Knee replacement : Knee prosthesis
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| Knee replacement
Arthroplasty is a generic term encompassing various surgical procedures consisting of replacing all or part of a diseased joint with a prosthesis. An arthroplasty can be performed for different joints: the hip (the most common), the knee, the shoulder. Thanks to technological progress, prostheses allow today a very good mobility, and have a satisfactory life.
What is knee replacement?
The knee replacement surgery consists of covering the ends of the damaged thigh and lower bones and usually the kneecap with artificial surfaces lined with metal and plastic. As appropriate, the doctor can replace either the entire surface at the ends of the thigh and lower bones, or only the inner or the outer knee surface. In fact, knee replacement intervention involves replacing all or part of the knee joint with a prosthesis, either uni-compartmental (a half-prosthesis to replace the inner or outer compartment of the knee) or total (replacing the two compartments of the knee). joint: the femoro-tibial compartment and the patellofemoral compartment). Besides, the surgeon removes the damaged cartilage and replaces it with an artificial joint surfaces, and then protects knee joint components to the bones with cement.
People who are good candidates for unicompartmental surgery have better results with this procedure than with total joint replacement.
Read also about Hip replacement surgery
Knee replacement price
The price of a Knee replacement in Tunisia coupled with a week of recovery or vacation in a 5 stars hotel is at least % cheaper than the sole procedure in Europe and for the same medical quality.
Causes For Knee Joint Replacement
The knee joint degeneration can generate by different conditions. In fact, osteoarthritis, known as "wear and tear arthritis", is the most common cause for patients who have knee replacement surgery. Besides, this disease can occur without previous knee joint injury. However, some people may have a genetic tendency that increases their chances of developing osteoarthritis.
The major problem in osteoarthritis is that the cartilage (the articular cartilage) on the surface of the bone inside the joint wears away. Indeed, bone rubs against bone when the smooth protective surface of the cartilage is worn out, thus, the person feels pain.
There are other factors that lead to knee joint dysfunction such as knee fractures, torn cartilage and ligaments. As a result, the joint will excessively wear and tear over time just as an out of balance tire can wear out quickly.
The symptoms of a degenerative knee joint usually begin as pain while bearing weight on the affected knee, such as when walking. You may start to limp. The knee may become swollen with fluid. Besides, the knee deterioration can affect the range of motion. As a result, the person may find a difficulty to bend and straighten out their knee. This leads to feeling pain and the sufferer will stay awake at night. Moreover, the x ray can display the bone spurs.
Not all knee injuries require a knee replacement surgery at first. Indeed, the doctor may prescribe different treatment, or may advice the person to use a cane in order to diminish pain and allow them to walk in more comfort. In addition, anti-inflammatory medicines may reduce the inflammation from the arthritis and reduce pain.
The Artificial Knee Joint is called a prosthesis
Artificial knee replacement exists in two common types:
- Cemented Prosthesis.
- Uncemented Prosthesis.
The two types mentioned above are commonly used depending on cases such as the patient's age, health condition, lifestyle and the surgeon's advice. However, the kneecap or the patellar is generally cemented into place.
Each prosthesis consists of four parts:
- The tibial component replaces the end of the tibia. The labia is known as shinbone. The femur part replaces the femur's end, where the kneecap slides. Besides, the fumur is also called thighbone, it is the largest bone in the body.
- The patellar part replaces the surface on the "bottom" of the patella. The "top" of the kneecap is the section you can feel through your skin. The "bottom" is on the other side, slides up and down in the femoral groove when the person bend or srtaighten their leg.
The femoral component is made of metal. The tibial component is usually made up of two parts - a metal tray, and a plastic spacer. Indeed, the plastic used is very tough and very smooth - that you could ice skate on a sheet of the plastic without causing much damage to the plastic.
A cemented prosthesis is maintained in place by using an epoxy type cement that binds the metal to the bone. In the other side, an uncemented prosthesis has a fine mesh of holes on the surface that makes the bone developing into the mesh and links the prosthesis to the bone.
How is knee replacement surgery performed?
Knee replacement is a widespread surgery with excellent safety record. The decision to undergo a knee replacement procedure should be made during preoperative examination where the surgeon explains the different knee prosthesis, the patient's need, the surgery details, recovery period, etc. The knee replacement intervention consists of the following steps:
- General anesthesia is carried out.
- The practitioner makes two incisions; one on the side and the other on the back on the knee
- During knee replacement, a surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with prosthesis.
- The surgeon will bend and spin the knee in order to check it and ensure its appropriate functions before suturing the incision
When the patient is still in the clinic, they will practice a range of motion exercises, walking in order to strengthen and improve the knee flexibility. Moreover, the therapist will show to the patient few movements that will help them to bend and straighten the knee. In addition, the surgeon may suggest a continuous passive motion, also known as CPM, machine adjusted for the patient's knee. Furthermore, the physical therapist will assist the patient for a short walk by using crutches or a walker for once or twice a day. By the end of the clinic stay, the patient will be able to get into and out of bed, walk up to 75 feet with crutches and get to the bathroom safely. Once the patient leaves the clinic, the medical staff will organize an everyday physical therapy treatment. As a result, the range of motion of the patient's knee will be improved. Furthermore, the strengthening program will consist of balance, endurance and functional activities that will focus on key muscles in the buttocks, hips, thighs, and calf muscles. We can state a few exercises that will enhance the knee's recovery such as riding a stationary bike, swimming laps, squatting, bending down, going up and down steps.
Results of knee replacement surgery
90 to 95% of treated patients are very satisfied or satisfied with their intervention. Survival of the prosthetic knee is on average 90% at 15 years, which means that out of 100 patients operated 90 patients still have their prosthesis 15 years and older. After a total knee replacement, 95% of patients will feel pain relief, mobility improvement and a better quality of life.
The results of this technique are therefore very encouraging. The pains disappear quickly and the muscular strength recovered the first months. Normal walking without any decision occurred within 2 months after the intervention. Even if the resumption of activities is often complete, it is better to avoid forced labor and violent sports.
Advices before and after knee replacement surgery
The patient should be follow the surgeon's advices before and after knee replacement intervention in order to prepare themselves. Indeed, it is advised to be accompanied the d-day and one week after the surgery because their mobility will be reduced the first period. Besides, it is important to make everyday stuff within reach such as wastebasket, medecine, pitcher and glass. Furthermore, the patient should bring their items at arm level to avoid muscle strain and bending down. After knee replacement procedure, it is important to follow the doctor's instructions such as taking medications on time, working with physical therapist to boost the knee recovery. Moreover, it is recommended not to carry heavy loads and maintain both hands balanced or to use crutches. In addition, the medical staff may suggest to the patient to buy "reacher" to help them turn on lights or grab things that are beyond arm's length.