Knee replacement is recognized as one of the most successful procedures in all of medicine. In the United States, over 600,000 people have their knees replaced each year, and a recent panel of independent experts determined that 90% of those opting for knee replacement reported "fast pain relief, improved mobility and better quality of life."
Total knee replacement is a surgical procedure where the worn out surfaces of the knee are resurfaced with metal and plastic components. Over time, the cartilage that cushions the bones can wear away, cause pain and discomfort and make simple pleasures like walking unbearable. Knee replacement can reduce or eliminate pain, allow easier movement and get you back to normal life.
Partial knee replacement is a minimally invasive surgical procedure that resurfaces the worn, arthritic surfaces of the knee joint with metal and plastic components. Over time, the cartilage covering the ends of the femur (thighbone) and tibia (shinbone) can wear away causing pain, swelling and reduced mobility. If the wear is confined to one area of the knee, partial knee replacement may be an option.
There are a number of advantages to partial knee replacement when compared with total knee replacement. Because a smaller area of the knee is affected, the implants are smaller, allowing surgeons to use smaller incisions. In addition, there is less trauma to the bone and surrounding tissue, resulting in less blood loss, less likelihood of transfusion and a quicker recovery time when compared with total knee replacement.
The knee joint is made up of three bones –the femur, the tibia and the patella (or knee cap). The femur contacts the tibia with two areas, called condyles – the medial condyle and the lateral condyle. The underside of the kneecap also contacts the femur and tibia as it glides along the groove in the femur. Any of these three areas of contact can fall victim to the wear and tear effects of arthritis – causing pain, heat, stiffness and swelling. Total knee replacement involves the replacement of all three surfaces with metal and plastic components. If arthritis is limited to either the lateral or medial compartment of the knee, partial knee replacement may be considered.
There are many kinds and designs of knee implants available today, and no one design or type is best for every patient or their particular situation. Each surgeon selects the implant that they believe is best for their patient's needs based on a number of factors including age, activity level, the implant's track record and his or her comfort with the instruments associated with the particular implant. If you have specific questions regarding implants, your surgeon will be happy to answer them for you.
Knee replacement surgery may be considered for those suffering from arthritic knee pain that severely limits the activities of daily living. It is only recommended after careful examination and diagnosis of your particular joint problem, and only after more conservative measures such as exercise, physical therapy and medications have proven ineffective. Only your doctor can determine which procedure you will be an appropriate candidate for.
With improvements in surgical techniques and post-operative care, it is common for patients who have a partial knee replacement to go home the day after the procedure. For patients who have a total knee replacement it is now common for many to be able to go home from the hospital after two or three days. If you have both knees replaced at the same time, the stay can be a day or two longer. Of course, each patient is different, but the goal should be for you to recover in the comfort and privacy of your own home as soon as possible.
Once again, this can vary from person to person, but most people will need to use an ambulation aid such as a walker for 4 weeks or so. Driving may be possible in 4 to 6 weeks, and activities such as golf and bowling can be resumed in as few as 10 to 12 weeks. Some activities such as running or jogging are not recommended after knee replacement. Most people will be able to go straight home from the hospital, though some patients, particularly those who live alone, may need to spend a few days at a rehab center or nursing home. Keep in mind that healing and recovery times can vary.
All knee replacements can wear out over time, including total knee replacements. How long a particular implant may last varies from patient to patient and depends on a number of factors including the patient's weight, activity level and the accuracy of the implant's placement. Recent studies have shown that for appropriately selected patients, partial knee replacement can last 10 years or more and total knee replacement can last up to 20 years or more.
Even though knee replacement surgery is considered a very successful procedure, it is major surgery, and as with any surgery, there are risks you need to be aware of. Possible complications include:
- Blood clots in your leg veins
- Implant loosening
- Nerve or blood vessel damage
- Knee stiffness
Your surgeon and healthcare team will be taking great care to minimize the risk of these and other complications. Keep in mind that complications are relatively rare, but they need to be understood by you and your family. Your surgeon will be happy to answer any questions that you may have.
You will experience some discomfort after surgery, but be assured we will be doing everything we can to keep you as comfortable as possible. Pain after surgery is quite variable from person to person, and not entirely predictable, but modern medications and improved anesthetic techniques greatly enhance our ability to control pain and discomfort after surgery.