Total Knee Replacement

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A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thigh bone abuts the large bone of the lower leg at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell.

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If medications, changing your activity level, and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. By resurfacing the damaged and worn surfaces of the knee can relieve pain, correct leg deformity and help resume normal activities.

One of the most important orthopaedic surgical advances of the twentieth century, knee replacement was first performed in 1968. Improvements in surgical materials and techniques since then have greatly increased its effectiveness. Approximately 581,000 knee replacements are performed each year in the United States.

Total Knee Replacement Surgery

The patient is first taken into the operating room and given anesthesia. After the anesthesia has taken effect, the skin around the knee is thoroughly scrubbed with an antiseptic liquid. The knee is flexed about 90 degrees and the lower portion of the leg, including the foot, is placed in a special device to securely hold it in place during the surgery. Usually a tourniquet is then applied to the upper portion of the leg to help slow the flow of blood during the surgery. An incision of appropriate size is then made.

1. Removing the Damaged Bone Surfaces

The damaged bone surfaces and cartilage are then removed by the surgeon. Precision instruments and guides are used to help make sure the cuts are made at the correct angles so the bones will align after the new surfaces (implants) are attached.

Small amounts of the bone surface are removed from the front, end, and back of the femur. This shapes the bone so the implants will fit.The amount of bone that is removed depends on the amount of bone that has been damaged by the arthritis.

A small portion of the top surface of the tibia is also removed, making the end of the bone flat. The back surface of the patella (kneecap) is also removed.

2. Attaching the Implants

An implant is attached to each of the three bones. These implants are designed so that the knee joint will move in a way that is very similar to the way the joint moved when it was healthy. The implants are attached using a special kind of cement for bones.

The implant that fits over the end of the femur is made of metal. Its surface is rounded and very smooth, covering the front and back of the bone as well as the end.

The implant that fits over the top of the tibia usually consists of two parts. A metal baseplate fits over the part of the bone that was cut flat. A durable plastic articular surface is then attached to the baseplate to serve as a spacer between the baseplate and the metal implant that covers the end of the femur.

The implant that covers the back of the patella is also made of a durable plastic.

Artificial knee implants come in many designs. Some designs may have pegs, requiring small holes to be drilled into the bone after the damaged surfaces have been removed. Others may have central stems. In addition, some designs may allow screws to be used on the lower implant to provide added attachment security. The surgeon will choose the implant design that best meets the patient’s needs.
Closing the Wound

If necessary, the surgeon may adjust the ligaments that surround the knee to achieve the best possible knee function.

When all of the implants are in place and the ligaments are adjusted, the surgeon sews the layers of tissue back into their proper position. A plastic tube may be inserted into the wound to allow liquids to drain from the site during the first few hours after surgery. The edges of the skin are then sewn together, and the knee is wrapped in a sterile bandage. The patient is then taken to the recovery room.

Your Recovery Care and Time at Home

Current ten-year survival rates for fixed and mobile bearing unicompartmental knee replacements range from 90% – 95%. The success of your surgery also will depend on how well you follow your orthopaedic surgeon’s instructions at home during the first few weeks after surgery.

Wound Care

You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.

Avoid soaking the wound in water until the wound has thoroughly sealed and dried. The wound may be bandaged to prevent irritation from clothing or support stockings.

Diet

Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and to restore muscle strength.

Activity

Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery. Your activity program should include:

• A graduated walking program to slowly increase your mobility, initially in your home and later outside
• Resuming other normal household activities, such as sitting and standing and climbing stairs
• Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.
• Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving approximately 4 to 6 weeks after surgery.

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Expert Author:
Dr Kevin Yip, Singapore Sports & Orthopaedic Clinic

Total Knee Replacement originally appeared on Singapore Sports & Orthopaedic Clinic and has been republished with permission