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Total Knee Replacement
If your knee is severely worn with arthritis or damaged from a prior injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. If treatments like medications, injections or using a cane are no longer helpful, it may be time to consider total knee replacement surgery. Knee replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities. Total knee replacements are one of the most successful procedures in all of medicine.
The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities. It is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. This cartilage allows the knee to move smoothly without resistance.
The meniscus cartilage is located between the femur and tibia. These C-shaped wedges act as "shock-absorbers" that cushion the joint. Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.
The joint is enclosed in capsule covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee.
Normally, all of these components work in harmony. But disease or injury can disrupt it, resulting in pain, muscle weakness, and reduced function, leading to degenerative joint disease (DJD).
The most common cause of chronic knee pain and disability is knee arthritis. Over time, and with wear and tear, injuries or increased inflammation from other arthritic conditions, the cartilage surface deteriorates and becomes rough. Bone spurs can form along the edges of the joint. The cartilage can even wear all the way through and such that the under lying bone begins to rub bone on bone, like sand paper on wood. This is very irritating to the joint and causes inflammation, pain and reduced function.
Worn cartilage does not heal and cannot regenerate. Even when other treatments fail to give relief, the debilitating symptoms of severe knee arthritis can still be relieved by knee replacement surgery. A knee replacement can be a long term solution, providing new smooth bearing surfaces in the joint and eliminate friction and inflammation. When there is generalized wear and tear throughout the knee a Total Knee Replacement is the best way to address the problem. In some cases where damage is limited to just one part of the knee, a partial knee replacement may be an alternative.
TOTAL KNEE REPLACEMENT PROCEDURE
Knee replacement procedures (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are actually replaced. A total knee replacement operation typically lasts between 1 and 2 hours and consists of:
- Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts are cemented into the bone.
- Resurface the patella. The under surface of the patella (kneecap) is cut and resurfaced with a plastic button.
- Insert a bearing. A medical-grade hardened plastic bearing is inserted between the metal components to create a smooth gliding surface.
You will be allowed to put your full weight on your leg, and be able to be move around on a walker the same day. Dr. Latteier uses less invasive techniques that reduce stress on the soft tissues and decreases post-op pain. In some cases Robotic assisted knee replacement techniques can also be used. With this kind of knee surgery many patients are able to go home the same day. We can do this procedure on an outpatient basis or with an overnight stay in the hospital. In some circumstances an extra day may be necessary.
Recovery varies from patient to patient. Plan for about 2-3 weeks on a walker and 2-3 weeks on a cane on average. It takes about 6 weeks for the incision and soft tissues to heal and for some of the tenderness to subside. Although the arthritic pain in your knee will feel better, it is common to have some pain and swelling, especially after physical therapy and at night during this time. It is ok to increase your activity as you feel better.
After surgery, you will feel some pain. This is a natural part of the healing process. With less invasive techniques, there is typically less pain. We use a multimodal pain management approach including nerve blocks, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics and narcotic (opioid) pain medications. You will be prescribed a combination of these medications to improve pain relief, as well as minimize the need for pain pills.
Dr. Latteier uses a plastic surgery technique for wound closure, where the sutures are under the surface, and will dissolve. There will be no clips staples or stitches on the outside. The skin is sealed with skin glue. A water tight clear plastic dressing is used to protect the incision. With this closure there is rarely any drainage, but if you notice any increasing redness or bleeding under the dressing, be sure to let us know right away. Showering is ok, but avoid soaking the wound in water until it has thoroughly sealed and dried.
Physical therapy and home exercises are an important part of knee replacement surgery. If you do not work and exercise, the knee will stiffen up. We will set up a physical therapy visit before surgery to teach you some exercises to help prepare you for surgery. We also schedule a physical therapist to come to your house the day after you return home. They will help you get comfortable navigating your house, practice any stairs you may have, and go over some exercises to help you recover. After 2-4 home visits, most patients can proceed to outpatient physical therapy for another 4-6 weeks.
Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.
Most people feel some numbness in the skin around the incision. You also may feel some stiffness, particularly with excessive bending activities. Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.
More than 90% of people who have knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. A knee replacement is not the same knee you had when you were 20. It may ache from time to time if you over-do it, or if the weather changes, but by and large, it is much better than the worn out knee you had.
With normal use and activity, every knee replacement implant begins to wear in its plastic bearing. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports after surgery.
Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.
With appropriate activity modification, a knee replacements can last for many years. Although they can start wearing out between 12 and 20 years, studies show that more than 80% of modern knee replacements are still functioning 20 years after the surgery. Taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.