What do you know about knee joint replacement?

 

If your knee has arthritis or is injured, you may feel pain while performing simple activities such as: walking, going up and down the stairs; You may even have pain while resting and lying down. In this situation, if the treatment methods without surgery (Conservative Treatments); If taking medicine or using assistive devices while walking do not have an effect on reducing your pain, then knee replacement may be suggested to you.
Knee replacement surgery is a safe procedure that reduces pain and corrects leg deformity and helps you to resume your daily activities. Knee replacement surgery was performed for the first time in 1968. Since then, the advances made in the surgical technique and the materials used to make the implants have increased the effectiveness of this procedure. Currently, knee joint replacement is one of the most successful operations in the field of medicine. According to AHRQ (Agency for Healthcare Research and Quality), more than 600,000 knee replacements are performed annually in the United States.

If you are just starting to research knee replacement, or even if you have already decided to have it done, this article will help you gain a better understanding of knee replacement surgery.

Anatomy of the knee

The knee joint is the largest joint in our body. Performing most daily activities requires healthy knees. The knee joint consists of three parts, which are: the end part of the thigh bone (distal femur), the upper part of the leg bone (proximal tibia) and the patella (patella). The joint of these three bones is covered by articular cartilage; A soft surface that protects the bones and makes them move smoothly on each other.
The meniscus is a "C"-shaped part in the knee joint, which, like a wedge, has thick outer edges and gradually narrows. This section is located between the femur and leg bones and plays the role of a shock absorber in the knee joint.
The two femur and leg bones are held together in the knee joint with the help of large ligaments. These ligaments help to stabilize the knee joint.
Other parts of the knee joint are covered by a layer called synovial membrane. In this membrane, a liquid is produced which causes the surface of the cartilage to slide, and in this way the friction against the movement of the bones is almost zero.
There is a kind of harmony between the activity of all parts of the knee. Disease or damage to the knee can disrupt this harmony and the result of this disorder is the occurrence of pain, muscle weakness and decreased efficiency of the knee joint.

Anatomy of the knee joint

What problems can eventually lead to knee replacement surgery?

Arthritis is one of the main causes of chronic pain in the knee joint and the inability of people to do their work. There are many types of arthritis, but knee pain is often caused by three types of arthritis, which are: Osteoarthritis, Rheumatoid Arthritis, and Post-Traumatic Arthritis.

     Osteoarthritis. This type of arthritis occurs with age. Osteoarthritis is often seen in people over 50 years old, but there is a possibility of its occurrence in young people as well. In this type of arthritis, the cartilage covering the bones is gradually worn out and destroyed. With the destruction of the cartilage cover, the bones are stretched directly on each other, and in this way, the person will feel pain and stiffness in the knee.
     Arthritic rheumatism. In this type of arthritis, the synovial membrane that covers the joint is thickened and inflamed. This chronic inflammation will gradually cause cartilage loss, pain and stiffness in the joint. Rheumatoid arthritis is the most common form of "Inflammatory Arthritis".
     Post-traumatic arthritis. This type of arthritis can cause a serious problem for a person. Fractures in the bones around the joint or tearing of the ligaments due to an accident can gradually cause cartilage loss and pain in the knee joint and limit its function.

Formation of bony appendages and wear of articular cartilage due to arthritis

What is the process of knee joint replacement surgery?
Depending on the patient's condition, the doctor suggests a complete or partial replacement of the knee joint.

Replacement of a part of the knee joint (Partial Knee Replacement):
Whenever one of the three parts, medial, lateral (referring to the inner and outer sides of the knee joint) and patella (patella) need to be replaced, it is called replacement of a part of the knee joint. In this way, by replacing only the damaged parts, more natural parts of the knee will be preserved. This method is less invasive than total knee joint replacement, and therefore the recovery period after the operation will be shorter.

Total Knee Replacement:
In the operation of complete replacement of the knee joint, first the damaged surfaces in the end part of the thigh bone (distal femur) are separated by special tools, then the surface of the bone is cut and finally the cut surface is replaced with a metal piece.
The preparation of the upper leg bone (proximal tibia) is the same way; First, the damaged surfaces are separated, the bone surface is cut, and finally a new piece (Tibial Base) is placed on the shaved leg bone. Then, on this new metal surface, a polyethylene piece is placed, which acts as a shock absorber between two pieces placed on the end of the bone.

