Knee Replacement

Knee Replacement
Knee replacement, or knee arthroplasty, is a common surgical procedure most often

performed to relieve the pain and disability from degenerative arthritis, most commonly
osteoarthritis, but other arthritides as well. Major causes of debilitating pain include meniscus
tears, osteoarthritis, cartilage defects, and ligament tears.
Knee replacement surgery can be performed as a partial or a total knee replacement. In
general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with
metal and plastic components shaped to allow continued motion of the knee.
Indications
Knee replacement surgery is most commonly performed in people with advanced
osteoarthritis. It should be considered when conservative treatments have been exhausted.
Physical therapy has been shown to improve function and may delay or prevent the need for knee
replacement.
Pre-operative Preparation
Knee Arthroplasty is major surgery. Before the surgery is performed, pre-operative tests
are done: usually a complete blood count, electrolytes, APTT and PT to measure blood clotting,
chest X-rays, ECG, and blood cross-matching for possible transfusion. Accurate X-rays of the
affected knee are needed to measure the size of components which will be needed. Medications
such as warfarin and aspirin will be stopped some days before surgery to reduce the amount of
bleeding. Patients may be admitted on the day of surgery if the pre-op work-up is done in the
pre-anesthetic clinic or may come into hospital one or more days before surgery.
Technique
The surgery involves exposure of the front of the knee, with detachment of part of the
quadriceps muscle (vastus medialis) from the patella. The patella is displaced to one side of the
joint allowing exposure of the distal end of the femur and the proximal end of the tibia. The ends
of these bones are then accurately cut to shape using cutting guides oriented to the long axis of
the bones. The cartilages and the anterior cruciate ligament are removed; the posterior cruciate
ligament may also be removed but the collateral ligaments are preserved. Metal components are
then impacted onto the bone or fixed using polymethylmethacrylate (PMMA) cement. A round
ended implant is used for the femur, mimicking the natural shape of the bone. On the tibia the
component is flat, although it often has a stem which goes down inside the bone for further
stability. A flattened or slightly dished high density polyethylene surface is then inserted onto the
tibial component so that the weight is transferred metal to plastic not metal to metal. During the
operation any deformities must be corrected, and the ligaments balanced so that the knee has a
good range of movement and is stable. In some cases the articular surface of the patella is also
removed and replaced by a polyethylene button cemented to the posterior surface of the patella.
In other cases, the patella is replaced unaltered.
Risks and Complications
• Deep Vein Thrombosis
According to the American Academy of Orthopedic Surgeons (AAOS), "blood clots in the leg
veins are the most common complication of knee replacement surgery. Your orthopedic surgeon
will outline a prevention program, which may include periodic elevation of your legs, lower leg
exercises to increase circulation, support stockings and medication to thin your blood."
• Fractures
Periprosthetic fractures are becoming more frequent with the aging patient population and
can occur intraoperatively or postoperatively.
• Loss of Motion
The knee at times may not recover its normal range of motion (0 - 135 degrees usually) after
total knee replacement. Much of this is dependent on pre-operative function. Most patients can
achieve 0 - 110 degrees, but stiffness of the joint can occur. In some situations, manipulation of
the knee under anesthetic is used to improve post operative stiffness. There are also many
implants from manufacturers that are designed to be "high-flex" knees, offering a greater range
of motion.
• Instability
In some patients, the kneecap is unstable post-surgery and dislocates to the outer side of the
knee. This is painful and usually needs to be treated by surgery to realign the kneecap. However
this is quite rare.
In the past, there was a considerable risk of the implant components loosening over time as a
result of wear. As medical technology has improved however, this risk has fallen considerably.
One implant manufacturer claims to have reduced this risk of wear by 79% in fixed-bearing
knees. Another implant manufacturer claims to have reduced the risk of wear by 94% in mobile-
bearing, also known as rotating platform, knees. Knee replacement implants can last up to 20
years in many patients; whether or not they actually survive that long depends largely in part
upon how active the patient is after surgery.

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Knee Replacement

Knee replacement, or knee arthroplasty, is a common surgical procedure most often

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