Knee replacement is a procedure where the weight-carrying surfaces of knee joint are replaced surgically to ease the pain or any disability. People suffering from osteoarthritis, rheumatoid arthritis or psoriatic arthritis undergo knee replacement. All these conditions revolve around stiffness and painful knee. This surgery is usually performed on people aged over 50.
Knee replacement is mainly of two main types:
Procedure: In case of partial knee replacement with minimal invasion, a smaller incision, which is 3 to 5 inches, is required. This leads to minimal tissue damage and the surgeon can work between the fibres of the quadriceps muscles. Here, an incision through the tendon is not required. This may result in less pain, recovery time is reduced, and motion is better as scar tissue formation is less.
In total knee replacement, four steps are performed:
After general or spinal anaesthesia, an incision of 8-12 inches is made in the front part of the knee. Joint part which is damaged is removed from the surface of the bones. The surfaces are then formed in a way to hold a metal or plastic artificial joint. The thigh bone shin as well as knee cap is attached to the artificial joint with either cement or a special material.
After Effects of the Procedure: After the surgery, patients may stay in a hospital for three to five days. Post surgery, notable improvement can be seen after a month or later. The patient is gradually relieved from pain with the construction of new gliding surface during surgery.
There will be slow progress in the movement. In the beginning, one may walk with a support of parallel bars and then with the help of crutches, walker, or cane. After full recovery in about six weeks, people can enjoy normal activities except running or jumping.
Presently, over 90% of total knee replacements function well even after 15 years of surgery. Hence, knee problem is no problem at all!
Total Hip Replacement is also known as Total Hip Arthroplasty, in which the damaged cartilage and bones in the hip area are removed and replaced with prosthetic components. On the other hand, Total Knee Replacement, also known as Total Knee Arthroplasty or resurfacing, involves replacing the bone surface of the knee area.
Causes of Hip and Knee Pain
Arthritis is the most common cause of chronic hip and knee pain or disability. Other causes include:
● Avascular necrosis or Osteonecrosis is a condition where there is an inadequate supply of blood to the femoral head due to a hip injury. The inadequate supply of blood may cause the bone surface to collapse and this can result in arthritis.
● Rheumatoid Arthritis is the most common inflammatory Arthritis. In this condition, the synovial membrane surrounding the joint begins to thicken and become inflamed. This results in cartilage loss, stiffness, and pain.
● Osteoarthritis is the type of arthritis, usually related to old age but can occur among young people too. The cartilage cushioning the hip and knee bones becomes soft and gradually wears off. The bones eventually start rubbing against each other which causes stiffness and pain in the knee and hip area.
● Post-Traumatic Arthritis can follow a severe hip and knee fracture or injury.
● Some children with hip disease or problem, even after treatment, can develop into arthritis later. This may be caused by uneven or unusual growth of hip which affects the joint surfaces.
Knee Replacement Procedure
● Bone Preparation: The surface of impaired cartilage at the end of the tibia and femur are separated besides a small extent of the underlying bone.
● Locating the Metal Implants: The removed bone and cartilage are substituted by metal implants creating the joint surface. These metal pieces may either be press-fit or cemented into the bone.
● Resurfacing the Patella: The undersurface of the kneecap or Patella is cropped and reformed with a plastic button. This process is variable depending upon the condition.
● Inserting a Spacer: To form a smooth gliding surface, a plastic spacer of medical-grade is positioned between the metal components.
Hip Replacement Procedure
● Metal stem replaces the damaged femoral head and positioned into the femur’s hollow center.
● On the upper portion of the stem, a ceramic or metal ball is planted. This ball acts as a substitute for the damaged/detached femoral head.
● The damaged Acetabulum or cartilage surface of the socket is discarded and supplanted by a metal socket. Cement or screws are used to sustain the socket in place.
● A spacer, either metallic, plastic or ceramic is placed between the socket and the new ball for a smooth gliding surface.
Knee and Hip Replacement are taken as the last option for the patient. The surgery and its outcome vary depending upon various factors. One should consult the doctor before undergoing for the Hip and Knee Replacement Surgery.
