Chronic articular pathologies are practically not amenable to treatment, moreover, they progress without leaving a person the right to a healthy existence. Endoprosthetics of the knee joint – operations, the essence of which is to replace it with an artificial implant.



Comparison of a healthy knee joint (left) and a completely destroyed (right).

The cartilage that covers the ends of the articular bones cannot be repaired if it is severely destroyed. Intra-articular injections of plasma or hyaluron are a waste of money, nerves, and time.

This is seen by the surgeon during the operation, pay attention to the unevenness, and in some places the absence of the cartilaginous membrane.

Simplified diagram of the implant installation.

The only treatment tactic that gives results is endoprosthetics. The industry produces modernized implants for the requirements of any patient. Artificial structures are created from biocompatible materials such as ceramics, innovative metal alloys and high molecular weight polyethylene, which do not have toxic, allergic  and carcinogenic effects on surrounding structures.



Introduction

The affected joint is examined with highly informative means of visual diagnostics, the patient is referred for laboratory tests , examination by doctors of narrow specialization. Then a decision is made on:

  • method of implantation (total or partial );
  • what material is better for the prosthesis;
  • fixation – cement, cementless or hybrid;
  • type of anesthesia.

Most often, spinal anesthesia is used.

It is not always possible to go through a high-tech quota procedure quickly, you will have to wait for your turn, and this can take 3-6 months, sometimes 12 months.

In the postoperative period, the knee takes longer to recover than the hip. This is due to the fact that the operation is technically more difficult. The postoperative suture is located just in the place of strong stretching of the skin, which also complicates the recovery process because you need to actively work on flexion-extension of the limb.How to Sit Correctly and Safely after Hip Arthroplasty

Indications for surgery

Approximately every tenth patient suffering from knee pathology requires arthroplasty. The following diseases are the cause of critical violations:

A surgical procedure is indicated if the following pathological changes are found:

  • bright painful symptoms and serious movement disorders, in which conservative methods and minimally invasive surgery do not help or no longer make sense;
  • gonarthrosis in severe manifestation;
  • systemic arthritic disease;
  • avascular necrosis of the articular bones;
  • local neoplasms;
  • congenital and acquired dysplasia ;
  • incorrectly fused fractures;
  • post-traumatic degeneration.

The dynamics of the disease on x-ray.

Postponing surgery for grade 3-4 gonarthrosis is fraught with spinal deformity. This is due to lameness . The degenerative processes of arthrosis will deeply affect the bones, because of which they become fragile, lose their density and it will become difficult to fix the components of the implant to them.Arthroscopy of the knee joint for meniscus injury: description of methods and techniques


Contraindications

It is allowed to carry out even in old age. But in the presence of any pathologies in the stage of decompensation, for example, diabetes mellitus  or hypertension, the surgery will be canceled. Any infectious inflammatory foci in the body must be completely eliminated before the scheduled procedure. General list of contraindications:

  • decompensated chronic diseases;
  • local and general infections, inflammatory processes;
  • anemia 2-3 tbsp., low blood clotting;
  • severe mental disorders;
  • uncontrolled diabetes;
  • bone tuberculosis;
  • limb paralysis;
  • deep vein thrombosis of the legs.

Sometimes it is necessary to carry out weight correction , if the body mass index is too high, it is dangerous for injuries and displacement of the implant. Disability after treatment is not provided.

Preparing for surgery

The most common type of knee implant.

Diagnostics is not limited to examining only the diseased limb, both legs are subject to examination. For these purposes, it is recommended to pass:

  • radiography;
  • ultrasound examination (ultrasound);
  • magnetic resonance imaging (MRI);
  • arthroscopy (not always).

The implant platform has served the patient for 16 years. Good result.

A bypass of highly specialized doctors (cardiologist, therapist, immunologist, anesthesiologist, ENT, dentist), general clinical tests, examination of organs and body systems is carried out. Standard diagnostics include:

  • general and biochemical blood tests;
  • coagulogram;
  • general urine analysis;
  • determination of blood sugar levels;
  • blood group and Rh factor test;
  • ultrasound dopplerography of the veins of the extremities (USDG);
  • electrocardiogram (ECG);
  • fibrogastroduodenoscopy (FGDS);
  • fluorography of the respiratory system.

Blood will also be taken for transfusion.

In clinics for knee arthroplasty, preparation begins approximately 2 weeks before the upcoming session. Physical therapy is definitely recommended. It will help prepare the muscle complex for rehabilitation, will help to strengthen it. Especially with the proposed surgery of both knee joints.Knee arthritis: what is it, symptoms, methods of diagnosis and treatment

Types of prostheses and related techniques

You already know that there is a complete and partial arthroplasty of the knee, where in the first case, treatment involves a full replacement of the articular surfaces, and in the second – the implantation of the damaged area of ​​one of the condyles. Accordingly, prostheses are classified into total, single-condom and revision for implant replacement.

  1. After setting up the unipolar system , the own osteochondral segment is preserved as much as possible and the ligaments are not affected, by the way, they must be in good condition.

