Knee Replacement
Total Knee Replacement
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 nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, we are here to help you understand more about this valuable procedure.
Cause
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. Osteoarthritis often results in bone rubbing on bone. Bone spurs are a common feature of this form of arthritis.
Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
How is Surgery performed?
A knee replacement (also called knee arthroplasty) might be more accurately termed as knee “resurfacing” because only the surface of the bones are replaced.
There are four basic steps to a knee replacement procedure:
1. Prepare the bone
The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
2. Position the metal implants
The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
3. Resurface the patella
The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
4. Insert a spacer
A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
You can watch a total knee replacement procedure here
Below you can see some surgical images of Dr Al-Khateeb performing replacement knee surgery on a cadaver leg.
Below is a video of Dr Al-Khateeb performing replacement knee surgery on a cadaver leg.
When is surgery recommended?
There are several reasons why Dr Al-Khateeb may recommend knee replacement surgery. People who benefit from total knee replacement often have:
- Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
- 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 the knee
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
Preparing for Surgery
Before
You will likely be admitted to the hospital on the day of surgery.
Before your procedure, a doctor from the anesthesia department will discuss anesthesia choices with you. You should also have discussed anesthesia choices with your surgeon during your preoperative clinic visits.
Anesthesia options include:
- General anesthesia – you are put to sleep
- Spinal anesthesia – you are awake but your body is numb from the waist down
Mr Al-Khateeb will also see you before surgery and sign your knee to verify the surgical site.
Procedure
If your osteoarthritis has advanced and nonsurgical treatment options are no longer relieving your symptoms, Mr Al-Khateeb may recommend knee replacement surgery.
In order to be a candidate for unicompartmental knee replacement, your arthritis must be limited to one compartment of your knee.
With the proper patient selection, modern knee replacements have demonstrated excellent medium and long-term results in both younger and older patients.
Recovery
Knee replacement is an invasive surgery which will need a longer recovery time than other knee surgery.
After care
At home, you should have someone look after you, at least for the first day.
Try to keep your leg elevated and put ice on it for a day or two to reduce swelling and pain. You’ll also need to change your dressing.
You will be given instructions telling you when to do these things and for how long. You will be given a follow up appointment one week post operatively where you will be reviews and assessed and your progress closely monitored.
Exercise
Mr Al-Khateeb will give you an exercise plan to follow at home to help your knee recover or will recommend a physiotherapist for you to see until you’re able to use your knee normally.
The exercises are necessary to help restore your full range of motion and to strengthen your muscles. With the proper care, your outlook after having this procedure is excellent.
Address
Clemenceau Medical Center Hospital, Dubai