If your knee isn't responding to medications and treatments, knee replacement surgery is an option. There are two types of replacement surgery: total knee replacement, the more common of the two, and partial knee replacement.
The traditional method of repairing a damaged knee is total knee replacement (TKR) surgery.
Since the first surgery in 1968, doctors have drastically improved the procedure. In fact, advances in medical technology have resulted in precise and highly functional artificial knee implants that closely mimic the way the human knee moves, custom-fitting to your body. A TKR is one of the safest and most effective of all standard orthopedic surgeries today.
During a TKR, a surgeon removes the surface of your bones that have been damaged by osteoarthritis or other causes and replaces your knee with an artificial implant chosen to fit your anatomy. The surgeon uses special surgical tools to precisely cut the arthritic bone and then shape the healthy bone underneath to fit the implant components snugly.
Essentially, the operation is a four-step process. In the first part, the bone is prepared by removing the damaged cartilage surfaces at the endsthigh (thigh)jtibia (shinbone), as well as a small portion of the underlying bone.
During the next phase, the surgeon places the metal tibial and femoral implants and cements or presses them to the bone. "Press-fit" refers to implants designed with rough surfaces to stimulate knee bone ingrowth to organically secure the implants.
Next, a plastic button is inserted under the kneecap (patella). This may require resurfacing of the underside of the kneecap to better attach it to the button.
Finally, the surgeon implants a medical-grade plastic spacer between the femoral and tibial metal components to create a smooth surface that slides easily and mimics natural knee movement. To ensure a successful outcome, the surgeon must precisely align the implants and carefully adjust them to the bone.
This is reported by the American Academy of Orthopedic Surgeons90 percentof those who have undergone TKR experience a dramatic reduction in knee pain and benefit from improved mobility and movement. Most can resume daily activities.
However, it's important to set the right expectations and avoid high-impact activities like running and skiing. Moderate use of your artificial knee increases the likelihood that the implant will last for many years. Around85 to 90 percentTKR implants continue to function well 15 to 20 years after surgery.
Please note that there isrisksare associated with a TKR. These risks include infections that could lead to further surgery, blood clots that could lead to stroke or death, and prolonged knee instability and pain. A TKR also requires an expanded rehabilitation program and home planning to accommodate the recovery period. You should plan to use a walker, crutches, or cane immediately after surgery.
Implant failure or loosening may also occur, particularly if misalignment between the implant and the bone has occurred during or after surgery. Although these failures are rare and usually occur in the weeks following the original surgery, they would require a return to the operating room for revision surgery. During this procedure, the surgeon removes the failed implant, prepares the bone again, and inserts a new implant.
Cross retention vs. posterior stabilized
There are two different variants of a TKR. Talk to your doctor about which approach works best for you.
Removal of the posterior cruciate ligament (later stabilized).The posterior cruciate ligament is a large band at the back of the knee that provides support when the knee bends. If this band cannot support an artificial knee, it is removed by a surgeon during the TKR procedure. Instead, special components of the implant (a cam and a post) are used to stabilize the knee and provide flexion.
Preservation of the posterior cruciate ligament (cruciate retainer).If the ligament can support an artificial knee, the surgeon can leave the posterior cruciate ligament in place when implanting the prosthesis. The artificial joint used is a "cross-retention" joint and usually has a groove that receives and protects the ligament, allowing it to continue to provide stability to the knee. Preserving the cruciate ligament is believed to allow for more natural flexion.
(Video) What are the different options for knee replacement?
Partial knee replacement (PCR), sometimes referred to as a unicompartmental knee replacement, is an option for a small percentage of people. Far fewer PKRs are performed in the United States than TKRs.
As the name suggests, only part of the knee is replaced to preserve as much of the original healthy bone and soft tissue as possible. Candidates for this type of surgery generally have osteoarthritis in only one compartment of the knee. Therefore, surgery is performed in one of the three anatomical compartments of the knee where the diseased bone is most painful: the medial compartment on the inside of the knee, the lateral compartment on the outside of the knee, or the femoral compartment of the patella, which is in front of the between the femur and the patella.
During a PKR, a surgeon removes the arthritic portion of the knee, including the bone and cartilage, and replaces that compartment with metal and plastic components.
PKR surgery offers some key benefits, including a shorter hospital stay, faster recovery and rehabilitation period, less post-operative pain, and less trauma and blood loss. Compared to those who receive a TKR, people who receive a PKR often report that their knee bends better and feels more natural.
