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Knee joint replacement


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Definition

Knee joint replacement is surgery to replace a knee joint with an artificial joint. The artificial joint is called a prosthesis.

Alternative Names

Total knee replacement; Knee arthroplasty; Knee replacement - total; Tricompartmental knee replacement

Description

You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain. Or, you may have a spinal or epidural anesthesia. In this kind of anesthesia, medicine is put into your back to make you numb below your waist.

After you receive anesthesia, your surgeon will make an incision (cut) over your knee to open it up. Then your surgeon will:

  • Move your kneecap (patella) out of the way, then shape the ends of your thigh bone and shin bone to fit the prosthesis. Your surgeon will also cut the underside of your kneecap to prepare it for the artificial pieces that will be attached there.
  • Fasten the two parts of the prosthesis to your bones. One part will be attached to the end of your thigh bone and the other part will be attached to your shin bone. Both parts will then be attached to the underside of your kneecap. Your surgeon will use a special bone cement to attach these parts.

Usually, artificial knees have metal parts. Now, though, some surgeons are using some different materials, including metal on metal, ceramic on ceramic, or ceramic on plastic.

Indications

Knee joint replacement may be recommended for:

  • Knee pain that hasn't responded to other therapy (including medication, injections, and physical therapy for 6 months or more)
  • Knee pain that limits or prevents activities
  • Arthritis of the knee
  • Decreased knee function caused by arthritis
  • Inability to sleep through the night because of knee pain
  • Some tumors involving the knee
Knee joint replacement is usually not recommended for:
  • Current knee infection
  • Poor skin cover around the knee
  • Paralysis of the muscles in the front of the thigh (quadriceps)
  • Severe peripheral vascular disease or neuropathy that affect the knee
  • Severe mental dysfunction
  • Terminal disease (for example, cancer that has spread)
  • Morbid obesity (over 300 pounds)

Risks

Risks for any surgery are:

The risks of this surgery are:

Expectations after surgery

The results of a total knee replacement are often excellent. The operation relieves pain in most patients, and most need no help walking after recovery. Most prostheses last 10 to 15 years, some as long as 20 years, before loosening and needing another surgery.

Convalescence

After surgery, you will have a large dressing on the knee area. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area.

You will also have an IV in place to provide fluids until you are able to drink. Special stockings are placed on your legs to reduce your risk of getting blood clots, which are more common after leg surgery.

Your doctor will prescribe pain medicines and, possibly, antibiotics to prevent infection.

You will stay in the hospital for 3-5 days, but the total recovery period varies from 2-3 months to a year.

You will be encouraged to start moving and walking as early as the first day after surgery. You will be helped out of bed to a chair on the first day after surgery. When in bed, bend and straighten your ankles often to prevent blood clots.

Some surgeons recommend using a continuous passive motion (CPM) machine that will bend the knee for you while you're in bed. Over time, the rate and amount of bending will increase. Always keep your leg in the CPM device when in bed. This device helps speed recovery, and reduces pain, bleeding, and infection.

Some patients need a short stay in a rehabilitation hospital to become safely independent in their daily activities. You might need to use crutches or a walker for a few weeks or even months after surgery.

The physical therapy started in the hospital will continue after you've gone home until your strength and motion return. Avoid contact sports, but you should be able to do low impact activities, such as swimming and golf, after you fully recover from surgery.

References

Crockarell JR, Guyton JL. Arthroplasty of the knee. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 6.

Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007; 33(1): 71-86.

 
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