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Total Knee Replacement
Transcript of Total Knee Replacement
Period 4 June/ 2014
Possible Complications of Surgery
The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. The menisci are located between the femur and tibia and act as "shock absorbers" that cushion the joint.All remaining surfaces of the knee are covered by a thin lining called the synovial membrane which releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. But disease or injury can disrupt this harmony in which they work, resulting in pain, muscle weakness, and reduced function.
(Left) In this x-ray of a normal knee, the space between the bones indicates healthy cartilage (arrow). (Right) This x-ray of an arthritic knee shows severe loss of joint space and bone spurs (arrows).
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
Points to Remember About Knee Replacement
What is a Total Knee Replacement?
Knee replacement surgery is a procedure that is performed when the knee joint has reached a point when painful symptoms can no longer be controlled with non-operative treatments. In a knee replacement procedure, your surgeon removes the damaged joint surface and replaces it with a metal and plastic implant.
Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
You will most likely be admitted to the hospital on the day of your surgery.
The procedure itself takes approximately 1 to 2 hours. Your orthopedic surgeon will remove the damaged cartilage and bone, and then position the new metal and plastic implants to restore the alignment and function of your knee.
After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.
Do you have:
The knee replacement prosthesis consists of 3 components: femoral (metal), tibial (plastic in a metal tray), and patellar (plastic). The prosthesis replaces your damaged knee joint.
Severe knee pain that limits activities? (walking, climbing stairs, getting in and out of chairs)
Moderate to severe knee pain while resting -- day or night?
Knee inflammation that is not helped by medications or rest?
Knee deformity such as bowing in or out of the knee?
Knee stiffness that makes it difficult to bend or straighten the knee?
Unsatisfactory relief from NSAIDs(nonsteroidal anti-inflammatory drugs)?
An intolerance to analgesic drugs(pain medications)?
Unsatisfactory results from other conservative treatments tried?
Candidates for Surgery
There are no absolute age or weight restrictions for total knee replacement surgery.
Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually.
Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
Preparing for Surgery
If you decide to have total knee replacement surgery, your orthopedic surgeon may ask you to schedule a complete physical examination with your family physician several weeks before the operation.
Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help your orthopedic surgeon plan your surgery.
Tell your orthopedic surgeon about the medications you are taking. He or she will tell you which medications you should stop taking and which you should continue to take before surgery.
To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your total knee replacement surgery.
People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking knee replacement surgery.
Although you will be able to walk on crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.
The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.
Infection. Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.
Blood clots. Blood clots in the leg veins are the most common complication of knee replacement surgery.
Implant problems. Implant surfaces may wear down and the components may loosen. Additionally, scarring of the knee can occasionally occur, and motion may be more limited,
Continued pain. This complication is rare, however, and the vast majority of patients experience excellent pain relief following knee replacement.
After having a knee replacement, be conscious of certain important aspects of your recovery:
Do your post-op exercises as instructed by your physical therapist.
Balance rest and activity, especially early in your recovery.
Follow instructions to prevent blood clots.
Know the signs of infection.
Be careful not to fall.
Adhere to your restrictions.
The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopedic surgeon. Your physician may refer you to an orthopedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.
Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs.
Moderate or severe knee pain while resting, either day or night
Chronic knee inflammation and swelling that does not improve with rest or medications
Knee deformity — a bowing in or out of your knee
Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
When Surgery Is Recommended
An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.
More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.
With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.
Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, and other low-impact sports.
With appropriate activity modification, knee replacements can last for many years.
Deciding to have Knee Replacement Surgery?