What type of knee replacements are available
It spares the quadriceps muscle from as much trauma as possible. Another variation of a quadriceps-sparing approach is called midvastus. It also avoids cutting the quadriceps tendon, but instead of completely sparing the vastus muscle by going under it, in this surgical approach the muscle is split along a natural line through the middle.
The decision to use one approach versus another depends on the condition of your knee and surrounding tissues. The subvastus and midvastus approaches often take longer to perform but may result in a faster rehab process. This is because there is little to no trauma to the underlying thigh muscle, making it easier to walk sooner after the operation. This approach is rarely used. The surgeon enters the knee joint laterally, or from the side of the knee. The lateral approach is less invasive than traditional surgery because it spares much of the quadriceps, making it easier for patients to return to walking faster.
Minimally invasive surgery trims the hospital stay to three to four days and it can shorten the recovery period to four to six weeks. People who get a PKR experienced less pain and were able to resume daily activities faster and better than those who had standard surgery.
At one year, however, there were no significant differences between the two groups. Also, minimally invasive surgery is more difficult to perform and requires a more specific technique, instruments, and surgical training.
One study found that it requires about one hour longer than a traditional surgery. Consult your surgeon to discuss your options.
Increasingly, surgeons are also turning to computer-assisted methods for both TKRs and PKRs involving both traditional and minimally invasive procedures. The software provides the surgeon with a more precise, computer-aided image of the knee.
The computer helps the surgeon align the knee components more precisely in the bone and increases the odds 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 joint.
Talk with your surgeon to determine what procedure is best for your specific needs. Knee joint replacement involves replacing an injured or ailing knee with an artificial joint. If knee pain is affecting your quality of life, it might be time to consider knee replacement surgery. This video and article can help you decide.
Have questions about knee replacement surgery? Here are a list of the top 12 questions and answers about knee replacement surgery.
Researchers say physical activity does not increase the risk of developing osteoarthritis in the knee and may actually help reduce symptoms. Erosive osteoarthritis has many of the same symptoms as traditional osteoarthritis, though the earmarks of the disease are usually limited to the….
Find out what Healthline readers are wearing, and what you should look for the next time you go shoe shopping. However results of revision knee replacement are typically not as good as first-time knee replacements. There is good evidence that the experience of the surgeon correlates with outcome in total knee replacement surgery; for this reason it is best to have the initial surgery done by an individual who is experienced fellowship-trained and with a practice that focuses on knee replacement in this kind of work.
Likewise the new technique of minimally-invasive quadriceps sparing knee replacement should only be performed by surgeons who have taken special training on the instruments and surgical approaches and who have experience using less-invasive surgical techniques around the knee.
It is therefore important that the surgeon performing the technique be not just a good orthopedic surgeon but a specialist in knee replacement surgery and in less-invasive joint replacement. Urgency Total knee replacement is elective surgery. With few exceptions it does not need to be done urgently and can be scheduled around important life-events. This does not change regardless of the technique used minimally-invasive or traditional. Risks Like any major surgical procedure total knee replacement is associated with certain medical and surgical risks.
Although major complications are uncommon they may occur; the possibilities include blood clots bleeding and anesthesia-related or medical risks such as cardiac risks stroke and in rare instances large studies have calculated the risk to be less than 1 in death. Risks specific to knee replacement include infection which may result in the need for more surgery nerve injury the possibility that the knee may become either too stiff or too unstable to enjoy it a chance that pain might persist or new pains might arise and the chance that the joint replacement might not last the patient's lifetime or might require further surgery.
Minimally-invasive quadriceps-sparing total knee replacement is a new procedure. For this reason it is fair to say that the specialty will need to pay close attention to results to make sure they are as good or better than the traditional techniques that have been in common use for quite some time now.