However, there is less certainty that PKR will relieve or eliminate the underlying pain. And because the preserved bone is still susceptible to arthritis, there's also a higher chance that subsequent TKR surgery will be needed at some point in the future.
Surgeons often perform PKR on younger patients (less than 65 years old) who still have a lot of healthy bone. The procedure is performed in one of the three knee compartments. If two or more knee compartments are damaged, this probably isn't the best option.
PKRs are best suited for those who lead active lifestyles and need a follow-up procedure, possibly a TKR, about 20 years after the initial implant wears out. However, it is also used for some older people who lead relatively sedentary lifestyles.
Because PCR is less invasive and involves less tissue, you're more likely to be ready sooner. In many cases, a PKR recipient can walk without crutches or a cane in about four to six weeks, about half the time for a TKR. They also experience less pain and better functionality, and report high levels of satisfaction.
Your doctor will also choose a surgical approach (as well as a general or regional anesthetic approach) that best suits your needs. You and the medical team will participate in the preoperative planning that will cover the type of procedure you will receive and any associated medical needs.
To ensure a smooth procedure, a qualified orthopedic surgeon will map your knee anatomy in advance so they can plan your surgical approach and anticipate any special instruments or equipment. This is an essential part of the process. Possible approaches are discussed below.
traditional surgery
In the traditional approach, the surgeon makes an 8- to 12-inch incision and operates on the knee using a standard surgical technique. The incision is usually made along the front and medial (midline or anteromedial) or along the front and side (anterolateral) of the knee.
The traditional surgical approach generally involves severing the quadriceps tendon to fold the patella and expose the arthritic joint. This approach generally requires three to five days of hospital recovery and about 12 weeks of recovery time.
minimal-invasive Chirurgie
A surgeon may suggest minimally invasive (MIS) surgery, which reduces tissue trauma, relieves pain, and slows blood loss and speeds recovery. A minimally invasive approach reduces the incision to 3 to 4 inches. A key difference between this approach and standard surgery is that the kneecap is pushed to one side rather than flipped. This results in a smaller cut on the quadriceps tendon and less trauma to the quadriceps muscle. Because the surgeon cuts less muscle, healing occurs faster and you'll likely experience a better range of motion after recovery.
The procedure modifies the techniques used in traditional surgery using the same implants used in traditional surgery. Manufacturers offer special instruments that help position the implant accurately, but also allow the incisions to be made as small as possible. Since the only difference between MIS and conventional surgery is the surgical technique, the long-term clinical outcomes are similar.
Types of minimally invasive approaches include:
Quadriceps Conservative Approaches
After a minimal incision, the surgeon moves the kneecap sideways and severs the arthritic bone without severing the quadriceps tendon. The quadriceps salvage method, as the name suggests, is less invasive than traditional surgery. Prevent the quadriceps muscle from suffering as much trauma as possible.
Another term for this approach is "subvastus" because the approach to the joint is from underneath (sub) the vastus muscle (the largest part of the quadriceps muscle group).
Another variation of a quadriceps-sparing approach is called a midvastus. It also avoids cutting the quadriceps tendon, but rather than completely sparing the vastus muscle by undercutting it, this surgical approach cuts the muscle along a natural line through the median. The decision to use one method or the other depends on the condition of the knee and the surrounding tissues.
The subvastus and midvastus approaches often take longer to complete, but can result in a faster rehabilitation process. This is because there is little or no trauma to the underlying thigh muscle, making it easier to walk after surgery.
Side access
This approach is rarely used. It's more common in those whose knees tend to bend outward. The surgeon enters the knee joint from the side or side of the knee. The lateral approach is less invasive than traditional surgery because much of the quadriceps is spared, making it easier for patients to walk faster again.
Minimally invasive surgery shortens the hospital stay from three to four days and can reduce recovery time from four to six weeks. People with PKR had less pain and were able to resume daily activities faster and better than those who had standard surgery. However, after one year there were no significant differences between the two groups.
Minimally invasive approaches are not suitable for everyone. Surgeons carefully evaluate each patient and choose the best approach. In addition, minimally invasive surgery is more difficult to perform and requires more specific technique, instruments, and surgical training. A study found that it takes about an hour longer than traditional surgeries. Contact your surgeon to discuss your options.
Computer Assisted Surgery (CAS)
Increasingly, surgeons are turning to computer-assisted methods, which include traditional and minimally invasive procedures, for both TKR and PKR. A surgeon enters a patient's anatomical data into a computer, a process called "registration," and the computer creates a three-dimensional model of the knee.
