Total Knee Replacement - Knee Arthroplasty
Arthritis causes joint pain, stiffness, and swelling. It can affect the cartilage in the knee joint. Cartilage is a very tough, shock absorbing material that covers the ends of many of our bones. The cartilage forms a smooth surface and allows the bones in our joints to glide easily during motion. Arthritis can cause the cartilage to wear away. Loss of the protective lining can cause painful bone on bone rubbing.
While the symptoms of knee arthritis may be tolerated with some medications and lifestyle adjustments, for many, knee replacement is the only way to reduce pain, restore function, and improve the quality of life. Knee Replacement Surgery, also called Knee Arthroplasty, involves removing the damaged portion of the knee and replacing it with artificial implants called prosthetics. Knee Arthroplasties are the most common type of joint replacement surgery. They are highly successful for relieving pain and restoring joint function.
Two cartilage disks, called menisci, are located on the end of the tibia. The cartilage forms a smooth surface and allows our bones to glide easily during motion. The menisci also act as shock absorbers when we walk or run.
A thin smooth tissue capsule covers the bones in our knee joint. A thin synovial membrane lines the capsule. The synovium secretes a thick liquid called synovial fluid. The synovial fluid acts as a cushion and lubricant between the joints, allowing us to perform smooth and painless motions.
Osteoarthritis is the most common type of arthritis. It tends to develop as people grow older. Osteoarthritis can result from overuse of the knee during sports or work. Osteoarthritis causes the articular cartilage covering the end of the bones to gradually wear away, resulting in painful bone on bone rubbing and disrupted movement.
Post-Traumatic Arthritis can develop in individuals of all ages after a serious knee injury. A knee fracture or severe torn ligaments can damage the cartilage over time. This can cause knee pain and limit function.
It may be difficult to move or bend your knee. Your knee pain may eventually limit your everyday activities, including walking, stair climbing, and getting in and out of chairs. Medications, rest, and physical therapy may provide little relief from the pain of severe knee arthritis.
Your doctor will order X-rays to see the condition of your bones and to identify areas of arthritis. Your doctor may order Magnetic Resonance Imaging (MRI) scans or a bone scan. A MRI is used to obtain more detailed images of the ligaments and cartilage. A bone scan identifies the location of abnormal growths in a bone. A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test. The substance collects in your bones in areas where the bone is breaking down or repairing itself. X-ray, MRI, and bone scans are painless.
Knee Arthroplasty involves removing your damaged joint and replacing it with an artificial one. This is an inpatient procedure. You will most likely be admitted to the hospital on the day of your Arthroplasty and stay there for several days. In most cases, you will be required to donate your own blood prior to the surgery so you can be transfused during or after the procedure, if necessary.
The most common types of anesthesia for the surgery are general anesthesia or spinal anesthesia. The general anesthesia will put you to sleep for the procedure. The spinal anesthesia will numb your body from the waist down, while you remain awake. Additional sedation is usually given. Your doctor will help you decide which anesthesia is best for you.
Your knee will be placed in a bent position for your surgery. Your surgeon will make a six to twelve inch incision on the side of your patella (kneecap). Your patella and thigh muscles will be moved aside to allow your surgeon access to your joint. Your surgeon will remove your damaged bone, cartilage, and connective tissue. Your knee joint will be replaced with an artificial joint.
There are many types of artificial knee joints. Your surgeon will choose the most appropriate one for you, depending on your age, weight, activity level, and overall health. Nearly all of them consist of three components. The new piece for the end of your femur is made of highly polished metal. The tibial component, for the top of your leg, is made of metal and plastic. The patellar part is made of plastic and fits inside of your kneecap. The artificial pieces may or may not be cemented in place. The artificial joint will allow you to perform most of the pain-free movements that you used to be able to do.
Physical therapy will begin immediately after your surgery. Your physical therapists will show you exercises to do in bed to help strengthen your knee and increase its flexibility. Your physical therapist will help you stand and walk. Walking and knee movements are very important to your recovery. At first, you will need to use a walker or crutches while standing and walking.
As you recover, you will learn ways to exercise to strengthen your knee and improve your endurance. This may include using exercise equipment, such as a treadmill or a stationary bike. Your physical therapist will provide you with a home exercise program. When your incisions are healed you may perform physical therapy exercises in a heated therapeutic pool. The heat may help to relieve pain and stiffness, while the water provides you with support while exercising your joints. It is important to keep the muscles around your knee joint strong.
An occupational therapist can show you ways to dress and bathe within the realm of your initial movement restrictions. Your therapists can recommend durable medical equipment for your home, such as a raised toilet seat or a shower chair. The equipment may make it easier for you to take care of yourself as you heal.
Your doctor may prescribe blood thinning medication and special support stockings. You should keep your leg elevated and move or pump your foot and ankle. Your doctor may prescribe compression boots and a Continuous Passive Motion (CPM) Machine. Compression boots are inflatable leg coverings that are attached to a machine. They work to gently squeeze your legs to aid blood circulation. A Continuous Passive Motion (CPM) Machine will move your leg in a cycling motion while you are in bed. The CPM Machine is helpful to improve circulation, decrease swelling, and restore movement in your knee.
The success of your surgery will depend, in part, on how well you follow your home care instructions during the first few weeks following surgery. You may need a little help from another person during the first few days at home. If you do not have family members or a friend nearby, talk to your physician about possible alternative arrangements. You should be able to resume most of your regular activities in three to six weeks after your procedure. You should notice a steady improvement in your strength and endurance over the next six to twelve months. Overall, the majority of people experience a dramatic reduction of knee pain and the ability to resume functional activities after Knee Arthroplasty.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.