Total Knee Replacement at St. Vincent's
What is Total Knee Replacement (TKR)?
Every year, more than 450,000 Americans undergo knee replacement surgery that often helps them get back on their feet and resume their active lifestyles. Total Knee Replacement refers to a procedure that involves resurfacing of the "worn" portion of the knee. The diseased surfaces are removed and replaced with specially designed components that provide a smooth low friction surface to restore function. The femur (thigh bone), tibia (leg bone) and patella (knee cap) are resurfaced. Bone preservation cuts are made in the collateral ligaments, while muscle and tendons are left intact. Current techniques should lead to less pain and earlier restoration of function.
Who Should Have Knee Replacement?
When severe pain limits your everyday activities such as walking, going up and down stairs, getting in and out of chairs you may want to consider knee surgery.
What about Arthritis?
Often, arthritis decreases motion and increases pain. The most common form of arthritis is Osteoarthritis, a developing condition influenced by genetics, trauma, leg alignment and certain metabolic conditions.
Rheumatoid arthritis is another form of arthritis that is caused by the dysfunction of the immune system, which leads to destruction of the cartilage surfaces. Patients with this condition may need total knee arthroplasty.
With both types of arthritis, the destruction of the normally smooth surfaces of the knee and related inflammation result in significant pain and disability.
There are many options for treatment depending on the severity of the symptoms. When conservative options fail, the Total Knee Replacement surgery can be considered.
What Can You Expect?
The typical hospital stay after Total Knee Replacement surgery is about three days. Walking and knee movement are important to your recovery and will begin the day after surgery.
The Goal of Total Knee Replacement
Relief of pain, and with that reduced pain, other goals such as improved knee motion and strength fall into place. Following surgery, a skilled team of health professionals will support you in your recovery process which typically takes up to three months.
Total Knee Replacement (TKR) Procedure
In total knee replacement surgery, the diseased surfaces are prepared; alignment abnormalities are corrected and ligaments are balanced. Once this is completed the new surfaces are applied to the ends of the bone.
The femoral component is metallic and is similar in shape, contour and size of the end of the femur (thigh bone).
The tibial component goes on the top of the prepared tibia (leg bone), which can have a metallic base with polyethylene surface or be made of only polyethylene.
The undersurface of the patella (knee cap) is covered with another polyethylene component.
Once completed, the knee replacement surfaces involve a metal on plastic joint articulation. The components are attached to the bone with "bone cement," which is a specialized polymer (polymethylmethaacrylate).
There are systems that allow for insertion of components without bone cement but these are less commonly used due to the high success rate of cemented components.
Partial Knee Replacement (Unicompartmental Arthroplasty)
Your surgeon may have diagnosed only one side of your femur with arthritis and therefor may have suggested you undergo a unicompartmental knee replacement. This is a partial knee replacement that replaces only the side of the femur that has damage. Patients having a partial replacement are usually admitted for 24 hours or less and have a shorter recovery period. Rehabilitation exercises are exactly the same as a total knee replacement. The incision is slightly smaller since the surgeon is working only on one side of the knee.
Total Knee Surgery Precautions
St. Vincent’s uses the latest, most efficient techniques and best practices to keep you safe during and after your Total Knee Surgery. Here are some answers to questions/concerns you might have about potential risks or complications:
Anesthesia, Pain Reduction Procedures:
The choice of anesthesia is based on many factors including patient preference, medical condition of patient and surgeon preference. St. Vincent’s has implemented Continuous Anesthesia to help ease pain from joint surgery. The newly implemented Continuous Regional Block Program at St. Vincent’s Medical Center is having a positive impact on the patient-care experience after orthopedic surgery. Patients who select this form of pain management are better able to handle the first sessions of physical therapy recommended soon after surgery, which have traditionally been painful.
Minimizing Risk of Blood Clots:
Blood clots can form in the large veins of the leg and cause pain, swelling and extend or break off and travel to the lung (pulmonary embolus). The risk is minimized as much as possible with a combination of early activity, mechanical compression devices and blood thinning medications. This is a relatively common complication of extremity surgery.
Total knee replacement infection is rare. Certain medical problems can place patients at higher risk of getting an infection and fighting infection. The incidence is minimized by antibiotics given before and after surgery and strict adherence to infection control policies throughout the patient’s hospitalization.
Blood Transfusion Protocols: Blood counts are checked before surgery and monitored afterwards. Starting (preoperative) blood count, surgical blood loss, extensiveness of the surgery and underlying medical problems determine the need for blood transfusion. It is less likely following knee replacement surgery but it may be necessary.
Post-Op Pain Management:
Despite the fact that TKR is a very successful surgical procedure, there are situations where patients can have persistent pain after surgery. Workup of this problem can include blood tests, and other special studies to determine the source.
Total Knee Replacement, Revision & Alternative Procedures
Total knee arthroplasty is a very successful surgery, but replacement may have limitations. Sometimes the plastic component (polyethylene) wears down. Failure of the knee replacement can occur from:
Loosening, wearing out of the polyethylene, osteolysis and/or component breakage. Loosening can occur as an isolated problem from relative motion between component and the bone.
Osteolysis (a resorption of the bone around the component) can result in particles produced as the polyethylene wears out. There have been extensive studies done to produce specialized polyethylene that can resist wear as well as other component modifications to influence the amount of wear particles produced by the knee replacement. However, this problem still exists.
Revision Total Knee Replacement:
When the total knee arthroplasty fails, treatment is usually surgical. The extensiveness of this surgical procedure depends on the reason for failure. Polyethylene exchanges are relatively less involved procedures that patients can expect a quicker recovery. Full revision surgery for all components can be very extensive and challenging. Bone integrity plays a significant role in determining the plan for this surgery.
More specialized and larger components tend to be needed due to the bone loss. Bone grafting or metal augments may be necessary. Rehabilitation can also be more challenging for the patient. However, the results can be very satisfying with significant pain relief.
Let the Orthopaedic Center at St. Vincent’s help you get your life back in motion.
The Orthopaedic Center at St. Vincent’s offers a full range of services to help relieve pain and musculoskeletal and nervous system conditions, diseases, or related injuries and assist you in returning to an active lifestyle. You can rely on St. Vincent’s team of highly skilled orthopaedic specialists and neurosurgeons to provide expert diagnosis, treatment, and rehabilitation. Contact our Orthopaedic Coordinator at (475) 210-5409 if you have any questions.