However preliminary studies on the technique have shown no increases in surgical or medical risk with this approach compared to traditional total knee arthroplasty and these same studies have shown benefits in terms of post-operative pain and early recuperation and rehabilitation after surgery. While the overall list of complications may seem long and intimidating the overall frequency of major complications following total knee replacement is low usually less than 5 percent one in Obviously the overall risk of surgery is dependent both on the complexity of the knee problem but also on the patient's overall medical health.
The major apparent risks of the minimally-invasive quadriceps-sparing procedure compared to traditional total knee replacement include the following:.
Managing risk Many of the major problems that can occur following traditional or minimally-invasive total knee replacement can be treated. The best treatment though is prevention. An orthopedic surgeon will use antibiotics before during and after surgery to minimize the likelihood of infection. S he will take steps to decrease the likelihood of blood clots such as early patient mobilization and use of blood-thinning medications in some patients. Good surgical technique can help minimize the knee-specific risks--so choosing a fellowship-trained and experienced knee replacement surgeon is important.
Again the overall likelihood of a severe complication is typically less than 5 percent when such steps are taken. Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients; chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well. Some patients opt to predonate their own blood in advance of surgery to try to minimize the likelihood that transfusions from the blood bank will be needed.
Surgeons will often spend time with the patient in advance of the surgery making certain that all the patient's questions and concerns as well as those of the family are answered. Timing The decision to have minimally-invasive or traditional total knee replacement is a quality of life choice best made by an educated patient in consultation with an experienced surgeon.
Only rarely does knee replacement get done as an urgent procedure. Very occasionally in cases of rheumatoid or other types of inflammatory arthritis excessive delays can result in the loss of bone and tendon tissue.
These losses can compromise the quality of the surgery and its result. Surgical team Minimally-invasive quadriceps-sparing total knee replacement requires an experienced orthopedic surgeon and the resources of a large medical center.
Patients should inquire as to the number of knee arthroplasty procedures that the surgeon performs each year overall and how many minimally-invasive knee replacements the surgeon has performed. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical physical therapy and social support services.
Finding an experienced surgeon There is good evidence that the experience of the surgeon performing partial knee replacement affects the outcome. It is important that the surgeon be experienced--and preferably fellowship-trained--knee replacement surgeon. Facilities A large hospital usually with academic affiliation and equipped with state-of-the-art radiologic imaging equipment and medical intensive care unit is clearly preferable in the care of patients with knee arthritis.
These centers have surgical teams and facilities specially designed for this type of surgery. They also have nurses and therapists who are accustomed to assisting patients in their recover from knee replacement surgery. Technical details Minimally-invasive quadriceps-sparing total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection followed by inflation of a tourniquet to prevent blood loss during the operation.
Next specially-designed alignment rods and cutting jigs — which are smaller and easier to pass through the smaller incision than those used for traditional total knee replacement — are used to remove enough bone from the end of the femur thigh bone the top of the tibia shin bone and the underside of the patella kneecap to allow placement of the joint replacement implants.
Proper sizing and alignment of the implants as well as final balancing of the knee ligaments all are critical for normal post-operative function and good pain relief. Again these steps are complex and considerable experience in minimally-invasive knee replacement is required in order to make sure they are done reliably case after case.
Provisional trial implant components are placed without bone cement to make sure they fit well against the bones and are well aligned; at this time good function--including full flexion bend extension straightening and ligament balance--is verified. Finally the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement see figure The surgical incision is closed using stitches and staples.
Anesthetic Total knee replacement may be performed under epidural spinal or general anesthesia. We usually prefer epidural or spinal anesthesia since these can help provide pain relief in the days following surgery and allow faster more comfortable progress in physical therapy. Length of minimally-invasive quadriceps-sparing total knee replacement No two knee replacements are alike and there is some variability in operative times but a typical total knee replacement takes about minutes to perform when traditional techniques are used because the wider exposure permits more rapid progress through the technical steps of the procedure see Figure Pain and pain management Whenever possible we use a spinal anesthetic with a long-acting morphine product to provide pain relief for up to 24 hours after surgery.
