Total knee replacement
What is the knee joint and what are its parts?
The knee is the largest and most complex joint in our body, which performs rolling and rotational movements of moderate degree during operation. It plays an essential role in movement when carrying weight in the horizontal (running and walking) and vertical (jumping) directions.
It actually consists of two real (femur and tibia, femur and kneecap) and one non-real joint (the end of the tibia and fibula near the knee). The meniscus (C-shaped elastic fibrous cartilage) is located between the articular surfaces (hard hyaline cartilage) of the femur and tibia, which reduces the shape difference of continuously changing surfaces during movement due to their elastic properties.
When is knee replacement surgery needed?
Since we use our knee every day, almost every minute, it is at risk of wear and accidents. If your knees are so worn out or you have an accident so severe that the damage is irreversible, in many cases only implanting a full knee replacement can help.
What affects our knees?
- Degenerative changes due to wear (in old age)
- Arthritis, alone or as part of rheumatoid arthritis
- Axial abnormalities (X-feet, O-feet), cartilage damage caused by frequent kneecap sprains
- Knee changes (instability, joint fractures, etc.) as a result of accident
Based on these, if, despite conservative treatment, walking causes pain in everyday life, or you can no longer sleep through the night because of pain, an orthopaedic specialist examination is needed, based on which your treating physician can decide what surgical treatment you may need, which may include the implantation of a knee prosthesis.
Which knee replacement surgery do we perform?
In our hospital, we perform primary total knee replacement surgery based on indication confirmed by preliminary examinations. During this process, our knee specialist orthopaedic surgeons replace the worn joint surfaces of the knee with an artificial prosthesis. This allows almost complete original stable movement of the knee.
How is knee replacement surgery performed?
At our hospital, the procedure is performed under regional (i.e. spinal) or general anaesthesia. The type of anaesthesia is decided by your doctor depending on your medical condition.
Knee replacement surgery is performed with a special bleeding cuff placed on the thigh to minimize blood loss. After proper anaesthesia, an approximately 20-centimeter incision is made above the kneecap, through which the surgeon exposes the joint. Worn cartilage surfaces are removed and templates are used to create the location of the knee prosthesis.
By inserting a test prosthesis, we check the stability and the range of motion.
Metal components of a predetermined size are glued with special antibiotic bone cement, between which a plastic lining is inserted to ensure proper movement and friction. Depending on the condition of the kneecap, a plastic “button” may also be used to replace the articular surface of the kneecap. If the movement and stability of the final components are adequate, thorough haemostasis is performed and then the tissues are layered over a drain tube to remove any haematoma that may form. A sterile dressing and elastic bandage are then applied.
What preparations are needed before the surgery?
To select the right knee prosthesis, functional X-rays, and in some cases CT scans, are required.
There is a risk of infection during knee replacement surgery, so a fuller examination is needed to prevent this:
- In addition to routine laboratory tests, pharyngeal and urine cultures are required prior to surgery.
- After the most careful haemostasis following surgery, blood transfusions may be necessary, so a blood type test and antibody screening is performed, based on which we always provide blood products for knee replacement surgery in our hospital, so that it could be available if needed.
What to do after knee replacement surgery?
One of the most important parts of postoperative knee replacement surgery is rehabilitation and early functional treatment of the knee.
To do this, it is extremely important to reduce postoperative pain, which is performed in the immediate postoperative period with a so-called EDA (EpiDural Anesthesia) cannula, which can be used to significantly reduce pain with an aesthetic placed in the epidural space.
Additionally, on the day after the knee replacement surgery, the drain is removed and physiotherapy treatment begins, which includes exercises that relieve the knee, assistive device mobilization, and CPM treatment, i.e. machine-controlled passive movement of the knee.
This happens every day of the postoperative period, and after 3-4 days you can leave our hospital and continue rehabilitation at home, with a complete physiotherapy program. Learning and doing gymnastic exercises regularly is very important to achieve painless movements as soon as possible.
It is extremely important for a good end result that you work properly with your physiotherapist, start and do physiotherapy on time to avoid joint mobility limitations and other problems.
What are the advantages of implanting a knee prosthesis?
- As a result knee replacement, your pain is expected to ease or even completely eliminated.
- The movement of the joint (in addition to the regular specific physiotherapy after the surgery) is significantly improved, the previous possible limping gait is eliminated.
- In this way, those who have undergone surgery can live a fuller life again, play sports with certain restrictions, thus live a healthier life, and also leave the painkillers they take regularly.
What are the risks of the intervention?
All interventions thus knee replacement surgery also involve risks. Despite the most careful examination, unexpected complications may occur. Therefore, an extremely thorough examination is necessary, during which we recommend postponing the operation in all cases that would put you at increased risk.
- The greatest risk is a wound infection, which can be mild (redness, wound healing disorder, etc.) as well as a severe, deep infection of the bone tissue. Diabetics, overweight patients, those on steroid treatment are at particular risk.
- Thrombosis (abnormal blood clots) can also occur, which can be associated with any surgery. Patients with varicose veins of the lower extremities and those who have previously undergone thrombosis or obese patients are particularly exposed to risk. To avoid this, we will give you anticoagulant injections for about six weeks, which will minimize the likelihood of developing thrombosis.
- Fractures of the affected bones may occur during or after knee replacement surgery. In this case, it may be necessary to extend the operation, to insert suitable new metal materials (implants), and to walk straining the leg only later than planned. The risk of this complication is especially possible in case of patients with osteoporosis.
- Blood vessels and nerves run in the area to be operated on, so very rarely, but damage to these formulas can also occur.
- After the implantation of a knee prosthesis, there may be a degree of haematoma that needs to be emptied with another surgery to prevent later infection. Therefore, blood transfusions may be necessary.
Am I suitable for knee replacement surgery?
In each case, your doctor will decide, based on preliminary tests, what the risks are. An anaesthesiologist is also consulted to determine the risk more accurately. The results of the tests and consultation with the anaesthesiologist are crucial.