The software provides the surgeon with more accurate computerized informationknee image. The computer helps the surgeon more accurately align the knee components with the bone, increasing the chances that the device will work effectively.
A computer-based approach also allows a surgeon to operate with a smaller incision and benefits the patient by reducing recovery time. A more precise fit can also reduce wear and increase the longevity of the new seal.
(Video) Knee Replacement | What You Need to Know
Today's processes are becoming more sophisticated and safer. They pave the way for millions of people to live healthier, more active lives. Talk to your surgeon to determine which procedure is best for your specific needs.
FAQs
What is the best type of knee replacement? ›
A TKR is now among the safest and most effective of all standard orthopedic surgeries. During a TKR, a surgeon removes the surface of your bones that have been damaged by osteoarthritis or other causes and replaces the knee with an artificial implant that is selected to fit your anatomy.
What is the newest procedure for knee replacement? ›Minimally invasive total knee replacement uses a smaller incision than a traditional knee replacement, so it may lead to less pain and decreased recovery time.
Which knee implant material is best? ›The metals commonly used include cobalt-chromium, titanium, zirconium, and nickel. Metal-on-plastic is the least expensive type of implant and has the longest track record for safety and implant life span.
What are the 2 types of knee replacement? ›What are the different types of knee replacement surgery? There are two main types: total knee replacement, where the entire joint is replaced with artificial surfaces. partial knee replacement, where only one damaged compartment of the knee is replaced.
What time of year is best for knee replacement? ›Many patients ask this question when considering TKR and the consensus is that the spring and early fall are the best seasons. You'll want to wear as little clothing as possible during your recovery because it makes cleaning the wound and moving around easier.
What is the downside of knee replacement? ›Disadvantages. Possible disadvantages of knee replacement surgery can include replacement joints wearing out over time, difficulties with some movements and numbness. We now know that knee replacements aren't so likely to be effective in the early stages of arthritis.
Do you need a knee replacement if you are bone on bone? ›As knee arthritis progresses, the knee becomes much looser and more unstable. In some cases, this is mild. In other cases, it is substantial enough that cause the patient to fall. Patients who have bone-on-bone arthritis and are starting to fall because of it should strongly consider surgery.
At what age should you not have knee replacement surgery? ›Doctors sometimes recommend that people under age 60 wait to undergo a knee replacement, because these artificial joints typically last only about 15 to 20 years. If someone younger gets the procedure, the joint will likely need to be replaced again down the line.
Did Oprah have knee replacement? ›“I had double knee surgery last year. I had knee surgery in August, and then I had another knee surgery in November,” the 68-year-old OWN mogul said in a recent “The Life You Want” Class on gratitude released earlier this week.
Can you kneel after knee replacement? ›There is currently no evidence that there is any clinical reason why patients should not kneel on their replaced knee, and reasons for not kneeling could be addressed through education and rehabilitation.
What is the most commonly reported problem after knee replacement surgery? ›
Knee Stiffness
One of the most common problems people experience after knee replacement is a stiff knee joint. 1 This can cause difficulty with activities that require a lot of bending, including going down stairs, sitting in a chair, or getting out of a car.
Pain is to be expected after the initial knee replacement, but it should not be severe. The first few days after surgery should include the highest level of pain, but your doctor will send you home with pain medication adequate for your pain level.
What is the most common knee surgery? ›The most common knee surgeries involve arthroscopy — a surgical technique used to repair many different types of knee problems — or knee replacement. Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems.
Is robotic surgery better for knee replacement? ›Robotic-assisted procedures allow for greater precision and can lead to shorter recovery times and better results. In more complex cases, a robotic-assisted knee replacement offers a better balance in the soft tissues around your knee, and better aligns the joint.
What is the fastest way to recover from knee surgery? ›- Follow All Physician Recommendations. You should always heed all of your surgeon's instructions and advice. ...
- Walk Frequently Once You're Allowed. ...
- Eat Healthy Foods. ...
- Get Plenty of Sleep. ...
- Do Physical and Occupational Therapy Exercises.
Total knee replacement
The procedure takes 1 to 3 hours: Your surgeon makes a cut down the front of your knee to expose your kneecap. This is then moved to the side so the surgeon can get to the knee joint behind it. The damaged ends of your thigh bone and shin bone are cut away.
There is a range of accepted weight ranges, but the current standard is that anyone obese (greater than 100 pounds over ideal weight or a BMI of roughly 40-45) should not consider joint replacement.
