Total knee arthroplasty
About the procedure
Total hip replacement is one of the most advanced and successful procedures in orthopedic surgery. In this operation, the damaged hip joint is replaced with an artificial one. Such a procedure may be necessary for several diseases and injuries that impair the joint and turn walking into a harrowing activity. The most common causes of hip pain are:
- Osteoarthritis is an age-related disease. It usually develops after the 50th birthday, and there is evidence of a family burden. It affects and tears the cartilage surfaces of the joint, resulting in pain and stiffness. Sometimes, osteoarthritis can appear much earlier due to problems with the development of the joint in childhood.
- Rheumatoid arthritis is the most common type of inflammatory arthritis. It is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. It is a chronic inflammatory process in which the cartilage is eventually destroyed, resulting in pain, stiffness, and the inability to put weight on the joint.
- Post-traumatic arthritis: This is arthritis that develops due to trauma or a fracture affecting the articular cartilage.
- Osteonecrosis (avascular necrosis) is a disease that develops due to damage to the blood supply to the femur. That can happen with trauma, such as a joint dislocation or fracture. Certain conditions can also cause osteonecrosis. As a result of the lost blood supply, the bone undergoes necrosis (dies) and deforms, leading to arthritis, which requires joint replacement.
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Frequently Asked Questions
Before the procedure
During the examination, the surgeon will collect detailed information about your health and condition (a questionnaire is filled out) and will ask you about the strength of the pain and the function of the affected knee.
The physical examination will measure the entire limb’s mobility, stability, strength, and alignment.
X-rays will be needed to determine the extent of the damage and deformity of the knee. Usually, a front view of the knee and a photo of the entire limb in the weighted position are required for good preoperative planning.
Sometimes, X-rays are not enough to determine the condition of the bone and soft tissues of the knee, and it is necessary to do other tests, such as an MRI.
Preoperative preparation
It is necessary to fill out the questionnaire that you will receive.
- You will be assessed for your general health. Allergies, blood pressure, diabetes, and urinary and dental infections are checked.
- Before the operation, some blood tests will have to be done (Hb, CRP, etc.)
- It will be necessary to stop drugs such as NSAIDs, Aspirin, and Coumarin derivatives (Syntrom).
If you are overweight, it is good to lose it first.
How is the procedure performed?
The procedure usually lasts 1-2 hours. It is generally performed under general anesthesia or spinal anesthesia. The anesthesia team chooses the kind of anesthesia that will be used.
Access is standard or minimally invasive, depending on the patient’s medical indications and personal preferences.
It consists of five main steps:
- Bone Preparation: The damaged cartilage surfaces of the joint are removed with a small portion of the underlying bone;
- Positioning of the metal implants: these implants recreate the joint’s articular surfaces and are put in place of the removed cartilage. They can then be cemented or “press-fit” to the bone;
- Soft tissue balancing: the ligaments around the knee are treated with surgical methods to make the joint stable and functional throughout the range of motion;
- Resurface the patella: the articular surface of the cap is removed and replaced with a plastic component. Sometimes, this step of the procedure is optional;
- Placing a spacer: a spacer made of special medical plastic is placed between the metal components of the joint. That creates a smooth, sliding surface.
Total knee arthroplasty with navigation: we sometimes use computer navigation (Orthopilot). It is believed that using it can lead to better balance and function of the knee joint, fewer perioperative complications, and faster recovery in patients who want to perform more excellent physical activities.
Aftercare and recovery
You will stay in the hospital for the first five days to be monitored for early post-operative complications. The rehabilitation program begins the day after the operation. It consists of standing up and learning to walk with aids (crutches).
The stitches are removed after 14 days. It is important to anticipate where and how your stitches will be removed.
About 20 days after the operation, riding an ergometer can be started.
Depending on individual progress, walking with crutches is usually discontinued after a month.
Driving is allowed three months after the operation.
Sports activities are allowed after a minimum of 6 months.
Recovery from this operation is better if specialized rehabilitation occurs, so we advise you to anticipate where you will have it.
Having realistic expectations regarding the possibilities of activities after Total Knee Arthroplasty is essential. A well-fitted prosthesis will provide unlimited walking, swimming, driving, golfing, light hiking, cycling, dancing, and other non-stressful sports. The knee replacement will last many years with appropriate modifications to your activity.
What are the risks of the operation?
The most common complication of Total knee arthroplasty is deep vein thrombosis (DVT), which can lead to pulmonary embolism. To eliminate this risk, all patients are prophylactically prescribed medication.
Other risks are infection and malfunction (poor functioning) of the prosthesis. It would help reduce the disease risk if you had no dental or urinary infections before Total knee arthroplasty.
Implant problems: Although implant design, materials, and surgical techniques are constantly improving, issues like wear of the articular surfaces and loosening prostheses are possible. Modern prostheses allow about 140° range of motion, but sometimes this cannot be achieved due to fibrosis on the knee. Patients with limited range of motion before surgery are at greater risk of not reaching full joint range of motion.
Our team is highly specialized and experienced in performing knee arthroplasty, including minimally invasive and computer-assisted techniques. We use preoperative planning for each of our cases. Revision surgery for failed, infected, or loose dentures is performed successfully at our center.
The implants we use are of the highest quality and have the highest rating in the world registry of knee arthroplasty implants.
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