Coping with knee pain is never easy. When the wear and tear of the knee joint are so severe that no medication works, it is the surgery that comes to the aid of the patient. Total knee joint replacement surgery improves mobility in the affected individuals.
What is knee joint replacement?
Basically, knee joint replacement means replacement of damaged cartilage rather than changing the whole knee joint
In the damaged surface (cartilage) of the joint is replaced by a smooth metallic surface on both sides between those metallic smooth surface we place highly cross-linked polyethene cushion, this creates a smooth and pain-free movement between the joint bones. So total knee joint replacement is basically a surface replacement only.
Who can go for total knee replacement surgery?
People with damaged knee joints due to severe osteoarthritis, trauma, or degenerative diseases.
When the knee joint pain and stiffness keeps increasing, the daily motion and capacity to conduct activities are restricted to a large extent. Such people can discuss with the doctors about the risks and benefits of the surgery, and go ahead with the same.
When one should go for a total knee joint replacement and can this be done in children also?
Knee joint replacement is usually advised in a patient of age more than 55 or 60 but in some rare situations where the disease is severe, it could be done in the age of 50 also and it should never be done in children.
Can both the joints of a patient replaced simultaneously?
Most of the time joint replacement is done in old patients so it is always safer to go one by one but if the patient is fit medically and the surgeon feels comfortable, both the joints can be replaced simultaneously.
Can it be done in Diabetic and high blood pressure patients also?
Yes, it can be done in hypertensive and diabetic patients also but before surgery, all this should be under control.
Can you continue to take the regular medications that you are taking even before the surgery?
Previous medicines Might be adjusted or discontinued.
When the surgery is planned, the surgeon evaluates the tissues and joints adjacent to the knee for optimal results. Also, the medical history is discussed. In case you are taking blood thinners or aspirin, you might have to discontinue them prior to surgery or they would be adjusted to suit the requirements of the surgery. This is usually done to prevent the risk of excessive bleeding during the surgery.
How long a patient has to stay in the hospital after surgery?
The patient is usually kept in the hospital for about five days after total knee joint replacement and then he can be discharged on oral medications.
What do you say about the results of total knee joint replacement?
Results of total knee joint replacements are wonderful, it is the most appreciated surgery in Orthopaedics in which patient satisfaction rates are very high. Patients usually become almost pain-free and his alignment of both knee and deformity of the knee joint is cured permanently.
What is the recovery period after the total knee replacement surgery?
The recovery period is 6 Months.
Usually after a successful knee joint replacement, the patient can walk on the second day of surgery with the help of a walker. One can return to daily activities within a short span of 6 weeks. For a few, it might take another couple of weeks. But the pain and swelling subside only after 6 months. Also, there are instructions given by the surgeon about things one shouldn’t do during this period. Walking is an exercise that is permitted, while strenuous exercises and other activities are avoided.
Which types of activities could be done safely after total knee joint replacement?
After total knee joint replacement, patients depending on his physical ability can walk as much as he wants, can climb upstairs and downstairs, can do swimming, can do cycling and even can ride bicycles, two-wheelers and can participate in light sports activities.
After a total knee joint replacement, can we do squatting or cross leg sitting?
After total knee, joint replacement patient can do squatting and can sit cross-legged but usually one should avoid these two positions because if a patient uses these two positions repeatedly, the life of the joint is decreased.
How to choose a hospital for total knee joint replacement?
This surgery can be done in any City, all you need is in a hospital which has an experienced Orthopaedic surgeon in joint replacement and a dedicated operation theatre ( that is a modular operation theatre with laminar airflow system), these are the basic and the most important requirement for a hospital to do a joint replacement.
Knee replacement is a surgery wherein an artificial joint is used to replace a diseased, damaged or worn out knee. This surgery is common among people who fall in the age group of 60-80, but recent trends seem to suggest that younger people are opting for this surgery as well. The lifetime of the artificial knee joint is around 20 years, provided the knee is well cared for.
Why do you need Knee Replacement?
Most common reason is “high grade osteoarthritis” due to wear and tear of the knee joint. The pre-hospital study of the Knee joint is mandatory and would decide what kind of Replacement is suitable to the patient. If there is diabetes or hypertension associated with this, then it should be controlled well before undergoing surgery. Hemoglobin of at least 10 gm% is required.
