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The Procedure overview:
What is a knee replacement surgery
A knee replacement surgery is called an arthroplasty. This is a surgical procedure that resurfaces a knee that has been damaged by arthritis. Typically within this procedure metal and plastic parts are used to cap the ends of the bones that form each knee joint, as well as the kneecap. The surgery may be considered for someone who has severe arteries or a serious knee injury.
Different types of arthritis can affect the knee joint differently. Osteoarthritis which is a degenerative joint disease affects many middle-aged as well as older adults. Osteoarthritis causes a breakdown in joint cartilage and nearby bones within the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane e and results in the excessive synovial fluid can lead to stiffness and pain. Traumatic arthritis, which id due to an injury may also cause e damage to the knee cartilage.
The purpose of the knee replacement procedure is to resurface parts of the knee that have been damage and relieve knee pain that cannot be controlled by other treatments.
The anatomy of the knee
Joints are areas where two more bones meet. Most points are mobile portions of the limbs. The knee is w long leg bones that are connected by the muscles, tendons and ligaments, and tendons. Each bone and is covered with a layer of cartilage that absorbs shock and protects the knee.
There are two groups of muscles involved in the knee, including the quadriceps muscles ( located on the front of the thighs), which align the legs, and the hamstring muscles (located on the back of the thighs) which bend the leg at the knee.
Tendons are fibrous cords fo connective tissue that connects muscles to bones ligaments are stretchy bands of tissue that attach bone to bone. Some ligaments of the knee give stability and protect the joints while other ligaments bound forward and backward movement of the tibia (shin bone)
The knee has the following parts:
- Tibia, This is the skin bone or larger bone of the lower leg
Former this is the thighbone or upper leg bone
- Patella – This is the kneecap
- Cartilage This is a tissue that covers the surface area of the bone at the joint. The cartilage functions to decrease the friction between the bones within the joint as the body moves.
- Synovial Membrane – This tissue is the lining of the joint and seals the tissue into a joint capsule. The synovial membrane discharges fluid, a sticky fluid) around the joint to lubricate it.
- Ligament. This is a tough elastic connecting tissue that surrounds the joint to give support and restricts the joint’s movement.
- Tendon- This is a tough tissue that connects the bones and muscles to each other and helps control the movement of the joint.
- Meniscus A cured part of the cartilage in the knees and other joints that function as the shock absorber. The meniscus increased the contact area and deepened the knee joint.
Why Do People have an Arthroplasty Knee Replacement Procedure
Knee replacement surgery is a treatment used to remove the pain and disability within the knee. The most common condition that results in the need for keen replacement surgery is osteoarthritis.
Osteoarthritis is defined by the deterioration of the joint cartilage. The damage did to the cartilage and bone reduces movement and may cause pain for the individual. People with the severe degenerative joint disease may be unable to conduct normal daily activities, such as bending over, sitting, walking, climbing stairs because they are too painful. The knee may swell because the joint is unstable.
Other forms of arthritis, such as arthritis due to knee injury or rheumatoid arthritis, which may lead to worsening the knee joint. Injuries, such as fractures, torn ligaments, and torn cartilage may cause irreversible damage to the knee joint.
In cases where medical treatments are not effective, a knee replacement surgery may be the best option. Some medical treatments for degenerative joint disease may include the following:
- Pain Medications
- Limit to painful activities
- Physical therapy
- Movement with assistive devices for walking, such as a cane.
- Weight loss – to reduce stress on knees
- Anti-inflammoarty medications
- Cortisone injections into the knee joint
- Viscoscupplemntaion injection ( This is additional lubrication injected into the joint to make movement less painful
There may also be other reasons knee replacement surgery is recommended.
Risk of Knee Replacement Surgery
Any invasive surgical procedure has its risk of complications. Ther are risk with this-this procedure as well, which may include, but not limited to:
- Blood clots developing in the leg or lungs
- Loosening or rearing out of the prosthesis, which is the replacement part that is getting placed on the knee.
- Continued pain and/stiffness
The replacement knee joint can become dislodged or loose or may not work the way it was intended, so in some cases the joint has to be replaced again the future
Nerves or blood vessels in the area of the surgery may be injured, which can cause numbness or weakness and joint pain may still exist after the surgery.
There are are also additional risk depending on other medical conditions that the patient may have.
- Your surgeon will walk you through the steps of the procures, and you have the chance to ask questions about anything you might want to know concerning the procedure and outcomes.
