Knee Replacement Surgery for Treatment of Severe Arthritis

Knee Arthritis

The word arthritis means inflammation of the joint. Most people think of arthritis as the wearing away of cartilage in a joint—this is the end result of inflammation within the joint. Over time, the inflammation can lead to cartilage loss and exposed bone, instead of a normal, smooth joint surface.

The most common type of knee arthritis is osteoarthritis. This is often referred to as "wear-and-tear" arthritis, and it results in the wearing away of the normally smooth cartilage until bare bone is exposed. Other types of arthritis include rheumatoid arthritis, gouty arthritis, and lupus arthritis.

Time to Have Replacement

Knee replacement surgery is a procedure that is performed when the knee joint has reached a point when painful symptoms can no longer be controlled with non-operative treatments. In a knee replacement procedure, your surgeon removes the damaged joint surface and replaces it with a metal and plastic implant.

A total knee replacement is a major surgery, and deciding to have the surgery done is a big decision. Here are some signs to look for to help you decide if the time is right (or not right) for knee replacement surgery. The most common question that I hear from people considering knee replacement is that they do not know how to tell if they have reached the point where they should consider surgery. There are some simple questions they can help you determine if knee replacement might be the right step for you to take.

Alternatives to Replacement

Treatment should begin with the most basic options and progress to the more involved, which may include surgery. Not all treatments are appropriate for every patient.

Knee replacement is generally reserved for patients who have tried all of the other treatments and are still left with significant pain during normal activities. Patients who have occasional pain, are able to participate in athletic activities, or have not tried non-operative treatments are probably not ready for a knee replacement. Non-operative treatment options include:

• Weight Loss
• Activity Modifications
• Anti-Inflammatory Medications
• Joint Supplements
• Cortisone Injections
• Hyaluronic Acid (e.g. Synvisc) Injections

None everyone will have a great response to nonsurgical treatment, but many people can address their knee arthritis with nonsurgical treatments, especially in the earlier stages. While it may be attempting to proceed directly to a surgical solution, some simple treatments should be attempted before considering a major surgical procedure such as a knee replacement.

Implant Types

Knee replacement surgery removes the damaged joint lining and replaces the joint surfaces with a metal and plastic implant that functions similar to a normal knee. These implants will wear out over time, and knee replacements are done infrequently in younger patients because of the concern of the implant wearing out too quickly.

Knee replacement implants have been modified in order to provide the best possible functioning with long-lasting results. This effort to perfect knee replacement implants is constantly taking place. Some newer implants have promise, others may not turn out to be better.

• Partial Knee Replacements
• Rotating Knee Replacements
• Gender Specific Knee Replacements
• Custom Knee Replacements

Some people will benefit from a specific type of knee replacement or they may need specialized implants to address a particular deformity or instability of the knee joint. However, for the vast majority of people undergoing knee replacement, many companies will make a suitable implant. Talk to your surgeon if you have specific questions about the implant that they may recommend for your particular situation.

Steps

When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create surfaces that can accommodate the implant perfectly. A metal and plastic knee replacement implant are then placed in to function as a new knee joint. Depending on the condition of the cartilage underneath the kneecap, the kneecap surface may also be replaced.

Risks

Knee replacement surgery has become quite common, but there are still risks. Fortunately, well over 90% of patients who undergo knee replacement surgery have good results.

You should have a thoughtful discussion with your doctor prior to total knee replacement surgery and make sure to have your questions answered.

You must understand the potential risks:

• Blood Clots
• Blood Loss
• Infection of a Knee Replacement
• Stiffness of the Knee Replacement

While complications following knee replacement surgery are unusual, they can occur. By knowing the complications, and importantly the signs of potential complications, you can help make sure any issues are addressed early, and before returning to more serious problems.

Knee Rehabilitation

Knee replacement surgery is very successful, but the success of the procedure is partly due to the rehabilitation period that follows the surgery. For patients to expect a good result from knee replacement surgery, they must be an active rehab participant.

Rehabilitation after knee replacement begins immediately. Patients will work with a physical therapist as soon as the surgical procedure has been performed. The emphasis in the early stages of rehab is to maintain motion of the knee replacement and to ensure that the patient can walk safely. The body reacts to surgery by making scar tissue, and patients may never recover normal motion if they do not focus on bending and straightening their knee replacement.