It plays the roles of thigh and leg. It is possible for the surgeon to replace the lower part of the patella bone with a polyethylene piece if needed.
Fixation of these parts in the bone is done in two ways:

     Fixation using cement
     Stabilization using the "Press-Fit" technique. In this method, the bone grows on the surface covering the implant, covers it, and in this way the implant is stabilized.

Choosing the method of fixing the implant parts is the responsibility of the surgeon and depends on factors such as: age, activity level of the person, bone quality and other medical conditions that may have an effect.
At the end of the surgical procedure, the surgeon secures the new knee joint. That is, when the implant is fixed in place and the proper functioning of the muscles around the joint is confirmed, then the surgeon closes the incisions around the joint with the help of sutures and bandages them. You can generally expect to be transferred from the recovery room to your room in the hospital one to three hours after surgery.

There are two types of platforms for total knee replacement, which are:

     Fixed platform (FB-Fixed Bearing). In the fixed platform, the polyethylene part is fixed on the metal part of the leg and cannot move.
     Rotating Platform (RP-Rotating Platform). In the rotating platform, the polyethylene piece can rotate on the metal surface of the tibia and move with knee flexion. This feature causes the freedom of movement of the replaced joint in this platform to be greater than other conventional knee replacement platforms and to be closer to the range of motion of a natural knee joint.

Two rotating and fixed platforms for complete replacement of the knee joint

Who are good candidates for knee replacement surgery?

So far, there is no specific weight and age limit for knee joint replacement surgery. Doctors usually recommend knee replacement surgery based on the patient's pain and disability, not age. Most of the patients who undergo this operation are between 50 and 80 years old. In any case, knee joint replacement has been successful at any age; From a teenager with juvenile arthritis to an elderly person with degenerative arthritis - a type of arthritis that occurs naturally due to old age.
A doctor may suggest knee replacement surgery for various reasons. In general, people who may benefit from this surgery have conditions similar to the following:

     Severe pain or stiffness in the joint that makes it difficult for a person to perform daily activities such as walking, going up and down stairs, or sitting in and out of a chair.
     Mild or severe pain while resting (both day and night)
     Chronic inflammation and swelling that does not improve with rest and medication
     Deformation in the knee - bracketing the legs inward (Valgus) or outward (Varus)
     Lack of effectiveness of other treatment methods such as: taking anti-inflammatory drugs, cortisone injection, injection of joint lubricants, physiotherapy or performing other surgical methods, in reducing the amount of pain.

When should you talk to a specialist about your treatment options?

Examining treatment options with the help of an orthopedic surgeon is very important and will help you decide more easily about your treatment process and see if knee replacement surgery is the best option for you. Therefore, it is better to get information about knee replacement surgery so that you can ask your surgeon any questions you may have about it. Before seeking treatment, try to get an accurate picture of your pain and how it affects your mobility and daily life. Answering the following questions is a good place to start.

Assessment of knee pain
If your answer to only one of the following questions is positive, then it's time to check your treatment options with the help of a doctor.

          1. Do you have knee pain more than one day a week?
          2. Does your pain interfere with your sleep?
          3. Is taking medicine no longer effective in relieving your pain?
          4. Are you having trouble doing your daily tasks?
          5. Do you feel pain in your knee while walking?

What doctors can help treat knee pain?

General physician, orthopedic surgeon, sports medicine specialist and rheumatism specialist are among the people who can help in the treatment of knee pain. Read more about these people and see how they can help you.

General practitioner
The doctors you see for your routine medical problems, such as annual check-ups or non-emergency illnesses, are called general practitioners. According to the type and severity of knee pain, these people will refer you to a sports medicine, rheumatism, or orthopedic surgeon for further treatment.

Sports medicine specialists
There are doctors who specialize in the prevention, evaluation and treatment of sports-related injuries. They will likely recommend treating your knee pain with medication, physical therapy, or steroid injections, and if they think surgery will improve your condition, they will refer you to an orthopedic surgeon for further evaluation.