- You will be requested to sign an consent form that gives your permission to proceed with the surgery. You should read the form carefully and ask any questions if something is not clear.
- Along with you complete medical history, your doctor will likely perform a full physical examination to ensure that you are healthy enough to undergo procedure. You may also undergo diagnostic and blood test.
- You will be asked to notify the doctor if you have any types of allergies such a latex, tape, anesthetic agents, and medications.
- You will be called upon to inform you, doctor of all of the medications( prescribed as well as over-the-counter drugs) that you are taking.
- Notify your doctor if you have nay bleeding disorder or anticoagulant (blood-thinning medications, aspirin) or medications that affect blood clotting. It may be nectary for you stop taking this drug before you undergo the surgery.
- If you are pregnant or think that you pregnant you should inform your doctor.
- You will be requested to fast for eight hours before the procedure after midnight
- You may receive a sedative before undergoing the procedure to help you relax
- You may need to meet with a physical therapist before the operation to discuss rehabilitation
- You should arrange for someone to assist you around the house for the week or two after you leave the hospital
Based on your medication condition your doctor may request additional preparation be completed before the operation.
The knee replacement procedure will require you to stay in the hospital. The procedure will vary with the state of your condition. A knee replacement is most often performed while the patient sleeps under general anesthesia. The anesthesiologist will discuss this process with the patient before the surgery.
Typically the knee replacement happens in the following process:
- The patient is asked to remove their clothing, and the patient is given a gown to ear.
- An IV or intravenous line is placed in the arm or hand.
- The patient is position onto the operating table
- A urinary catheter may be inserted into the patient.
Of there is excessive hair within the surgical site the medical team may remove it.
- The anesthesiologists will continue to monitor the heart rate, breathing, blood pressure and blood oxygen levels during the surgery.
- The skin over the surgical site will be cleansed with antiseptic solution
- The doctor will begin to make the incision in the knee area.
- The surgeon will then begin to remove the damaged parts of the knee joint surfaces and resurface the knee joint with the prosthesis. The knee prosthesis can be made of metal and plastic. The most common type of knee prosthesis is a cemented prothesis. Uncemented prostheses are not used anymore. The cemented prosthesis attached to the porous bone surface, in which the bone will grow to attach to the prosthesis. Sometimes there is two types of components used, other times there may be three components used. The tibial component, which will resurface the top of the tibia or shin bone. The femoral or the thigh bone component, which is used to resurface the end of the thighbone, and the patellar component, which is used to resurface the bottom of the kneecap that rubs against the thighbone
- The incision is then stitched and closed, or surgical staples are used
- A drain tube may be placed in the incision site to remove excess fluid
- A serial bandage or dressing is applied to the incision site.
- In the hospital, after surgery, the patient is taken to the recovery room for observation. The doctor will take the blood pressure, pulse and monitor the breathing and then the patient is taken to his/her hospital room. Knee replacement typically requires someone to stay in the hospital several days.
- The physical therapist will recommend, that the patient starts moving the new joint after surgery. The physical therapist will design a therapy plan and exercise program for the patient. A continue passive motion (CPM) may be used to being the physical therapy. The machine moves the knee joint through various ranges of motion while the patient is in the bed. The pain is controlled via medication so that the patient can participate in exercise. The doctor will discharge the patient after a couple of days to home or a rehabilitation center. The doctor will arrange the continuation of the therapy until the patient regain muscle strength and goo range of motion.
Once a patient is at home, it is essential to keep the area around the incision clean and dry. The doctor will give the patient particular bathing instructions. The stitches or staples are removed during the following check up.
To reduce swelling, the patient should keep the leg elevated and may need to apply ice to the knee.
The doctor will prescribe pain relief medications for the soreness such as aspirin, however, the changes the chance of bleeding may increase.
The patient should immediately notify the doctor if to report the following:
- A fever
- Increased pain around the injection site
- Redness, bleeding swelling or draining from the incision site
You may resume a normal diet unless your doctor tells you not to
The patient should not drive until the doctor gives permission. Other activities may be restricted. The therapist may recommend a sensitive device such as cane or walker to help the patient get around.
Modifications may also be needed for the home such as:
- Safety handrails in the shower or bath
- Shower bench or chair
- Proper handrails on the stairs
- Raised toilet seat
- Long-handled sponge and shower hose
- Reaching stick to grab objects
- The doctor may also tell the patient to remove loose carpets and electrical cords that may cause him/her trip and avoid start climbing until recommended.