Knee replacement is the process of changing the damaged joint surfaces with metal and/or polyethylene implants that were specially designed to mimic the natural movement of a healthy joint. Advanced cases of knee osteoarthritis that don’t respond to other methods of treatments can get treated by knee replacement surgeries.
It is favorable for patients who have pain during daily activities such as walking and for those who have intense pain due to damaged cartilages in the joints. With patients younger than 55 other treatment options are recommended, however if the case is an emergency or the patient has intense pain surgery might be chosen with young patients too.
Why Knee Joints Get Damaged?
- Congenital joint defects
- Not having blood flow in the knee area
- Rheumatic reasons
- Metabolic illnesses
- Due to blood coagulation
- Age, specially above 65
- After rheumatic illness
Who Needs Surgery?
Most common 2 cases are:
- When patient can’t walk longer than 300 meters without pain.
- Patients who need to use painkillers everyday due to their pain. Excessive use of painkillers can cause serious problems in the liver and kidneys after sometime. Surgery is a must to stop the pain and stop the consumption of painkillers in these cases.
There are also some cases that shouldn’t have knee replacement. If there is an active infection in the patients body, the surgery can’t be performed until the infection is gone.
Treatment options other than knee replacement
One option for patients with jobs require heavy physical work (construction workers, miners etc.) would be stabilizing the joint with a surgery. However if the patient has problem at both knees this procedure is not recommended. Since it reduces the joint movement significantly, the procedure is not being chosen as much as it used to be in the past.
Physical Therapy: PT would help developing the muscles around the knee and reducing the pain temporarily. However it doesn’t cure osteoarthritis.
Arthroscopic Joint Cleaning: The process of cleaning the joint from loose tissue pieces caused by osteoarthritis. However this procedure doesn’t cure osteoarthritis permanently.
Who Are Suitable for Knee Replacement?
Most common case is elder patients between 60 – 80 years of age who have advanced osteoarthritis. Each case should be treated individually and the doctor would decide on the treatment method depending on how advanced the problem is. There are examples of successful surgeries from 16 years old young patients to 90 years old elder patients.
Types of Knee Replacement Surgeries
There are two kinds of knee replacement surgeries. The orthopedic surgeon will decide on the procedure after examining the case.
In Total Knee Replacement, both inside and outside surfaces of the joint are changed with a prosthesis.
In Unicondylar Knee Replacement, only the surface inside or outside of the joint gets changed. This process aims to gain time before having the Total Knee Replacement surgery. However the patient must be young, not overweight and deformation of the joint should be on a single side for this treatment.
Before the Surgery
Like every other surgery, first the patient gets checked with blood and urine tests to see if the patient is suitable for surgery. If the results are good and there is no infection in the body, patient is suitable for a surgical procedure.
If the patient is using any blood diluent there would be a switch in the medicine between 10 to 5 days before the surgery. When the risk of bleeding ends after a few days of the surgery the patient can get back to the original medicine.
Standard operating rooms are unsuitable for prothesis surgeries. There should be a special ventilation system to preserve the proper air conditions of the operating room.
After the Surgery
Depending on the case, patient needs to stay at the hospital for the first 5-7 days. On the second day, the patient starts basic exercises in the bed with the directions of the doctor. Once patients can get up on their own, go to the restroom and bend their knees they can leave the hospital. When leaving, the patient gets prescribed medicines to use for 30 days. Patients should strictly listen the doctors advices and be careful at all times until the healing process in completed.
Patients should use a wheelchair for the first 12 hours. During the stay in hospital the patient walks short distances with the supervision of the doctor to prevent possible problems with the blood flow. Also, the bandage should stay on the area to prevent swelling and bleeding.
The stitches will be removed in approximately 15 days, and then physical therapy starts. After knee replacement most of the patients are cured from their pain completely. Daily activities such as walking, climbing the stairs etc. can be done easily without the assistance of a walker. Patients should not participate in heavy physical activities and sports after the surgery.
Possible Complications During and After the Surgery
Some possible complications that may occur during a prosthesis surgery are damages on the blood vessels and the nerves, fractures and cracks on the bone.
After the surgery, there are some possible early and late complications.
Possible early complications are infection of the wound and vein obliteration in the leg.
Possible late complications are pain due to loosening of the prosthesis.
A total knee replacement surgery will serve the patient successfully for about 20-25 years. There are cases where the prosthesis served the patient with no problem for even longer years. The expected life of the implant is determined by the techniques applied by the surgeon, the quality of the prosthesis, the level of activity of the patient, the quality of the bone and the weight of the patient.
Choosing an expert surgeon specialized on these surgeries is very important to prevent possible complications and to have a healthy implant.
How to Prevent Infection After Surgery
The prosthesis in the knee will be vulnerable to possible infections. To be protected, patients should use certain antibiotics before any other surgical procedures, including basic procedures like having a tooth pulled. Doctors will inform the patients about the medicines in these cases.