Knee Replacement Surgery
If physical therapy or medication has not been effective for knee arthritis, the only solution is knee replacement surgery. As with all surgeries, anesthesia is necessary. Anesthesia is applied by numbing the lower half of the patient's body. This is called epidural or spinal anesthesia.
Access to the knee joint is obtained by a cut made in the front of the knee. The worn cartilage tissue and the thin layer of bone that make up the surfaces of the three bones (femur, tibia, and patella) that form the joint are removed by cutting, and then the prosthetic, which has been selected in appropriate sizes for the patient, is placed on the prepared bone surfaces using a filler substance called bone cement (polymethyl methacrylate).
Who Is a Candidate for Knee Replacement?
Knee replacements may not be the best treatment option for every patient. Therefore, the patient's history is thoroughly examined by the doctor when making surgical decisions. However, the patient's age, lifestyle, and mobility are also important factors in determining whether or not to perform surgery. While non-surgical treatments or alternative approaches may be used depending on the patient's complaints, surgery is not usually the first choice. However, in cases where the patient cannot get rid of their pain and their mobility cannot be prevented by methods such as medication and physical therapy, the most effective method is knee replacement surgery.
When Is Knee Replacement Necessary?
Arthritis occurs in the knee joint due to various reasons. This is also referred to as knee osteoarthritis. Most knee arthritis occurs naturally with age. Being overweight increases degeneration. Degeneration can also occur due to causes such as fractures, meniscus injuries and surgeries, rheumatic diseases, infectious diseases, and traumatic cartilage damage in the knee joint. Knee replacement surgery is performed on patients whose joints have been severely damaged by all these conditions. If there is an active infection in the patient's knee, knee replacement surgery is not performed.
Does Knee Replacement Have a Lifespan?
The metal and plastic parts that make up a total knee replacement begin to wear down due to friction caused by movement. With the use of proper surgical techniques and advancements in prosthesis designs through modern technology, the lifespan of knee replacements has been extended to 15-20 years. If the knee replacement becomes dislodged, a new one can be placed with a second surgery. However, the lifespan of the second prosthesis will not be as long as the first one. To prevent problems such as wear and dislodgement, regular check-ups and X-rays of your knee replacement are necessary, even if you have no complaints.
Is Weight and Age Important for Knee Replacement?
Knee replacements are not performed on young patients except in necessary circumstances. Other methods that protect the joint and cartilage are preferred for young patients with knee problems. Knee replacements are more common for those over the age of 60. In the past, knee replacements were not preferred for young patients due to the short lifespan of prosthetics, as prosthetic technology had not advanced as much as it has today. However, modern technology is more compatible with the human body, stronger, and more durable...
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Due to the pain, loss of function in daily life, and expectations of the patient, knee replacement can be performed at very advanced ages. However, other systemic diseases that come with age (such as diabetes, heart failure, coronary artery disease, lung disease, and kidney disease) increase the surgical risks. Therefore, after deciding to have knee replacement surgery, the patient is thoroughly examined to identify any underlying problems that might increase the surgical risk. If the additional problems are severe, the decision to proceed with the surgery is made by considering the pros and cons of the operation.
Overweight patients may also be at risk, as other problems (such as diabetes, high blood pressure, and heart disease) are more common. However, overweight patients often find it difficult to lose weight due to the limited range of motion caused by knee problems, which can lead to further weight gain. Therefore, if the surgery does not pose a serious risk after evaluating the likelihood of risks, even if the patient is overweight, a knee replacement can be performed.
What are the Risks of Knee Replacement Surgery?
As mentioned earlier, age-related diseases in candidates for knee replacement surgery can pose risks for anesthesia and surgery. The risks of knee replacement surgery are infection (inflammation), blood clots in the veins, and prosthetic-related mechanical problems.
Infection risk is a problem that occurs at very low rates when protective antibiotics are used and the surgery is performed in good operating room conditions. For this reason, the patient is checked to make sure there is no infection in other parts of the body and, if necessary, surgery is planned after treatment. Protective antibiotics are applied to all patients just before the surgery and continued for 1 day after the surgery. Operating room conditions and precautions taken by the surgical team take into account the possibility of infection. Despite all these measures, the probability of microbes from another part of the patient's body reaching the knee joint during and after the surgery and causing an infection in the prosthesis is very low.
Blood clot formation in veins is a problem that is most noticeable in patients with clotting disorders who remain inactive for long periods of time. All patients are protected from this problem by taking drugs that prevent clotting for 2-4 weeks after the surgery. Additionally, rapid movement and walking by the patient after surgery also prevent this problem. Despite all precautions, the formation of blood clots in leg veins and the rare occurrence of pieces breaking off and blocking lung vessels, causing respiratory problems, are rare.
Mechanical problems related to prosthetics (loosening, wear and tear, and dislocation of the prosthesis) are among the rarest problems today. In addition to these problems, difficulties in wound healing, less-than-expected knee movements, and pain that is still considered normal are among the other rare problems.
Is There an Alternative to Knee Replacement?
Joint freezing surgery can be performed on those who have walking problems and severe pain due to excessive deterioration of the knee joint. However, for patients with deterioration in both knees, the options are limited to knee replacement surgery. There is no cure for knee joint problems other than joint replacement, but nonsurgical treatments such as physical therapy and medication can help manage symptoms in some cases.
How is Knee Replacement Surgery Performed?
Once a knee osteoarthritis diagnosis is made requiring surgery, the decision to proceed with the operation is made. Then, considering the patient's overall health, it is determined whether or not they are suitable for surgery. If everything goes well, the patient is provided with detailed information about the procedure and the surgery date.
Knee replacement surgery is usually performed under general anesthesia. However, if general anesthesia is not possible, the procedure can be performed under spinal anesthesia. After the area is numbed with local anesthesia, the surgeon starts the procedure. In this open surgical technique, the surgeon first cleans the damaged joint surfaces. A prosthesis is then placed onto the cleaned bone. Finally, the incision is closed and the procedure is completed. After the surgery, an 8-12 cm scar may be left in the operated area.
What Should Be Done After Discharge?
If no problems develop after the third day of knee replacement surgery, the patient can be discharged. The patient continues to walk with crutches, do exercises, and use prescribed medications regularly at home. The dressing is changed every three days using only iodine-based medications and is covered with a sterile gauze. In addition, the operated area should not be exposed to water until the stitches are removed. Unless otherwise indicated, the stitches will be removed 21 days after the surgery and the compression stocking will be removed. Six weeks after the operation, the patient returns to the hospital for examination, X-rays, and, if necessary, blood tests.
What Should Be Considered After Knee Replacement Surgery?
After knee replacement surgery, the following should generally be done:
Avoid sudden and reckless movements.
Take the medications prescribed by the specialist regularly.
Do not miss physical therapy sessions.
Take regular walks.
Consume foods rich in vitamin D and calcium.
Do not take a bath or expose the operated area to water until the first check-up.
Take blood-thinning medications correctly.
Avoid movements such as squatting and going up and down stairs.