Rheumatism specialists
Doctors who, in addition to diseases related to bones, joints, muscles and ligaments, also specialize in the diagnosis and treatment of joint arthrosis and joint rheumatism. They will recommend treating your knee pain, possibly with medication, physical therapy, or steroid injections, and if they think surgery is needed to fix your knee problem, they will refer you to an orthopedic surgeon for further evaluation.

Orthopedic surgeons
Doctors who have more expertise in the field of injuries of the musculoskeletal system of the body (bones, muscles and joints) are called orthopedic surgeons. These specialists will probably recommend treating knee pain with medication, physical therapy, steroid injections, and eventually knee replacement.

How to prepare to see an orthopedic surgeon?

Check insurance coverage
Before agreeing to the knee joint replacement operation, get information from your insurance plan regarding this operation; An operation that will cost thousands of dollars. Keep in mind that the cost of partial knee replacement is almost half of the total knee replacement. Therefore, contact your insurer and get detailed information about the coverage of your insurance plan.

Create a medical history of yourself
To create a medical history, you can use the following checklist and provide it to your doctor on the day of your appointment:
All medications and supplements you take, along with how much and when
Significant and chronic diseases that you have suffered from
All surgeries you've had so far and any other conditions you've had, such as reactions to anesthesia
Any drug or food allergies or sensitivities
Background of diabetes, cancer and heart disease in your family
habits and lifestyle; Such as: smoking, drinking alcohol, exercising or a special diet

Orthopedic doctor examinations

Orthopedic surgeon examinations can include the following:
Medical background check. Your orthopedic surgeon will collect information about your general health and ask you questions about the severity of your knee pain and your performance.
Conduct physical examinations. At this stage, the surgeon checks the range of motion, strength, stability and alignment of the knee joint.
X-ray imaging. With the help of X-ray images, the surgeon finds out the severity of the injury and the deformation of the knee joint.Their daily activities have also improved. You should keep in mind that doing this will bring your ability level back to normal, not beyond.
Activities that you will be able to do after knee replacement surgery include: unrestricted walking, swimming, golf, driving, light hiking, cycling, and generally any activity that has a low intensity of difficulty.
Remember that by making adjustments to the way you do things, you can keep your joint replacement healthy for years.
Prescribing other diagnostic tests. The surgeon will sometimes order blood tests and more advanced imaging such as an MRI. The MRI test is usually performed to check the condition of the bone and soft tissues around the knee joint.
After completing the examinations, the orthopedic surgeon will share the results with you and check with your help whether knee joint replacement will be effective in reducing pain and returning you to the flow of life. other possible treatment methods; Such as: taking medicine, doing injections, physiotherapy or doing other types of surgeries are also discussed and checked at this stage.
If you choose knee joint replacement, the surgeon will explain the risks and possible complications of the surgery.

Deciding to perform knee joint replacement surgery

One of the important factors in deciding to undergo knee replacement surgery is to know what to expect from this surgery.
In 90% of patients who have undergone knee joint replacement, knee pain has decreased to a great extent and the ability to

 

How to prepare for knee replacement surgery?

Everyone wants the best possible outcome from their surgery. In knee joint replacement surgery, the best result is significant reduction of pain and swelling, increased range of motion and improvement of knee joint strength. To achieve this goal, you need to adjust certain habits in your lifestyle.
Preoperative preparation can reduce postoperative and intraoperative complications and even prevent their occurrence. Therefore, try to prepare your body for surgery in the weeks before the operation. During these weeks, your orthopedic surgeon may:
Make your diet difficult or add food supplements to it
Ask you to stop taking some medications
refer you to a physiotherapist and suggest some light sports movements before the operation; Because the stronger the leg is during the surgery, the stronger it will be after the surgery, and this can help speed up your recovery process.

Medical evaluation
If you ultimately decide to have knee replacement surgery, your orthopedic surgeon will refer you to a general practitioner a few weeks before the operation for a full evaluation. This evaluation includes reviewing the patient's medical history and performing physical examinations. The purpose of this evaluation is to ensure your readiness to perform surgery and complete the recovery period.
People with chronic diseases such as heart disease should be evaluated by specialists for that disease before surgery.

Performing diagnostic tests
In order to plan for surgery, the surgeon may prescribe tests such as blood and urine tests.

Regulation of drugs
Provide your surgeon with a list of all medications you are taking. In this way, he will tell you which medications you should stop and which medications you can continue until the surgery.