Beyond that pain medications by vein or in pill form are used to permit early rapid rehabilitation. Alternatively an epidural catheter a very thin flexible tube placed into the lower back at the time of surgery to manage post-operative discomfort.
This device is similar to the one that is used to help women deliver babies more comfortably. As long as the epidural is providing good pain control we leave it in place for two days after surgery. After the epidural is removed pain pills usually provide satisfactory pain control. Patients who have epidural or spinal anesthesia can expect to walk with crutches or a walker and to take the knee through a near-full range of motion starting on the day after surgery.
In the days that follow the patient is transitioned on to pain pills to allow rehabilitation and rapid recovery following minimally-invasive quadriceps-sparing total knee replacement. Some patients are not candidates for spinal or epidural anesthetics or choose not to have them. These patients receive pain medications by vein for the first day or two and then can go home on pain pills following minimally-invasive quadriceps-sparing total knee replacement.
Use of medications Following discharge from the hospital most patients will take oral pain medications--usually Percocet Vicoden or Tylenol for one to three weeks after the procedure mainly to help with physical therapy and home exercises for the knee.
Aggressive rehabilitation is desirable following this procedure and a high level of patient motivation is important in order to get the best possible result. Pushing through a certain amount of discomfort or pain is part of recovery from any knee replacement.
Most patients take some narcotic pain medication for between 2 and 6 weeks after surgery. Patients should not drive while taking these kinds of medications. Effectiveness of medications While any surgical procedure is associated with post-operative discomfort most patients who have had the total knee replacements say that the pain is very manageable with the pain medications and the large majority look back on the experience and find that the pain relief given by knee replacement is well worth the discomfort that follows this kind of surgery.
Minimally-invasive quadriceps-sparing total knee replacement seems to be associated with less pain than traditional total knee replacement. However it is important to realize that it is a real surgical procedure and a good outcome depends on a motivated patients who is willing to push through a certain amount of discomfort to get the best possible knee motion and outcome after surgery.
Important side effects Pain medications can cause drowsiness slowness of breathing difficulties in emptying the bladder and bowel nausea vomiting and allergic reactions. Patients who have taken substantial narcotic medications in the recent past may find that usual doses of pain medication are less effective. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint. A curved part of cartilage in the knees and other joints that acts as a shock absorber, increases contact area, and deepens the knee joint. Knee replacement surgery is a treatment for pain and disability in the knee.
The most common condition that results in the need for knee replacement surgery is osteoarthritis. Osteoarthritis is characterized by the breakdown of joint cartilage. Damage to the cartilage and bones limits movement and may cause pain. People with severe degenerative joint disease may be unable to do normal activities that involve bending at the knee, such as walking or climbing stairs, because they are painful.
The knee may swell or "give-way" because the joint is not stable. Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury, may also lead to degeneration of the knee joint. If medical treatments are not satisfactory, knee replacement surgery may be an effective treatment.
Some medical treatments for degenerative joint disease may include, but are not limited to, the following:. Viscosupplementation injections to add lubrication into the joint to make joint movement less painful. As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:. The replacement knee joint may become loose, be dislodged, or may not work the way it was intended. The joint may have to be replaced again in the future.
Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The joint pain may not be relieved by surgery. There may be other risks depending on your specific medical condition.
Be sure to discuss any concerns with your doctor prior to the procedure. Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. You will be asked to sign a consent form that gives your permission to do the procedure.
Read the form carefully and ask questions if something is not clear. In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure.
You may undergo blood tests or other diagnostic tests. Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents local and general. Notify your doctor of all medications prescribed and over-the-counter and herbal supplements that you are taking.
Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure. You will be asked to fast for eight hours before the procedure, generally after midnight.
Arrange for someone to help around the house for a week or two after you are discharged from the hospital. Caring for an aging parent? Tips for enjoying holiday meals.
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