If the mobility in your knee joint is reduced leading to impaired functioning of the knee joint, then you might need a knee replacement surgery. You may experience pain while walking, sitting and, in some cases, resting as well.
Some of the common reasons why you may opt for this particular surgery are:
Knee replacement surgery is classified into:
1. Partial Knee Replacement: In this surgery, only one part of the joint is replaced.
2. Total Knee Replacement: Total knee replacement surgery involves replacement of both sides of the knee joint.
The usual hospital stay period is around 2-3 days after the surgery is completed. Initially, you will require the help of crutches to walk for at least 2 months. You may also be asked to do gentle knee strengthening exercises. It may take up to two years to recover completely from a knee replacement surgery.
Human bones are continuously being removed and formed which is necessary for its proper maintenance. However, in certain cases, especially with aging, some bones and joints will be worn down to an extent where the body will not be able to reform them. This is especially true in the case of hips which may become worn due to age or other problems within the body.
When this happens, a hip replacement surgery can be performed to replace the original joints with a prosthesis or artificial hip which is usually made out of metal alloy or a specially formed composite material or even a combination of the two. Along with other parts, it replaces the natural hip with an artificial hip to restore mobility and other related functions.
Benefits of hip replacement surgery:
1. Lessening hip pain - This is one of the major factors as well as symptoms of requiring hip replacement surgery. Due to the grinding down of the bones, even the slightest movement causes pain and after the surgery and the recovery period, the pain is lessened.
2. Correction of bone deformity - When the bones grind down and are abnormally reformed, deformities may occur reducing mobility. Artificial hips will ensure that deformities are corrected and resulting problems are thus eliminated.
3. Return to normal activities and resumption of normal activities - This is possibly one of the primary advantages of this surgery, although it entails a long recovery period. However, most patients can get back to their normal activities and are able to resume a pain-free life.
4. Ability to have painless sleep - Many persons who have hip arthritis or AVN (avascular necrosis of femoral head) or other congenital hip anomalies are not able to sleep properly due to pain mainly at night (night cries). But after surgery and recovery period then can get rid of that night cries and have sound sleep.
5. Leg strength increase - Many patients tend to have an increase in their leg strength as one side of the hip tends to become very weak due to bone problems before surgery. After surgery and recovery, the same side tends to have an increased strength due to the implant.
6. In most cases, a lifelong solution to hip problems - As the hip prosthesis are made up of metal alloy and if surgery is done by proper technique by trained surgeon, it tends to last for life long, as it usually doesn’t tends to have any problems if all post operative instruction about life style changes given by the doctors is been followed properly.
Oa is a chronic progressive degenerative disease, medical cure of which is still not possible. The last and only resort to get rid of the severe knee pain and deformity is total knee replacement surgery.
Joint Replacement Surgery is a procedure where the damaged surface of the advanced arthritic joints are removed and replaced with artificial joints, such as metallic, plastic and ceramic joints.
These surfaces closely replicate the original anatomy.
When do you need a knee replacement?
When you suffer from severe pain or deformity in the joint (knee in this case), the pain or stiffness and deformity makes it difficult to perform simple tasks. Severe grade IV osteoarthritic knees of people over 50 years when have pain, swellingand deformity fail to respond to medicines, physiotherapy, injections and rest.
Aim of the surgery:
With age, the mobility and flexibility of the knee joint reduces significantly. This can affect one’s lifestyle as simple activities such as walking or lying down become painful and difficult. Moreover, there is the emotional stress resulting from an inability to perform routine activities smoothly. In short, any serious problem of the knee joint can affect your ability to function well.
Apart from medications and exercise, the only way to permanently treat such problems in the knee is to go for a joint replacement surgery. The Subvastus approach is often considered to be the best form of knee replacement for a number of reasons.
Subvastus Knee Replacement:
Here is a look at the step-by-step procedure for performing a subvastus total knee replacement surgery:
Advantages of Subvastus Knee Replacement:
This form of surgery is greatly preferred over the conventional knee replacement surgeries. Its benefits include-
Given the advantages, If you are eligible for the subvastus knee replacement surgery, opt for it.
