Knee replacement

Overview:

A Knee replacement surgery refers to a surgical procedure to substitute a knee damaged by arthritis. Different types of arthritis that impact the knee include osteoarthritis, which is a degenerative joint disorder; rheumatoid arthritis, which is an inflammatory type of joint disorder; and traumatic arthritis, which occurs due to an injury. Knee replacement surgery is alternatively termed as Knee arthroplasty or Total knee replacement surgery. 

The knee replacement surgery aims to rectify the parts of the damaged knee joint and relieve the knee pain that other treatments cannot control. This surgery is generally preferred for individuals with severely damaged knees/joints that different management strategies cannot treat. The bones that form the joint are capped by metal and plastic parts along with the kneecap. 

Indications: 

The major reason for knee replacement surgery is to reduce the pain caused by arthritis. Clinical indications include joint pain, stiffness, limited range of motion, and swelling. Disease conditions like osteoarthritis and rheumatoid arthritis also require knee replacement surgeries. 

Knee injuries due to trauma falls and contact sports are some indications for knee replacement surgery. 

Types of knee replacement surgeries:

Presently, there are two types of knee replacement surgeries i.e., total knee replacement surgeries, where all three areas of the knee joint are replaced, and partial knee replacement surgeries, where only some areas of the joint are replaced and resurfaced. Partial knee replacements are generally indicated in young individuals who have undergone a recent trauma or injury. 

A knee is generally replaced with a prosthesis made of metal or plastic. It has three components:

• The tibial part replaces the top of the tibia or shin.
• The femoral part replaces the thighbone.
• The patellar part replaces the kneecap.

These prostheses can be cemented or uncemented. Cemented prostheses attach to the bone with surgical cement, and uncemented prostheses attach to a porous surface on which the bone grows. 

Before knee replacement procedure:

Before undergoing a knee replacement procedure, an individual should get a surgical profile done, including blood tests, urine tests, an Electrocardiogram (ECG), and a few imaging studies (Chest x-ray, computed tomography, or Magnetic resonance Imaging) along with physical examination. This helps healthcare professionals (HCPs) to understand the functioning of other organs, gives information about general health status, and helps them to identify any factors that may interfere with bone healing, like diabetes or any infections. An Electrocardiogram may be needed to check the electrical activity of the heart, as well as a chest x-ray may be necessary to check the functioning of the lungs. 

Imaging studies of the bones/joints, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), are needed to visualize the bones and joints. A detailed history of past surgeries, disease conditions, and any medications being taken should be informed before the surgery. Certain drugs like blood thinners might have to be stopped before surgeries, and other medications that an HCP finds necessary might have to be taken. Knee replacement surgeries are done on an empty stomach. Hence, stopping eating or drinking at least 12 hours before surgery is better. 

During the knee replacement surgery:

The knee replacement surgery is generally done in a hospital under general anesthesia. An intravenous line is placed on the arm for giving medications, and a urinary catheter will also be placed. Post cleaning the surgical site with an antiseptic solution, an cut is made in the knee portion; damaged knee surfaces will be removed and resurfaced. A new prosthesis made of metal or plastic will be added. Based on the requirement, cemented or uncemented prostheses can be used. Stitches or surgical staples are used to close the area, a drain is placed to remove fluid, and a sterile bandage dressing is given. 

Recovery from Knee replacement surgery:

Knee replacement surgery generally takes an hour or two. After the surgery, the individual will be monitored continuously for emergencies until the vitals are stabilized. A physical therapist will give a detailed plan on the exercises to be done in the hospital and after discharge at home. 

After a knee replacement surgery, one can be involved in low-impact activities like walking, swimming, and biking. However, it is better to consult an HCP to be engaged in high-impact activities like sports or jumping. 

Risks and complications:

Risks associated with knee replacement surgery are mainly due to the surgery, but they may vary depending on the individual's health condition. Risks include bleeding, infections, blood clots in the legs or lungs, fractures, wearing out of the prosthesis, weakness, and failure due to continued pain or stiffness. Prosthetic failures include loosened or dislodged prostheses. 

The success of Knee replacement surgery:

The success of the surgery can be assessed by reduced pain, increased joint movements, and better quality of the joint. Most of the surgeries last for about 15 to 20 years. 

Conclusion: 

Knee replacement surgery significantly improves the way of life for patients suffering from severe knee pain as well as mobility issues due to various forms of arthritis or injury. This surgical procedure involves replacing the damaged components of the knee joint with durable prosthetic parts, aiming to restore function and decrease pain. As medical technology as well as surgical techniques continue to advance, knee replacement remains a highly effective solution for many patients, enabling them to take part in everyday activities with less discomfort and more excellent range of motion.