natural response is to make scar tissue. This is true both on the skin, and deep down inside the joint as well. Because scars contract, this can cause a tightening of the soft-tissues around the knee joint. If this occurs after a knee replacement procedure, you may have difficulty bending your knee, sitting in a chair, or walking up and down stairs. Because of this, it is important to begin bending, and fully straightening the knee, as soon as possible after surgery. Aggressive physical therapy must be continued for months following the surgery. If stiffness persists despite physical therapy, a manipulation under anesthesia may be performed. This breaks up scar tissue, but it will require you to again be aggressive with physical therapy.
- Implant Loosening/Failure
Over time, implants wear out and may loosen. New technology has helped this problem, but wearing out and loosening still occur. Most knee replacements last an average of about 20 years. Some last less than 10, some more than 30. But every implant eventually wears out. This is more of a problem in younger patients, who live longer, and typically place more demands on the implanted joint.
If the joint wears out, a revision replacement (replacement of a replacement) may be performed. This is a more complicated surgery, and with each revision surgery, the life-span of the implant decreases. This is one reason why physicians often delay joint replacement surgery as long as possible, especially in younger patients.
Is knee replacement too risky?
These are some of the common complications following surgery, however, this is by no means comprehensive. Before undergoing this surgery you should have a long discussion with your doctor, and ask all your questions. You may be referred to an internist to have a full medical evaluation before surgery, and discuss any medical issues that may be unique for you.Knee replacement surgery is outstanding--the results have been excellent and the outcome of most patients is wonderful. However, there are risks to this surgery, and it is important to understand these before you proceed.
Extra Information
Important, Before You Fly:
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All Clients:
Please advise us if you are taking aspirins, as we need to make sure that you have at least two clear weeks of not taking them, before any operation.
Ladies:
When choosing your operation date, please make sure that the start date of your period does not commence on date of operation. The operation will be cancelled, and we cannot be held responsible for any costs associated with rebooking of flights etc., - around new date(s) offered. Please note: It does not matter if your period starts immediately after the operation. If in doubt, please select dates which you can be sure about, or see your local GP, as they can offer tablets/medication to delay your period.
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Last update: 14th November 08