Knee injuries are the most complex injuries of bone and cartilages. A direct hit can lead to this situation. You may get this injury while doing your daily activities. An activity as simple as walking or a deadly accident can lead to this injury. You never know, when you are left with a damaged knee. In critical cases, you are advised to undertake a joint replacement surgery conducted by experienced Orthopedic.
According to the latest studies, doctors replace more than a million knees or hips in a year in the United States. It is a life-changing procedure. But you need to know whether you are the right candidate or not? Follow the below-mentioned points to get a clear picture:
Reasons to replace your knee:
Nowadays, total knee joint replacement is a very common surgery for old age persons. As we all know, with the ageing process, our bone and joint degenerate which leads to pain. With increasing age, this degeneration of joint keeps on increasing and so the pain. We Indians, generally have the tendency of ignoring joint pain unless the pain adversely prevents them from carrying out their day to day activity.
A patient should consult a knee surgeon way before his/her knee gets damaged to a great extent so that a total knee joint replacement could be avoided by carrying out knee preserving surgeries. There are many knee preserving surgeries like high tibial osteotomy and unicondylar knee surgery which can be done in early osteoarthritis. If these procedures are done at a suitable time total knee joint replacement can be delayed as well as avoided.
Here are the 5 critical symptoms or signs that should never be ignored and immediately get addressed by a joint replacement surgeon.
1. Recurrent Severe Knee Pain: Not all knee pains validate the need for knee surgery. But if the knee pain becomes sever even by doing basic activities like -
Standing up after sitting for a long time
Standing for more than 10-15 minutes
Climbing up/down even a few stairs
Pain due to movements in bed while sleeping
Stepping in/out of a car or bus
And the pain does not go away even after taking painkillers and icing, it is very much possible that your knee joint bones have suffered irreparable damage and might require surgical intervention. An x-ray might show the extent of damage, based on which a knee surgeon can suggest the treatment protocol.
2. Stiffness or Limited range of Motion: Stiffness in joints is normal as human body ages. As the body ages, the ligaments and cartilages tend to wear out. They keep the joints lubricated and avoid friction between the bones. As they deteriorate, the friction between joints and stiffness increases while the range of motion gradually reduces. If this increased stuffiness is preventing a person from walking, sitting cross-legged, accompanied by aggravating pain, chances are you might need to consult an orthopedic surgeon.
3. Deformity: In osteoarthritis of the knee joint, there is in bowing or out bowing of the knee joint which is very obvious when we stand in front of a mirror with our exposed knee joint. This deformity causes point loading on cartilage which further aggravates the disease.
4. Gait change: Change in the alignment of the knee joint causes typical changes in person gait (walking style).
5. Instability: The weakening of ligaments and stiffness in joints generally leads to instability of the knee. It’s a bit difficult to identify & explain. However, if you get the feeling that your knee might give away and you might fall while trying to do basic activities, you should immediately get a consultation from a doctor. If untreated, the feeling can turn into actual fall. This cannot only affect the knee but cause other problems like fracture of other bones as well.
What if one continues to live with these signs: The beauty of the human body is that it tries to adapt itself based on the changes in the body. If the signs highlighted above are only present in one leg and if it is left untreated, the body will try to shift its weight to the better leg. Needless to say, this will make matter worse for the second leg and the problem which could have been treated by knee preserving surgeries like high tibial osteotomy and unilateral total knee replacement (single leg), might now need a bilateral total knee joint replacement. This is very important to notice that even if total knee joint replacement is done at a proper stage of disease (means with fewer deformities and less bony defects) the results of this joint replacement is far better than one which is done in advanced diseases with severe deformities and lots of Bony defects.
Why consult for Knee replacement?
Not all patients need to undergo Total Knee Replacement Surgery. If the knee damage is caught early on, only the realignment surgeries (that is high tibial osteotomy) will work and sometimes only the damaged part of the knee can be replaced (Unicondyler knee), and the person can have a more comfortable life. Partial knee replacement surgery gives freedom to a patient to perform all activities which he was doing earlier. There are absolutely no restrictions of movements after partial knee replacement surgery. A feeling of natural knee and movement is an advantage of partial over total replacement.