Do you walk the same day as a knee replacement? ›The first walk after surgery occurs within hours of waking from the procedure. This first walk will involve assistance from nurses and a walking device and may only be from your medical bed to the bathroom. During your stay in the hospital, the medical staff will focus on: Pain management.
Does arthritis go away after knee replacement? ›Unfortunately, knee replacement surgery does not cure arthritis. Although it can correct the damage caused by arthritis and relieve the pain associated with the condition, it cannot make the arthritis go away.
What happens if your knee is bone on bone? ›What Does Bone-on-Bone Knee Pain Feel Like? Bone-on-bone knee pain, caused by advanced arthritis, can vary from person to person depending on its severity. Generally speaking, it will feel like a dull and achy pain. However, some people get a sharp pain that can bounce back and forth between those two qualities.
What can be done for a knee that is bone on bone? ›
Other possible options range from pain-killing drugs, injections, exercise, weight loss, and knee braces. Typically it is recommended that you combine several of these methods in order to achieve the best results.
Is walking good for bone on bone knee pain? ›Walking is a fantastic option for many patients with knee arthritis because it is a low-impact activity that does not put undue stress on the joints. Furthermore, walking can increase the knee's range of motion and keep it from becoming overly stiff.
Do knee injections work for bone on bone? ›The idea behind these injections is that they will temporarily restore the natural function of the knee by injecting a substance which will provide cushioning and reduce bone-on-bone contact. Individual responses vary, but many patients experience months, if not potentially a year or more of relief.
Does walking help bone on bone knees? ›People with knee osteoarthritis may reduce their risk of knee pain by walking more, according to a study published online June 8, 2022, by Arthritis & Rheumatology.
How long is the bed rest for knee surgery? ›TKA patients begin rehabilitation during the seven-day bedrest period, with the goals of decreasing swelling, increasing ROM, promoting normal leg control and promoting normal gait with an assistive device.
What percentage of knee replacements are successful? ›About 90% of Knee Replacements Last 10 Years and 80% Last 20 Years. Knee replacement surgery has an extremely high success rate. Patients tend to be very good at adhering to their recommended exercises, stretches, and physical therapy recommendations in order to ensure longevity of the new knee joint.
Can you squat after total knee replacement? ›Can I squat or kneel? Half squats for exercise are acceptable. Deep squatting is neither usually possible nor desirable after a knee replacement. Kneeling is not harmful but may not be comfortable.
Is titanium the best knee replacement? ›Additionally, the elastic nature of titanium and titanium alloys is lower than that of the other metals used in knee implants. Because of this, the titanium implant acts more like the natural joint, and as a result, the risk of some complications like bone resorption and atrophy are reduced.
Is it better to have a partial or full knee replacement? ›Compared to total knee replacement, partial knee replacement better preserves range of motion and knee function because it preserves healthy tissue and bone in the knee. For these reasons, patients tend to be more satisfied with partial knee replacement compared with total knee replacement.
Are titanium knee replacements better? ›Lighter weight and lower modulus are potential advantages of titanium (Ti) implants over cobalt chrome (CoCr) implants in total knee arthroplasty (TKA).
Can your body reject a titanium knee? ›
Knee implant rejection is extremely rare. Implant rejection or metal hypersensitivity happens when the metal in the implant triggers a reaction in the patient's body. This issue can be an allergic reaction or an autoimmune response.
Who is not a good candidate for total knee replacement? ›You may not be a good candidate if: Your knee symptoms are not related to joint disease. Your weight is too much for the artificial joint to support. You have fragile skin or poor skin coverage over your knee.
What is the quickest recovery from a knee replacement? ›- (1) Move Little and Often, Every Hour.
- (2) Get Great Sleep and Rest.
- (3) Avoid Putting Pressure Or Kneeling On Your Knee.
- (4) Use Equipment Given To You.
- (5) Follow Your Exercise Plan (Tips to Recover)
Ice and over-the-counter pain medication like acetaminophen or ibuprofen can help. Sometimes physical therapy or a guided exercise program can provide bone-on-bone knee pain relief by strengthening the muscles that support the knee, particularly the quadriceps.
Will I be able to kneel after a partial knee replacement? ›After partial knee replacement, patients can kneel, but they need to be taught to do so: a single-blind randomized controlled trial.
What is the best age to have a partial knee replacement? ›“We generally use a partial knee replacement to preserve knee function for patients between the ages of 30 and 60. Then we can convert to a total knee replacement.
Can you still have arthritis after knee replacement? ›It is still possible to have arthritis after knee replacement surgery. However, people who need the surgery are less likely to experience pain from arthritis after they recover from the procedure.