With total knee replacement, significant relief can be achieved and pain will be relieved by severe arthritis and arthrosis. In this article, we will consider how knee arthroplasty is performed.
The first surgical operation was performed in 1968. Since then, surgical materials and methods have been improved, greatly increasing its effectiveness. It is believed that this operation is one of the most successful procedures in all medicine. According to health and quality data, more than 966,000 operations are performed annually in USA.
Preparation for knee arthroplasty
How does knee replacement work? Endoprosthetics can be performed with the patient under local or general anesthesia. Which of these methods is used depends in part on the patient’s state of health, although cardiovascular outcomes, cognitive functions, and mortality associated with regional and general anesthesia have not been proven to a significant degree.
It has been shown that patients with epidural anesthesia develop fewer postoperative deep vein thromboses. Whether this is a generally positive effect for the patient is unknown.
Types of knee prostheses include the following:
- Fixed bearing.
- The medial rod.
- Rotating platform and movable bearing.
- Posterior cruciate ligament.
A preoperative medical examination of a patient includes the following:
- Medical examination – patients must have good cardiovascular health in order to withstand anesthesia and cope with a blood loss of 1000-1500 ml in the postoperative period; standard preoperative electrocardiography (ECG) should be performed on elderly patients.
- Laboratory studies – these include: (1) a complete blood count, (2) erythrocyte sedimentation rate, (3) serum electrolytes, (4) kidney function tests, (5) prothrombin time and activated partial thromboplastin time, (6) urine analysis
- Image research. These include 1) standing front – rearview, 2) side view, 3) patellofemoral view (horizontal), 4) radiographs with legs and 5) standing radiographs of the knee in the extension or at an angle of 45º (Rosenberg view)
Antibiotics and antithrombotic agents.
Antibiotics and antithrombotic prophylaxis are administered approximately 30 minutes before an incision is made. Mechanical antithrombotic devices (e.g. stockings, foot pumps) are used during surgery.
How does knee replacement work?
Knee arthroplasty is a complex procedure that requires an orthopedic surgeon to take accurate measurements and skillfully remove the diseased parts of your bone to form the remaining bone to accommodate the knee implant. During the procedure, the surgeon creates an artificial knee inside your leg, one component at a time, to create a highly realistic artificial joint.
1. Creating a section of the knee joint.
The surgeon makes an incision on the front of your knee to gain access to the patella, often called the patella. With traditional knee replacement, the incision is usually 20 to 25 cm long. With minimally invasive knee surgery, the incision is usually about 10 to 15 cm in length. Doctors still don’t know how much the advantages of a smaller scar outweigh the disadvantages of a smaller surgical area. Talk with your doctor about which procedure is right for you.
2. Rotation of the patella (patella).
The front part of your knee that is exposed is your patella, called the patella. When your knee is open, the surgeon rotates the patella outside the knee area. This allows the surgeon to view the area needed to complete the surgical procedure.
3. Preparation of the thigh (femur).
The first bone your surgeon will open is your femur, commonly known as the thigh. Once the surgeon has opened your knee joint, he or she will carefully measure your bones and make precise cuts using special tools. Damaged bone and cartilage from the end of the femur are cut off. The end of your femur is cut and resumed to fit the first part of the artificial knee, the femoral component.
4. Implantation of the femoral component.
The surgeon attaches the metal femoral component to the end of the femur and uses bone cement to fix it in place.
5. Preparation of the tibia (lower leg).
The next bone your surgeon opens is your tibia or lower leg. The surgeon removes the damaged bone and cartilage from the top of the tibia and then forms the bone in accordance with the metal and plastic components of the tibia.
6. Implantation of the tibial component.
The lower part of the implant, called the tibial tray, is attached to the lower leg and fixed in place using bone cement. After the tray is in place, the surgeon will fix it in a polyethylene (drug-plastic) insert to sit between the tibial tray and the femoral component and act as a kind of buffer. This insert will provide support for your body when you bend your knee.
7. Re-adjustment of the patella.
Before returning the kneecap to its normal position, the surgeon may need to smooth the kneecap and place it with an additional plastic component to ensure a proper fit with the rest of your implant. A plastic part, if necessary, is cemented into the underlying bone.
8. Completion of the procedure.
Your surgeon will bend and bend the knee to make sure the implant is working properly and that alignment, calibration and positioning are appropriate. To complete the procedure, the surgeon will close the incision with stitches or staples, and then bandage it and prepare for recovery.
When you wake up from the operation, you will experience great discomfort and, most likely, there will be fixation to maintain the knee joint. Pain medications will be provided, as well as ongoing monitoring and care. Despite the pain and size of the incision, patients will be lifted and weighed during the first 24 hours under the guidance of professional staff. Home treatment will be needed, and physical therapy is mandatory from day one. The patient usually returns home from the hospital within three to five days, and the remainder of the recovery will take place on an outpatient basis.
Physiotherapy will begin twice a week, both at home and in the office, and up to three months a week. This first step will mainly focus on re-engaging your quadriceps muscles and exploring how your joints feel and function. Pain treatment will be necessary throughout this phase, as physiotherapy sessions are very painful. Working through pain and focusing on a goal is an important step in this period of time. Physiotherapy will mainly focus on restoring the range of motion at this stage.
First 6 months
Physiotherapy is extremely important for recovery after a complete knee replacement surgery. An experienced physiotherapist can do much more for your recovery than any medicine or doctor’s consultation. The process includes rehabilitation of the knee muscles, as well as the surrounding leg muscles and the basic strength of the body. Balance, movement and stability are concentrated at various stages of rehabilitation, and by the end of physical therapy, which is usually about six months after the knee arthroplasty, the knee should be better than new, and the patient is ready to resume a much more active and painless lifestyle. Once the initial two weeks of physiotherapy are done, the focus will shift to strength-strengthening exercises such as leg lifting, resistance exercises,
Each week there will be new goals, and your attention to achieving these goals will be of great importance for the overall speed and totality of your recovery. There will be times when you will be afraid to go to physiotherapy and will consider that the pain is not worth the effort, but keep in mind that the goal is an active healthy lifestyle, and you can cope with the tasks that face you. Painkillers will gradually decrease and finally stop, and addiction will shift to over-the-counter drugs such as ibuprofen.
Although you can be relieved of your doctor’s care and regular physical therapy after six months, two-year follow-ups will also be done to make sure your knee is functioning properly. In addition, it is extremely important to make sure that you continue some of the rehabilitation methods that you learned during physical therapy. Daily exercises should include leg lift, hip exercises, stretching and walking. These exercises are designed to continue and help you maintain strength and ease the wear of your new knee.
After knee arthroplasty is performed, it is important to remember that recovery is actually a lifelong process. The better you take care of the new knee, the longer it will last, and the better your life will be. If at any time after knee surgery you experience swelling or joint pain that does not decrease after applying ice, resting, lifting and squeezing, it is important that you contact your doctor for an examination. Remember that knee replacement can only be done twice in a lifetime, so taking care of your new knee is vital to its longevity.
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