Evaluation of teeth
The probability of infection after knee replacement surgery is very low. Infection occurs when bacteria enter the bloodstream. To reduce the risk of infection, dental procedures such as tooth extraction or gum surgery must be performed before joint replacement surgery.

Urine evaluation
People who have frequent urinary tract infections or have recently had urinary tract infections should have a urine evaluation before surgery. Elderly people who have prostate disease should also treat that disease before undergoing surgery.

Nutrition
Before surgery, you should pay a lot of attention to your nutrition. Protein, calcium, and vitamin D all play a role in bone repair. If needed, the surgeon will determine the nutritional supplement and its dosage for you.
Herbal medicines and anesthetics interact, and since this risk is not well known to the medical community, it is better to limit the use of any herbal medicine twice as suggested by the American Society of Anesthesiologists (ASA). Stop three weeks before surgery. In addition, some dietary supplements can thin the blood. Since your doctor may prescribe blood thinners in the weeks before your surgery, talk to your doctor about continuing your nutritional supplements along with your blood thinners. Alcohol and caffeine can also cause bleeding problems during or after the procedure. For this reason, you should stop drinking alcohol, coffee and tea at least one week before the surgery.

Weight Loss
Since the knee bears most of the body's weight, heavier patients will experience more difficulties and complications during and after the operation. Preoperative weight loss will reduce the likelihood of these complications. On the other hand, weight loss improves your ability to move and participate in physical therapy sessions. Many of these problems can be avoided with a serious weight loss program in the weeks leading up to surgery. Most importantly, the less body weight, the less stress is placed on the new knee joint. Therefore, the doctor will help you to reduce your weight according to your body mass index (Body Mass Index).

Quit Smoking!
Most likely, the doctor will ask you to refrain from smoking tobacco for 24 hours before the operation. In general, the probability of infection in the replaced knee and lung problems such as pneumonia is higher in patients who smoke. These negative habits also slow down the healing process of the replaced joint. The weeks before the operation is a good time to quit smoking. Your doctor will help you find the right way to quit these habits.

Other diseases or medical conditions
If in the near weeks of surgery, serious illness or special conditions; Such as: cold, flu, sprain, any allergic reaction or an open wound, be sure to inform the doctor. If these conditions occur, your doctor will decide whether it is necessary to move the surgery date or not.

Planning for surgery
Patients who plan their joint replacement surgery are more likely to have a better experience with their procedure. There are many things you can do to speed up your recovery after surgery, including:
Educate yourself. Get information about the surgery you are about to undergo through the surgeon's office or reference websites.
Blood donation. Talk to your surgeon about whether it is necessary for you to donate blood for possible use in your own blood transfusion during surgery or not.
Leave due to illness. If you are employed somewhere, take some time for surgery and rehabilitation

Then take a break. Consult your surgeon regarding the duration of leave.
A temporary place to park a vehicle. Ask the hospital or surgeon's office about this.

Planning for the post-operative recovery period
Although you will be able to walk with the help of a walker or cane immediately after surgery, you will need help with daily tasks such as: cooking, shopping, bathing and washing your clothes for weeks after surgery.
If you live alone, you can ask your orthopedic surgeon's office, or a social worker, or a person in charge of discharge and post-discharge services at the hospital (Discharge Planner), to make arrangements for a skilled person, after discharge. The hospital will help you at home or, if needed, make arrangements for you to stay in an Extended Care Facility for a short time after being discharged from the hospital.

Preparing the home for the recovery period after surgery
Making improvements at home can make your recovery easier. For example, the following can make daily activities easier for you:
Install safety bars or railings next to the shower or bathtub
Fence all stairways
For the beginning of the recovery period, prepare a chair that has a strong and rigid seat (about 45 to 50 cm high), two handles, a strong back and a stool to raise the level of the legs.
Use the toilet and raise its sitting surface, if necessary, by using special equipment so that there is less pressure on you when not sitting.
When taking a shower, use benches or chairs that are strong and stable and are specially designed for this.
If there is a slippery carpet or electric wire on your way home, which may be dangerous, remove it from your path.
Since it will be difficult for you to use the stairs at the beginning of the recovery period, it is better to go up and down the stairs less and for a while, temporarily consider a living room for yourself on a fixed floor.