Knee is the largest joint in the body and one must have a healthy knee to perform most of the everyday activities. There are mainly four types of knee replacement surgery:
1. Total knee replacement – the most common form of knee surgery in which surgeon replaces the thigh bone and shin bone surfaces that connect to the knee.
2. Partial knee replacement – this replacement can be done through smaller incisions and recommended if the patient have strong knee ligaments.
3. Kneecap replacement –This replaces only the undersurface of the kneecap.
4. Complex or revision knee replacement- in case of severe arthritis or if the patient already had two or three knee replacement surgeries.
Total knee replacement surgery, also known as total knee arthroplasty is a complex surgical procedure in which requires surgeon to skillfully replace the diseased knee joints with artificial parts. The surgeon builds the artificial knee inside the patient’s leg to create a very realistic artificial joint. The artificial joint is attached to the thigh bone, shin and kneecap with a special material like acrylic cement. The aim of this surgery is to relive pain, improve quality of life, doing normal activities (walking, climbing stairs etc), maintain and improve knee function. This can be done in people of all ages except children whose bones are still in the growing process. People who are finding it difficult to perform their daily routine activities and have been suffering from knee problems should considered the total knee replacement surgery. Some of the reasons are as following:
1. Osteoarthritis - is most common age-related condition for which people prefer knee replacement. This occurs when cartilage (cushion between the knee and bone joints) breaks down.
2. Rheumatoid arthritis – when the body’s immune system attacks and destroys the lining of the knee. The synovial membrane surrounding the joint becomes inflamed and thickened which can damage the cartilage eventually resulting in cartilage loss, pain and stiffness.
3. Leg deformities – bowed legs or knock knees can be corrected with the total knee replacement surgery.
4. Trauma or knee injury – a broken bone or torn ligaments around the knee that can cause severe pain and restrict the movement.
5. Osteonecrosis or avascular necrosis – when the blood stops flowing to the bones.
6. Chronic knee inflammation and swelling- that cannot be improved by medications.
Doctor may suggest some orthopaedic evaluation before planning for the type of surgery required for the patient based on a medical history, general health, a physical examination, x-rays, some blood tests, MRI to determine the condition of the bone and soft tissues of the patient’s knee.
During the surgery, anesthesia team may decide what type of anesthesia (general anesthesia, spinal, epidural or regional nerve block anesthesia) is needed by the patient. The total knee replacement surgery can take approximately 2 to 3 hours during which the surgeon will remove the damage cartilage and bone and position the new metal and plastic implants to restore the alignment and knee function. Patient may need to stay at the hospital for several days post surgery and after discharging it is very important for the patient to continue with physical therapy sessions for the optimal results. There are also some complications and risk involved with this surgery treatment:
1. Blood clots – blood clots in the leg can travel to lungs causing pulmonary embolism resulting in breathlessness, chest pain or shock.
2. Urinary tract infection
3. Nausea and vomiting
4. Bleeding into the knee joint
5. Nerve damage
6. Blood vessel injury
Patient should immediately inform the doctor if there any signs of infection, abnormal redness, increasing warmth, swelling or unusual pain. Some rigorous activities like running should be completed avoided instead can go for golf or swimming which can be a ideal exercise since it improves muscle strength without putting any pressure on the replaced joints.