Description

Knee Replacement

Knee Replacement

Overview

Knee replacement surgery is among the most common operations
in the field of orthopedics.

The knee joint is formed by the lower end of the
femur, the upper end of the tibia and the kneecap (patella). The joint surfaces
on these three bones are covered by articular cartilage, a soft substance that
protects the bones and allows them to move easily.

The knee joint may lose its normal structure and
functioning due to various diseases, including osteoarthritis as the most
common one, trauma, or wearing off over time. This condition is frequently
manifested by pain, laxity, and reduction in the range of motion of the knee
joint.

When a problem occurs in the above mentioned parts of
the knee joint and it cannot be solved by medication and physical therapy, your
surgeon cuts the damaged parts of these bones and places the artificial joint
made of metal alloys or other suitable materials.

Why is knee replacement procedure done?

Your knee is among the most important joints of your
body. Having healthy knees is a must to perform daily life activities.

If your knee is severely damaged due to arthritis or
injury, it becomes difficult to do routine daily life activities such as
climbing stairs, walking or going uphill. For initial stages, motions of the
knee joint cause pain, but you may feel pain even at rest as the damage
progresses.

If medication treatment, physiotherapy and
rehabilitation and use of walking aids cannot manage the pain and do not help
to maintain the function of the knee joint, total knee replacement may be
considered.

Most common cause of the chronic knee pain and
disability is arthritis. Although there are many types of arthritis, only three
of them account for most knee pains: osteoarthritis, rheumatoid arthritis and
post-traumatic arthritis.

Risks

The rate of complication after total knee replacement is
low, but as the case for all surgeries, total knee replacement also involves
some risks.

Although all possible measures that modern medicine
allows are taken to prevent occurrence of risks, it is no means possible to
warrant that the risks will be completely eliminated.

These risks may be related to surgery and anesthesia,
but there are also some risks that may be faced after the surgery.

Potential risks of total knee replacement are as
follows:

• Infection
• Persistence of the knee pain
• Clot formation in the leg veins and migration of
  the clot to other body parts
• Anesthesia-related complications
• Damage of the nerves and blood vessels around the
  knee
• Wearing of the implant (artificial knee joint)
  over time
• Failure to obtain desired range of motion in knee
  joint

When these complications occur, albeit rare, recovery
time may prolong, complete recovery might fail or revision surgery might be
required. You should inform your orthopedic surgeon about your concerns before
the surgery.

Your surgeon will explain in detail whether those
risks apply to you or if so, the rate of occurrence.

Preparation

The first phase of preoperative preparation is same in
all Medicana Hospitals. Decision of total knee replacement is made by your
orthopedic surgeon based on a series of tests and examinations. Your doctor
will make a comprehensive assessment to determine whether this surgery helps
your complaints or not. All other treatment options, including but not limited
to medications, injections, physiotherapy and other surgical procedures, are
taken into consideration.

• Review of health history
• A detailed physical examination
• Necessary laboratory tests and radiology studies
• Assessment by anesthesiologist and other
  laboratory tests and radiology studies to minimize anesthesia-related complications

After it is verified that the surgery does not pose
risk, you will be asked to quit smoking, if you are a smoker, and to stop
taking certain medications that increase risk of bleeding. All other prescribed
and over-the-counter medications, herbal products and supplements will also be
questioned and you will be informed to continue or stop taking them.

A preoperative discussion with your orthopedic surgeon
about total knee replacement is very important. All details of the procedure,
potential risks and healing period are explained.  

You will also be instructed to stop eating and
drinking at a particular time before the surgery and you should strictly follow
this instruction in order to undergo the surgery at the scheduled date.

Moreover, it is reasonable to plan discharge,
post-discharge accommodation and travel at this phase in order to manage
postoperative period better.

Surgery and early postoperative period

After you are hospitalized, preparations are completed
and your anesthesiologist will assess you to determine the best anesthesia
technique. Orthopedist will first cut the damaged cartilage and bone and
prepare them for joint replacement. Artificial (prosthesis) knee joint, which
is made of metal alloy or other suitable materials, is then placed so as to
take over the function of the knee joint. Artificial joints are attached to
existing bones and surrounding tissues using screws, plates and other fixation
materials. The range of motion of the knee joint is checked once more before
the surgery is completed.

Our physiotherapist will help you to learn how to use
your new knee joint, but moving your knees and legs after the surgery will not
only facilitate wound healing, but it will also contribute to the success of
the surgery.

You will be given pain killer(s) after the surgery in
order to manage the postoperative pain. The swelling in and around the incision
line will regress over time. You may also need to use antibiotics to prevent a
possible infection.

It is very important that you follow all instructions
of your doctor after the surgery to protect and support the outcome of the
surgery.

You should see your surgeon for follow-up visits that
are scheduled before you are discharged.

If you experience warmth and redness in your incision
line, or if you have a fever or any symptoms that you think are due to surgery
after you are discharged, contact your surgeon immediately.

Results

You will need inpatient care for several days after
the surgery. At this time interval, both your overall health will be stabilized
and your joint will be adapted to post-discharge period by physiotherapy
procedures.

Always remind that postoperative pain is a natural
component of the recovery. Your doctor and nurse will take necessary measures
to manage your pain.

More than 90% of patients, who undergo a knee
replacement surgery, experience a substantial regression in knee-related
complaints, including pain, and substantial improvement in daily life
activities.

Prosthetic material will certainly wear, including
normal use, after the surgery. Excess activity may accelerate the wearing.
Laxity may develop and knee prosthesis may cause pain. Therefore, it is
extremely important that you do the exercises and avoid all activities
instructed by your surgeon.

Physical Medicine and Rehabilitation

Most patients start exercising with their knees the
day after the surgery. If necessary, walking aids are also used Our
physiotherapists will instruct you specific exercises to strengthen your leg
muscles and to demonstrate the correct use of your artificial joint.

Moreover, your surgeon may ask you to use continuous
passive motion (CPM) device that moves your knee slowly while you are lying on
the bed.

If you strictly follow all instructions, you will
probably start doing all routine daily life activities, with no restriction,
within several weeks. However, time is required for sufficient strengthening
and elasticity of muscles.