Total Knee Replacement | Richardson TX
Total knee replacement, also known as total knee arthroplasty (or TKA for short), is one of the most important advances of modern medicine. Total knee replacement is a surgery that replaces a nonfunctional, painful knee joint with metal implants and a plastic bearing surface to create a new, “prosthetic” knee joint. The goal of a total knee replacement is to reinstate a patient’s knee function, regain range of motion and eliminate knee pain.
Why do I need a knee replacement?
Most knee replacement surgeries we perform are elective surgeries. This means that it is a surgery that can be scheduled and that occurs at a time and on a date of mutual convenience. The benefits of elective knee replacement surgery are that timing and factors that could potentially complicate your surgery can be altered to give you the best potential for a successful outcome.
Some knee replacement surgeries may have to be completed in urgent circumstances. For example, this would be the case if a patient fell down and sustained a knee fracture that would require a knee replacement rather than a repair. In this case, the knee replacement surgery would take place as soon as possible after admission to the hospital.
What causes the conditions that lead to a knee replacement?
The most common factor leading to a need for a knee replacement is osteoarthritis of the hip. Osteoarthritis results in the loss of the protective cartilage surface of the knee, resulting in a knee that no longer functions adequately. The previously smooth cartilage surface becomes rough, exposing the bone that is underneath. The bone is where the nerves live, and so osteoarthritis becomes more and more painful. As the pain increases, activity decreases and flexibility suffers. This becomes a vicious cycle that eventually results in a patient calling and scheduling an appointment for a total knee replacement.
What type of knee replacements do you offer?
Texas Orthopedic Surgery Consultants is founded on the concept of treating patients as we ourselves would want to be treated. We tailor a care plan specifically designed to benefit a patient regarding their specific needs. To this end, we offer both partial and total knee joint replacements.
A partial knee replacement refers to the surgical replacement of only part of the knee joint damaged by OA or trauma. Most commonly, this is the medial compartment (inside) of the knee joint. By preserving the other, undamaged parts of the knee, we allow a more naturally functioning knee as well as decreasing the potential need for a total knee replacement in the future.
A total knee replacement is one in which all components of the knee require removal and replacement. This is a much more common scenario than that of a partial knee replacement. In a total knee replacement, the joint surface of the femur (thigh bone), the tibia (shin bone), and that of the patella (knee cap) are all replaced.
What is the surgical procedure for a knee replacement?
The knee is referred to as a “hinge” joint in that the knee moves characteristically with a forward and backward motion like that of a hinge. There are actually three joint surfaces that make up the knee joint. One is contributed by the femur (thigh bone), one by the tibia (shin bone) and one by the patella (knee cap). All three of these surfaces are removed and replaced in a total knee replacement surgery.
In the procedure, the patient is generally placed resting on their back under general anesthesia. The surgeon makes a cut in the skin over the front of the knee that allows access to the joint deep within. The bone of the joint surfaces that make up the knee is removed and replaced by metal components on the femur (thigh bone) and tibia (shin bone). The joint surface of the patella (knee cap) is removed and replaced by a plastic replacement. Some of these components are held in place with a strong cement, others are specially designed to allow bone to grow into their surfaces to hold them tightly in place. The components are then repositioned within the joint making the new knee. The knee replacement surgical wound is then thoroughly cleaned and closed over the new knee, and the patient is ready to start on their the road to recovery.
How long does it take to recover from a knee replacement?
The postoperative recovery for elective knee replacement is a gradual process. In general, most patients are up and walking on their new joint the same day as their knee replacement surgery. This progression is slow and is aided by the assistance of a rolling walker and the coaching of a physical therapist. As a patient progresses, they will be able to walk farther and with less need for assistance. A patient can be expected to graduate from a walker to a cane or crutches in around four to six weeks. Most patients no longer need walking aids by two to three months after knee replacement surgery.
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That being said, knee pain itself and its subsequent debility is not a new phenomenon. Joint destruction and the ensuing pain resulting in eventual disuse has been common since human beings have walked the earth. For years untold, healers, doctors and surgeons have sought to offer relief to patients suffering from knee pain through pills, potions, and surgical intervention. Early joint replacement efforts had met with mixed success. Thermistocoles Gluck, the original pioneer of knee replacement, had replaced a patient’s knee ruined from tuberculosis with an implanted knee made of ivory and wood. This actually worked to restore the ability of the patient to walk after the surgery, however the implant eventually failed due to complications of infection and failure of fixation. Regardless, the idea of replacing a damaged joint had been born.
