This type of joint replacement often results in more natural movement in the knee and you may be able to be more active than after a total knee replacement.
Talk to your surgeon about the type of surgery they intend to use and why they think it's the best choice for you. If only your kneecap is damaged, an operation called a patellofemoral replacement or patellofemoral joint arthroplasty can be performed. This is a simpler surgery with a faster recovery time. However, the long-term results are still unclear and it's not suitable for most people with osteoarthritis. The surgeon makes a smaller cut than in standard knee replacement surgery.
Specialised instruments are then used to manoeuvre around the tissue, rather than cutting through it.
This should lead to a quicker recovery. Read the NICE guidance on mini-incision surgery for total knee replacement. The surgeon performs this operation using computerised images, which are generated by attaching infrared beacons to parts of your leg and to the operating instruments. These are tracked on infrared cameras in the operating theatre. Results so far suggest that this may enable the new knee joint to be positioned more accurately.
Most hospitals don't yet have the equipment to do this and only around 1 in knee replacements are performed in this way. This is a more recent advance in knee replacement surgery. A guide is created using MRI scans. It is performed primarily to relieve knee pain and stiffness caused by osteoarthritis.
Most people who get this surgery have advanced knee arthritis, in which the knee cartilage is worn away and the surface of the knee becomes pitted, eroded, and uneven. This causes pain, stiffness, instability and a change in body alignment. Knee replacement surgery can also help some people who have a weakened knee joint caused by an injury or other condition. To understand a total knee replacement, also known as total condylar knee arthroplasty, you must be familiar with the structure of the knee, a complex joint that consists of three bones:.
Strong ligaments connect the powerful muscles of the thigh and calf to the bones around the knee to control knee motion and function. Cartilage such as the meniscus and other soft tissues cover and cushion the bones to help them glide together smoothly. When you bend or straighten your knee, the end of the femur rolls against the end of the tibia, and the patella glides in front of the femur. When the cartilage that cushions the joint degrades or is worn away completely, the bones rub together and become scraped and rough.
This causes inflammation known as osteoarthritis, which results in pain and stiffness that make walking and other movement difficult. The implants used in knee replacement are smooth like the surfaces of a healthy knee. First, the orthopedic surgeon makes an incision cut in the knee and moves the patella kneecap to the side. If are any bone spurs small bony growths are present, as sometimes occurs in osteoarthritis, they will be removed.
Next, the two menisci between the femur and tibia are removed, as are the anterior cruciate ligament ACL and, in some cases, the posterior cruciate ligament PCL. In some types of knee replacement, the PCL is retained. During the main phase of the operation, the surgeon cuts and remove cartilage and some bone from the upper part of the tibia and lower sections of the femur.
The femoral sections removed are two knobby protuberances called the femoral condyles. The tibia and femur are then be capped with metal implants to create new surfaces for the joint. The surface of the femoral component mimics the shape of the original femoral condyles. If the kneecap has also degraded, the surface on its underside may also be cut away and replaced with a polyethylene implant. Finally, the various layers of tissue are repaired with dissolvable sutures and the skin incision is closed with sutures or surgical staples.
A bandage will be wrapped around the knee and the patient is be taken to recovery. Fixed-bearing knee implant with a polyethylene articulating surface plastic tray sandwiched between the metal tibial implant and metal femoral implant.
Side-view illustration of a knee with a fixed-bearing knee implant in place. X-ray of a knee after total knee replacement, showing the implanted prosthesis. The selection of knee replacement prosthesis design and materials depends on each individual patient. The main implant components are made of metal — usually titanium or chrome-cobalt alloys. Before closing the incision, he or she bends and rotates your knee, testing it to ensure proper function.
The surgery lasts about two hours. You'll be taken to a recovery room for one to two hours. How long you stay after surgery depends on your individual needs. Many people can go home that same day. Medications prescribed by your doctor should help control pain. You'll be encouraged to move your foot and ankle, which increases blood flow to your leg muscles and helps prevent swelling and blood clots.
You'll likely receive blood thinners and wear support hose or compression boots to further protect against swelling and clotting. You'll be asked to do frequent breathing exercises and gradually increase your activity level. A physical therapist will show you how to exercise your new knee. After you leave the hospital, you'll continue physical therapy at home or at a center. Do your exercises regularly, as instructed.
For the best recovery, follow all of your care team's instructions concerning wound care, diet and exercise. Artificial knee joints used in knee replacement surgery are typically made of metal and plastic.
Metal alloy parts replace the damaged thighbone and shinbone. High-density plastic replaces cartilage on the shin and kneecap components.
For most people, knee replacement provides pain relief, improved mobility and a better quality of life. And most knee replacements can be expected to last more than 15 years. Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. The most common type of artificial knee prosthesis is a cemented prosthesis.
Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2 types is used to replace a knee. The prosthesis is generally comprised of 3 components: the tibial component to resurface the top of the tibia, or shin bone ; the femoral [thigh bone] component to resurface the end of the thighbone; and the patellar component to resurface the bottom of the kneecap that rubs against the thighbone.
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Knee replacement surgery usually requires an in-hospital stay of several days. It is important to begin moving the new joint after surgery.
A physical therapist will meet with you soon after your surgery and plan an exercise program for you. A continuous passive motion CPM machine may be used to begin the physical therapy. This machine moves your new knee joint through its range of motion while you are resting in bed. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge. You will be discharged home or to a rehabilitation center.
In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion. Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit. Take a pain reliever for soreness as recommended by your doctor.
Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.
It is important that you avoid falls after your knee replacement surgery, because a fall can result in damage to the new joint. Your therapist may recommend an assistive device cane or walker to help you walk until your strength and balance improve. Making certain modifications to your home may help you during your recovery.
These modifications include, but are not limited to, the following:. Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
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