Find out more about Total Knee Replacement with the following links.
Figure C shows an example of an Walldius hinge total knee prosthesis
Total Knee Replacement - OrthoInfo - AAOS
This procedure has many of the same potential complications as a total knee replacement. The advantage is that it maintains the patient's own cartilage. The main disadvantage is that it will eventually require conversion to a total knee replacement as the remaining articular cartilage degenerates.
Similar to hip replacement surgery, a knee replacement is indicated when you have advanced osteoarthritis of the knee joint and non-operative measures (eg. Weight loss, anti-inflamatories , physiotherapy etc) are no longer controlling your pain.
Knee and Hip Center | Total Knee Replacement | Total …
Total knee replacement is a rapidly-growing procedure. Initially, knee replacement was intended for patients in their late 60s and 70s. Recent improvements to the prosthesis and overall surgical technique have enabled the procedure to be performed on patients in their 50s as well as their 80s and 90s. Each year, over 600,000 primary total knee replacements are performed in the United States.
Total knee replacement is actually a resurfacing procedure where approximately ½ inch of bone is removed from the lower end of the thigh bone (femur), the upper end of the lower leg bone (tibia), and the under-surface of the knee cap (patella). These surfaces are then covered with a metal prosthesis on the femur and a plastic prosthesis on the tibia and patella.
Total Knee Replacement | Hip and Knee Care
A total knee replacement is designed to resurface the femur, tibia and patella and in-between the femur and tibia is a layer of polyethelene. The polyethelene (plastic shock absorber) is the bearing surface which ALL knee replacements use. Unlike in hip replacement surgery there is no ceramic on ceramic knee replacement bearing. There is also NO metal on metal bearing so the problem that happened with some metal on metal hip replacements does not exist in knee replacements.
Arthritic knees that require surgery usually require a Total Knee Replacement. A unicompartmental or “half knee” replacement is reserved for a select few patients who have knee arthritis isolated to one area of the knee joint and who satisfy other preoperative criteria. The revision rate of a unicompartmental knee replacement is significantly higher that a total knee replacement (16% vs 6% at 11 yrs) and therefore there are strict requirements in patient selection.
Total Knee Replacement Surgery | Elvis Grandic, MD
US3696446A - Total knee prosthesis - Google Patents
Total knee prosthesis - Bone & Joint Surgery
Patent US5824102 - Total knee prosthesis - Google Patents
Total knee prosthesis Before surgery : Osteoarthritis is an erosion of the cartilage of the knee joint
Total Knee Replacement (TKR) - Sydney Orthopaedic
With total knee replacement, the entire surface has to be removed
Total Knee Arthroplasty Technique for Total Knee Replacement
Log on to Tuesday, March 22nd, 2005 at 7pm EST, and witness Adolph Lombardi, Jr., MD, FACS, perform a total knee replacement using the new Vanguard™ Complete Knee System with innovative Premier™ instrumentation from Biomet Orthopedics, Inc.
How painful is a total knee replacement? | Surgery
A total knee replacement (TKR) or total knee arthroplasty is a surgery that resurfaces an arthritic knee joint with an artificial metal or plastic replacement parts called the ‘prostheses'.
04/04/2017 · How painful is a total knee replacement
On Tuesday, March 22nd, 2005 at 7pm EST (00:00 UTC / 8:00 am China 23.3.05),witness Adolph Lombardi, Jr., MD, FACS, perform a total knee replacement using the new Vanguard™ Complete Knee System with innovative Premier™ instrumentation from Biomet Orthopedics, Inc
What is the weight of a total knee replacement prosthesis?
There are two main types of artificial knee replacement prosthesis—cemented and uncemented. Both types are widely used. In many cases, a combination of the two types are used. The kneecap, or patellar, part of the prosthesis is usually cemented into place. The choice to use a cemented or uncemented prosthesis is usually made by the surgeon based on your age and lifestyle, and your surgeon’s experience.