    Single-sided joint replacement on x-ray.

  2. If total arthroplasty was performed, rehabilitation will require persistent, continuous, long-term work on recovery. Leading clinics for surgery and knee arthroplasty are much more often approved of this treatment. This is explained by the fact that it allows you to achieve a normal range of motion, gives you more freedom in terms of physical activity and has a fairly long-term effect.
  3. In revision arthroplasty – replacement of an endoprosthesis, constructions with longer legs are mainly used to ensure reliable stability. The revealed defects of the thigh and lower leg are eliminated with the help of metal plates of various configurations, bone chips, cement, allo- and auto-bone grafts, wedges, rods, etc. It is necessary when the implant is worn out, damaged or initially incorrectly performed.

    With each subsequent operation, the success statistics are lower. At the same time, implants are becoming more and more cumbersome.

Single-condylar prosthetics implies a maximum lifespan of a non-biological device of 7 years. Total replacement provides for the service life of the implanted mechanism from 15 years. Revision is more difficult to tolerate, and the risk of infection and other negative phenomena is almost 2 times higher than after the primary operation.



Liquid Knee Replacement

It is also important to briefly give information on liquid knee replacement . These are injectable sodium hyaluronate preparations that serve to replenish synovial fluid. Liquid knee replacement is performed by injecting a solution of hyaluronic acid into the intra-articular space through a syringe. Such treatment tactics do not restore the destroyed hyaline cartilage, but they help to temporarily reduce the signs of osteoarthritis  (reduce stiffness and pain) by improving the lubricating properties of the natural joint. It is applicable as a symptomatic therapy for arthrosis, but there is no alternative to real arthroplasty.

No injections can cure arthrosis!

Description of the surgical process

The type of anesthesia is determined by the anesthesiologist. What does general anesthesia mean , we think everyone knows. And regarding the second type, rather, not everyone understands the essence and principle of action of anesthesia, let’s make it clear.

Epidural anesthesia is one type of regional anesthesia, the meaning of which is to supply it to the epidural space of the spine (in the lumbar region) through a catheter of a special composition that blocks the transmission of impulses from the nerve plexuses of the spinal cord. The lower body becomes insensitive. The person does not feel any pain at all, but remains conscious. It is possible that the anesthesiologist will additionally connect the intravenous system, which delivers an effective sedative drug, in order to relieve nervous tension or immerse in a deep medication sleep.

The easier the anesthesia, the easier it is for everyone, the patient, the traumatologist and the anesthesiologist.

When the anesthetic “works”, total knee replacement begins.

  1. The joint is accessed from the front of the knee by dissecting the soft tissue, bypassing the patella. The incision is small, it is approximately 12-14 cm.
  2. It is gently released from the anatomical space.
  3. Since the total knee joint prosthesis has a complex geometry, the surgeon performs several high-precision cuts of the femur and tibia to ensure correct fit.
  4. After that, a “blank” of different sizes is placed to select the best.
  5. After making sure that the bones are prepared correctly, the specialist proceeds to install the permanent parts of the prosthesis in their final place.
  6. At the end, the area within which the operating actions were performed is washed with an antiseptic liquid. Then a temporary drainage system is inserted into the wound to drain the wound discharge, the incision is sutured and covered with a sterile bandage.

The patient is lying on the operating table, his leg is bandaged, the operation will begin now.

After being discharged from the hospital, you should apply for a treatment and rehabilitation center. In such medical institutions, they provide highly competent assistance after total cement knee arthroplasty or cementless, partial prosthetics and revision intervention.How to sleep properly after hip replacement surgery


Adverse reactions

No less depends on the work of rehabilitators than on the work of a surgeon.

The patient must be under the close supervision of methodologists-rehabilitation therapists in the postoperative period, fulfill all their requirements regarding physical exercise and attendance at physiotherapy procedures, and also come for a scheduled examination to the main attending physician on time. Only in this case, by the end of the 3rd month, you can count on a successful outcome.

By the condition of the seam, one can judge the healing processes inside the joint. You see a calm, well-healing suture

After 6 months it will look like the photo

Possible intraoperative consequences include bleeding, which occurs in isolated cases. Significant blood loss is promptly replenished with a donor blood supply, prepared before the operation. Infection and an allergic response to anesthesia are also unlikely if the installation is carried out in compliance with all regulations. During the first month after the arthroplasty  , the following complications are encountered (the probability is low, but present):

  • paraprosthetic infection ;
  • thrombus formation in the venous bed of the limb;
  • thromboembolism;
  • fat embolism;
  • divergence of sutures and opening of a wound;
  • dislocation of the prosthesis, displacement of the patella;
  • violation of sensitivity in the knee area;
  • an increase in local and general temperature due to local inflammation or infection.

Pathological reactions that develop in the long-term (after 4 weeks and later):

  • loosening, displacement, instability of artificial components;
  • fracture of the prosthesis or bone into which it is inserted;
  • the formation of rough growths, scars around the device;
  • joint-muscle contracture ;
  • chronic pain;
  • change in limb length .



Categories: Knee joint

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