Dr. Charnley was the one who was successful in mating metal implants and plastic (polyethylene) bearing surfaces to create a durable and reproducible joint replacement prosthesis. This provided Dr. Insall with a formula that would eventually result in the successful replacement of the knee. Dr. Insall’s total condylar prosthesis varied from earlier efforts at knee replacement in that it replaced all three components of the knee; the damaged surfaces of the femur (thigh bone), the tibia (shin bone), and patella (kneecap) were all replaced in the procedure. The result was that patients suffering from debilitating knee pain were afforded the ability to walk again and enjoy life without the limitations brought about by extreme knee pain associated with end-stage knee disease.
Many advancements have been made over the forty or so years since Dr. Insall’s remarkable discovery. Other great surgeons have contributed to Dr. Insall’s surgical procedure with innovative techniques and implants which continue to benefit patients during and after knee replacement surgery. Advancements have been made to further reduce complications in blood loss, infection, and postoperative complications. Scientific study has resulted in better pain control, affirmation of the benefits of postoperative physical therapy, and early mobilization has resulted in even further lowering the burden of perioperative complications seen with earlier knee replacement surgeries.
The story of successful knee replacement is by no means complete. Changes continue to be advanced on a regular basis by inquisitive surgeons, engineers, and scientists that promise to benefit patients even more, and empower surgeons charged to treat them. Different surgical approaches to total knee replacement have been tried, but none has been demonstrated to be superior to another. Improvements in instrumentation, fixation, and knee replacement implants have certainly contributed to today’s superior results, but the majority of total knee replacements continue to be performed through an incision in the front of the knee joint.
Although total knee replacement surgeries greatly outpace all other joint replacement surgeries, patient satisfaction with knee replacement is not regarded to be as high as with total hip replacement. This remains a frustration for many patients and joint replacement surgeons alike. Many theories have been advanced for this, but the bottom line is that no one is really sure why approximately 20% (or 1 out of every 5) of patients who undergo total knee replacement has some manner of persistent dissatisfaction with their outcome. his number appears to endure for all patients, all surgeons, and all implants the world over.
For these reasons, attempts at improving the outcomes for total knee replacement remain ongoing. Some of these efforts have focused on replacing the need for cement used to fix metal components to bone with implants that allow for bone to actually grow into the implant in order to secure it without the risks inherent with addition of the acrylic cement. Although it stands to reason that addition of cement provides an additional interface that might provide a genesis for implant loosening and subsequent dissatisfaction, the results of these efforts continue to be studied. Other knee replacement surgery improvements include utilizing preoperative imaging to create patient-specific guides that help to tailor surgical procedure for an individual patient’s unique anatomy. Surgical “robots” have even been invented to assist the surgeon with the procedure; contrary to what one might think, the “robot” does not perform the knee replacement procedure, rather it helps to guide the surgeon’s hand during removal of the joint surfaces in an attempt to improve accurate preparation of the joint surfaces for prosthetic implantation.
Although there is presently a somewhat robust movement to perform knee replacement surgery where patients go home the same day of their procedure, a less hurried approach to discharge may yet prove the better part of valor. Most patients who undergo an elective knee replacement with Texas Orthopedic Surgery Consultants today can expect to leave the hospital after staying at least one night, and in most cases two. Patients are encouraged to walk the same day as their procedure and nurses are available to attend to any pain and medication needs. A physical therapist will meet with patients following the completion of their surgery. Early mobility has proven beneficial in regards to pain reduction and minimizing the risk of postoperative complications.
Most knee replacement patients are discharged from the hospital two days following their surgery, provided that they are able to mobilize reasonably and understand the follow up instructions. If not, they will be asked to stay another night in the hospital. Patients will be discharged with instructions for follow up and prescriptions for pain medication, continued physical therapy, and anticoagulation medication to reduce the risks of blood clots. Continued ambulation and mobility is encouraged. Any restrictions are thoroughly discussed, and follow-up appointments are scheduled before the patient leaves the hospital. Patients can expect to go home with a walker for assistance with walking and stabilization. The elimination of assistive walking devices, as well as weaning of postoperative medications, will be an individualized endeavor.
– Christopher Blair, DO, MBA, Texas Orthopedic Surgery Consultants