Types of Knee
Surgery
There's a wide
variety of surgical
approaches to
problems in the knee,
many of which are
also used in other
joints. Fusion, or
arthrodesis, for
example, fixes an
arthritic joint in
place, fusing bone to
bone. While the joint
will no longer bend,
fusion does relieve
the pain.
For people with
inflammatory
arthritis in one (or
both) of their knees,
occasionally a
synovectomy -
removal of the
inflamed lining of
the joint, often
performed
arthroscopically -
can in some cases
slow down the
progress of the
disease into
adjoining tissues and
postpone more radical
surgery. Removing the
lining eliminates the
major source of
inflammation, and may
preserve the
cartilage; however,
the operation is
generally only
successful for very
early disease in a
relatively healthy
joint. Once the
cartilage is
destroyed, a
synovectomy isn't
much help. The
synovium will
generally regrow
after surgery, but it
may redevelop with
the disease process
intact. And although
the operation can be
repeated, it probably
won't be that
rewarding.
Another procedure
that's sometimes
helpful in the early
stages of arthritis
is an osteotomy
- cutting and
realigning the bones
so that some of your
weight on the hips
and knees is shifted
on to good cartilage.
(In the majority of
young, high-demand
patients, osteotomy
can buy at least 10
years before they
require a total joint
replacement.) An
internal metal staple
holds the bone in
position until it
heals, usually in
eight to 12 weeks,
with optimum
improvement about a
year after surgery.
If it's done early
enough, an osteotomy
may delay or even
eliminate the need
for total joint
replacement surgery.
Total knee
replacement is
still a relatively
young procedure,
trailing hips by a
decade or so, but the
technique has
definitely caught up:
Total knee surgery
now achieves results
as good as total hip
surgery. Where total
knees are sometimes
less successful is in
people with RA who
have multi-joint
involvement, says
Toronto orthopaedic
surgeon Dr. David E.
Hastings: 'If you
hear of somebody
who's very unhappy
with total knees, it
makes you wonder if
she's got bad hips.
If you have that
combination - bad
hips, knees and feet
- you've got to
really look at your
priorities.'
In other words, if
you have several
joints that need
replacing, it may be
best to begin with
the largest joints
(hips) before
proceeding to your
knees and ankles.
Surgeons prefer to
postpone knee surgery
as long as possible,
unless you're in
severe distress, with
conservative
strategies. The less
often a revision is
necessary the better.
Any surgery involves
a slight risk of
infection, and in hip
and knee surgery
there's also the
possibility of blood
clots forming in the
legs, which can break
off and travel to the
lung, causing a
pulmonary embolism (a
blockage in the blood
vessels of the lung).
Normally blood
thinners are
administered to
prevent the problem.
Artificial Knee Replacement
When a knee is so severely damaged by
disease or injury, an artificial knee
replacement may be considered. Approximately
266,000 knee replacement surgeries are
performed annually in the US. The most
common age for knee replacement is between
ages 60 to 80 years old.
Candidates for
artificial knee replacement
The most common condition that results in
the need for knee replacement surgery is
osteoarthritis, a degenerative, joint
disease that affects mostly middle-aged and
older adults. Osteoarthritis is
characterized by the breakdown of joint
cartilage and adjacent bone in the knees.
Other forms of arthritis, such as rheumatoid
arthritis and arthritis that results from a
knee injury can also lead to degeneration of
the knee joint. In addition, fractures, torn
cartilage, and/or torn ligaments also can
lead to irreversible damage to the knee
joint over the years.
What to expect before
the surgery
In addition to a complete medical history,
your physician may perform a complete
physical examination, including x-rays, to
ensure you are in good health before
undergoing surgery. In addition, you may
also meet with a physical therapist to
discuss rehabilitation after the surgery and
undergo blood tests (or other tests).
After knee
surgery
Knee replacement surgeries usually require
an in-hospital stay of several days. Even
while in the hospital, the patient usually
begins physical therapy exercises to begin
regaining range of motion in the knee.
Physical therapy will continue at home. Pain
medication also will be administered to keep
the patient comfortable.
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