Knee Replacement: An Overview of Procedures, Risks, and Recovery

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Introduction

In this concise overview, Dr. Vedala Ramakrishna, an experienced medical professional with qualifications in MBBS, delves into the critical aspects of knee replacement surgery.

Dr. Ramakrishna provides an expert analysis of the procedures, materials used, and the causes leading to the necessity for surgery to alleviate pain and restore mobility in patients suffering from severe knee conditions. This article is designed by him to equip patients and caregivers with essential information on the benefits, risks, and recovery expectations associated with knee replacement surgeries.

Meet the Author

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PRIMARY JOINT REPLACEMENT

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Primary Joint Replacement Surgeries are performed to repair severely damaged hips, knees, and shoulders. This method is a definitive process for removing joint pain, correcting deformities, restoring mobility, and improving overall functional status.

In primary joint replacement surgeries, the two most commonly done surgeries are:

1. Total knee replacement surgery.
2. Total hip replacement surgery.

Other areas include shoulders, ankles, fingers, and elbows.

KNEE REPLACEMENT

Knee replacement or arthroplasty is a surgical process in which the weight-bearing surfaces of the knee joint are replaced by a prosthesis. This process decreases pain and reforms the joints’ actions, decreasing the ability to move freely.

During the surgery, many types of implants or prostheses are used.

Materials used include:

• Chromium alloys – Femoral component.
• Cobalt alloys – Femoral component.
• Titanium alloys – Tibial component and a Patellar Component.
• Polyethylene – Tibial component

Other materials used are Stainless steel uncemented implants, tantalum, and zirconium.

Zirconium is a new type of femoral implant that is used if any allergies are seen.

Causes:

The main causes for total knee replacement are:

1) Osteoarthritis– OA is a kind of joint disease that is due to the breakdown of cartilage and the bone underneath. the most common symptoms are joint pain and stiffness.  The symptoms generally show over the years. The main symptoms like joint pain and swelling, reduced mobility, generalised weakness of arms and legs are seen.  Most commonly involved joints are the knee and hip joints.

2) Rheumatoid Arthritis– It is a chronic inflammatory disorder which affects joints and other organs like skin, eyes, lungs, heart and blood vessels. In rheumatoid arthritis – the immune system of the body will affect other healthy tissues.

3) Post Traumatic arthritis– This occurs due to any injury to any joint. It occurs due to wearing of the joint which has any kind of injury. The injury could be due to accident due to vehicle injury, sports injury etc.

Diagnosis

Before advising surgery, the condition should be diagnosed and thoroughly evaluated (pre–operative evaluation). An extensive physical examination and medical history must be taken to ensure there are no side effects of any sort.

The regular examination comprises of:

1. To gain information about the patient’s health status and to examine the knee.
2. The knee must be examined in terms of stability, mobility strength, and alignment.
3. X-ray of the knee, and MRI – the knee is done.
4. A complete blood picture and ESR and RA factors were also taken.
5. Renal function tests with uric acid.
6. Compete urinary examination and evaluation.

Procedure:

Once the entire physical examination and a thorough knee examination are done, the surgery begins. The procedure takes a minimum of 2 hours to complete. The anesthesia given is general, epidural, or nerve block.

The process is as follows:

1) The portion of the cartilage that is damaged on the tibia and femur is removed, along with some other portions of the bone.

2) The removed portions of the cartilage and bone are then replaced by metal components, which can be cemented into the bone or even press-fit into the bone.

3) The undersurface of the patella is then cut and resurfaced.

4) A plastic spacer is then inserted between the metal components to create a gliding surface.

5) The posterior cruciate ligament, which stabilizes the knee joint, is retained, or a polyethylene post is substituted in place of it.

People can undergo partial or total knee replacement. TKR patients are usually between 50 and 80 years old.

Risks and Complications:

Risks and complications are part and parcel of any surgery and can be subjected to the risk of reactions towards anesthesia, and sometimes excessive bleeding may occur. The possible risks and complications are:

• infection
• blood Clots
• stiffness due to scar tissue formation
• nerve injury
• blood vessel injury
• anesthetic complications
• medical complications
• pain

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Frequently asked questions:

Who needs total knee replacement surgery?

Ans: – knee arthroplasty or TKR is a surgical procedure that is done to replace the weight-bearing surfaces of the knee joint so that pain and disability of the joints towards movements can be relieved.

Will I have pain after surgery, and when can I walk after surgery?

Ans: The patient will experience some pain after surgery, which will decrease quickly by 4 to 5 days. Most people will be up and about and walking by the day after surgery or the next day with the help of a walker.

How long can artificial knee joints last?

Ans: – Studies show that eighty-five percent of those who undergo TKR have functioning artificial joints.

What pieces are used in a TKR, and how are they kept in place?

Ans: Implants are comprised of metal and medical-grade plastic. The materials used to seal the components are: –

1) Bone cement

2) A cementless approach that uses components with a porous coating that grows into tissues or can attach to bone.

Should the patient be concerned about anesthesia?

Ans: – Complications are usually low in General Anesthesia, epidural, or regional nerve block.

What is the age by which a knee replacement can happen?

Ans: – RA and knee arthritis can develop at a young age. The knee replacement surgery can be carried out on adults of nearly any age, but it’s typically suggested for individuals aged 50 to 80.

Nonetheless, the decision to proceed with knee replacement is primarily based on the individual’s overall health, the extent of knee degeneration, and the impact of knee pain on their quality of life, rather than solely on age. Younger patients with severe joint problems and older individuals in good health may also be considered for this surgery if their healthcare providers deem it necessary.

Will there be any dietary restrictions?

Ans: – There will not be any link between food and the development of infection. High protein intake helps with fast wound healing.

Will my medical insurance cover the surgery?

Ans: Most medical insurances cover TKR, but some cover it after three years of taking the policy.

Are there guidelines for selecting an orthopedic surgeon?

Ans: Choosing an orthopedic surgeon is the most essential part of the knee replacement process. The surgical team should also have a well-endowed plan for post-operative rehabilitation.

Is a double knee replacement procedure appropriate?

Ans: People with more advanced arthritis over both knees can consider a double knee replacement. However, there are certain risks and advantages associated with it.

Does surgical technology matter? Should minimally invasive knee replacement surgery be considered?

Ans: Computer-assisted surgery and custom cutting blocks are examples of newer technology. Minimally invasive knee replacement surgery preserves muscle and soft tissues around the knee, facilitating faster recovery.

Is there any other way apart from surgery?

Ans: Lifestyle modifications, medications, or alternative treatments like acupuncture and prolotherapy, which inject fluid to strengthen the connective tissue, will help moderate knee problems.

What happens during the surgery, and how long does the surgery elapse?

Ans: Most TKR procedures take 1.5 to 2 hours to complete. The orthopedic surgeon makes a 10-inch incision on the top of the knee and moves the knee cap, cutting the damaged bone and cartilage. These are then replaced with new metal and plastic components. These components combine to form a synthetic joint that functions like the natural knee.

What are the complications if TKR fails?

Ans: – Complications include problems with wound healing, infection, DVT, and pulmonary embolism.

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