Knee replacement surgery

Total knee arthroplasty (total knee replacement) is the process of replacing the joint surfaces of severely damaged joint structures in cases of advanced knee disease (osteoarthritis, rheumatoid arthritis, traumatic arthritis). The procedure consists of the removal of damaged bone and cartilage of the femur, tibia and patella and their respective replacement with an artificial joint (called prosthesis). In order to obtain an indication for knee arthroplasty, an orthopedic specialist will, by clinical exam, determine the range of motion and stability of the knee. With additional radiological imaging studies (such as X-Ray or MRI) the extent of knee damage will be determined and the best decision for the therapy of each patient will be made. According to the degree and localization of knee damage, but also based on the information gathered through patient history and clinical exam, the orthopedics specialist will choose between total knee arthroplasty (the replacement of all of the joint surfaces of the knee) and unicompartmental knee arthroplasty, a procedure where only one part of the knee joint gets replaced (the internal, outer or anterior portion of the knee).

Total knee arthroplasty (TKA)

Total knee replacement surgery is the procedure of replacing damaged knee structures with artificial implants. It is mainly indicated to relieve the pain and increase range of motion in a patient with osteoarthritis. In advanced cases of arthritis, where the cartilage of all the parts of the knee has been completely damaged, the joint surfaces become uneven and the underlying bone starts making contact with bone. This is what causes pain, swelling, instability, misalignment of the mechanical axis and decreased range of motion, in which case it is necessary to replace all the joint surfaces of the knee, i.e., undergo total knee arthroplasty. In the hospital we do total knee arthroplasty with the help of cutting-edge computer navigation, which makes the knee replacement surgery precise and increases the functionality and duration span of the prosthesis itself.



What are the reasons for surgery?

The main reason for total knee arthroplasty is to relieve the pain caused by knee osteoarthritis. Other issues that a patient with osteoarthritis of the knee may have, and that lead to surgery are: problems with walking (limping, decreased walking distance, walking up and down the stairs), with range of motion and problems with normal daily activities such as standing up from bed or a chair. Many patients in advanced stage of the disease also have pain at rest.

Do you think you’re a candidate for total knee arthroplasty? Contact us and book your appointment with one of our experts.

Anatomy

• Femur- thigh bone
• Patella - kneecap
• Tibia- shin bone
• Fibula - smaller bone of the lower leg
• Cartilage- tissue that covers the bone on joint surfaces and reduces friction during movement of the joint
• Ligaments - strong, elastic connective tissue that surrounds the joint and gives stability to it
• Menisci - rounded cartilaginous structures of the joint that function as shock absorbers. They absorb the load, increase the contact between joint surfaces etc.
• Muscles - serve to dynamically stabilize the joint

Risks of the surgery

Total knee arthroplasty, as with any other surgery, has its own risks. The most serious undesirable event after surgery, even though very rare, is infection of the prosthesis.

Other risks, related to the prosthesis itself, include:

• loosening of the components
• fracture of bones around the prosthesis
• persistent pain around the knee

Other, even less frequent risks of the surgery include:

• nerve damage
• thrombosis of the veins of the leg and of the lungs
• heart attack or stroke

How long will my replacement last?

In everyday loading of the prosthetic joint, pressure is put on its materials which wear down over time. The greater the load on the joint, the more it wears down, therefore increased body weight and inappropriate physical activity may speed up the weathering process of the joint. Studies have shown that 80% of prostheses have a duration of more than 20 years, while 90% have a duration of 15 years.

What can you expect?

Before the surgery

What can you do before your appointment with the orthopedic surgeon?

• Undergo radiological imaging procedures (X-ray imaging of the painful knee, standing, in two projections)
• Prepare the answers for the orthopedic surgeon’s questions, which include:
  • Tell me your symptoms, how long do they last, when have they started?
  • On a scale from 0 to 10 how much pain do you feel at rest and how much when moving?
  • Are there activities that increase your pain? Do you feel pain at night?
  • Have you had any knee injuries so far?
  • Do you take any medications or supplements?
  • Do you have any other medical conditions?
• Prepare questions for your orthopedic surgeon
  

Orthopedic specialist examination

In order to establish an indication for total knee replacement, the orthopedic specialist will, with his clinical exam, determine the range of motion and stability of your knee. Radiological imaging (X-Ray) is also necessary to complete the indication for surgery, and it is preferable to do it before your appointment. After the clinical exam, the orthopedic specialist will decide whether there is a need for additional imaging (panoramic X-ray of the lower limbs) for preoperative planning.

Preanesthetic assessment

After the indication for surgery and the date of the surgery have been set, it is necessary to book an appointment with the anesthesiologist, who will choose the type of anesthesia.

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Arrival at the hospital

Upon arrival at the hospital the patient is accommodated in the room and gets an informed consent form with all the relevant information about the surgery. The patient signs it and then gets ready for surgery. Each patient will get an antibiotic before, during and after the surgery, in order to prevent postoperative infections.

During the surgery

The orthopedic specialist will make a 15-20 cm incision on the knee, successively he will remove all the damaged parts of the joint, bony spurs (osteophytes) and will shape all the bony parts and get them ready for the placement of the prosthesis. The final size of the prosthesis will be determined during surgery and stability and function of the artificial knee will be tested with test pieces. After the prosthesis is placed, all the tissues previously cut will be sutured in layers and the skin will be closed either with sutures or with a stapler. Surgery itself lasts around 2 hours. The sutured wound is then covered with a plaster and bandages, the patient gets then transferred to the ward.

During surgery the patient is either in general or in spinal anesthesia, which is decided by the anesthesiologist. The patient in general anesthesia is unconscious and wakes up after the surgery. In spinal anesthesia, on the other hand, the patient is awake, but does not feel pain from the waist down.

After the surgery

After surgery is done, the patient is moved to the ward where he stays for a few (3-5) days. Our anesthesiologists will take care of the pain treatment after the surgery. During your stay in the hospital, our doctors and nurses take care of the dressing of the surgical wound, while our physical therapists will carry out physical therapy in order to maximize as soon as possible the range of motion of the replaced knee, but also to educate you about how to perform certain movements, such as:

• getting in and out of bed
• sitting down and standing up from a chair
• walking with crutches and walking frames
• walking up and down the stairs etc.

After leaving the hospital it is advisable to continue rehabilitation in our Center for Physical Medicine & Rehabilitation and in therapeutic springs. In order to assure a faster and more effective recovery, it is important to follow the instructions on wound dressing, diet, physical activity etc.

The check-ups, their frequency and additional postoperative radiological imaging will be indicated by the orthopedic surgeon.

Regular check-ups are extremely important, therefore don’t delay your check-up and book your appointment.

Results

For most patients, total knee arthroplasty relieves the patient from pain, it improves the mobility and quality of life of patients with osteoarthritis of the knee. Studies have shown that 80% of prostheses have a duration of more than 20 years, while 90% last more than 15 years. Recently, arthroplasty with prostheses of the knee that have a fit which corresponds more to the normal anatomy of the joint, has been implemented. These prostheses allow for a greater range of motion, and recently these have started to be implanted in our Hospital.

Most of the patients return to normal activity 2 months after the surgery. It is suggested to do activities which don’t put large stress and load on the joint, such as walking, riding a bike, swimming, but it is also advised to avoid activities such as running, skiing, jumping, i.e., activities that might overload the knee joint and shorten the duration span of the knee prosthesis. You can talk more about the limitations and daily activities with your orthopedic specialist.

Be one of those who successfully returned to their everyday activities and eased all their discomforts. Contact us with confidence!