Total Hip and Total Knee Replacement — NEJM
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This website and the general handout I provide in the office will outline all the general principles of hip and knee replacement surgery, the realistic outcomes and things you need to be aware of. This handout provides extra information that you may find useful.
Before surgery you will need to attend a pre-admission clinic at the hospital where you will meet a clinical nurse who will go over the basic admission process and post operative course. In addition there are routine pre-operative blood tests and an ECG that are performed. Occasionally a chest X-ray is needed.
If any significant abnormality is detected in your pre-operative visit, the appropriate action/referral will occur to investigate and treat any issue needing attention.
If you see a cardiologist routinely and are on a regular blood thinner, please advise your cardiologist you are having a joint replacement and that you need to stop blood thinners such as warfarin, plavix/clopidigrol and aspirin. I am happy to perform the replacement under low dose aspirin (100mg) if your cardiologist insists.
MEDICATION YOU NEED TO STOP
Please stop all anti-inflamatories (mobic, celebrex, nurofen, voltaren etc ) 1 week before surgery.
Herbal medication (fish oils, garlic, echinacea, kava, glucosamine etc ) need to be stopped 1 week before surgery as they can cause excessive bleeding.
If you are diabetic it is important that your diabetes is under proper control. Your GP will usually see to this.
Dental issues. If you have any major dental issues requiring attention please get this done before your joint replacement.
If you have any prostate issues (Males), please inform me as every patient needs a urinary catheter for 24-48 hrs and prostate problems can result in a difficult catheterisation therefore it is best to have a urologist consult if need be.
ANTISEPTIC SHOWER SOAP
You will be given an antiseptic soap at the pre-admission clinic that you need to shower with for the 2 days prior to surgery. This will reduce the risk of a skin infection after surgery.
Please DO NOT shave hair around the hip or knee before surgery. The hospital nursing staff will shave the area if needed using special clippers that do not cut the skin.
The surgery is usually carried out under a combined spinal anaesthetic and light general / sedation. Spinal anaesthesia is safe and has been shown to assist in reducing complications during joint replacement surgery. It provides excellent post operative pain relief. The Anaesthetist will discuss this with you in detail.
A urinary catheter is used in all cases. Patients with a spinal as well as those who don't have a spinal but get morphine for pain relief, will invariably have difficulty passing urine for 12-18 hrs and hence the need for a catheter. It is much easier to pass a urinary catheter when you are sedated just before surgery than to pass a catheter when you are awake on the ward with a full bladder.
Removing a catheter is a very easy process done by the ward nurses and is not painful at all.
Antibiotics are given intravenously for 24-36 hrs and your IV cannula will remain in your arm for this period. The cannula is also often attached to a PCA machine which allows you to administer pain killers when needed. I do not use a PCA in all patients as often (such as in the minimally invasive hip approach) the local anaesthetic and oral pain tablets are sufficient.
You will be given the appropriate pain relief regime that the anaesthetist will order. This regime is tailored to each individual's needs.
The key to preventing thrombosis is mobilisation and exercise . Every patient is fitted with a calf compressor after surgery. This machine compresses the calf intermittently which promotes venous blood flow back to the heart and prevents clots. The compressors are used whilst in bed for the first 48 hrs. The sooner you get out of bed and walk the less the risk of a thrombosis.
In addition to early mobilisation and calf compressors you will either be given oral aspirin or clexane injections to assist in reducing the incidence of thrombosis.
I encourage 2 walks a day whilst in hospital. The more you can manage the better but don't overdo things.
Whilst the risk of a thrombosis is low despite all preventative measures they can still occur and are treated accordingly. I do not perform a routine Doppler scan to check for thrombosis as all studies have shown that routine scanning is a waist of time.
ANTIBIOTIC POLICY FOR PROCEDURES FOLLOWING JOINT REPLACEMENT
The risk of getting an infection in your replaced joint is extremely rare following routine procedures such as dental work and colonoscopies.
For routine dental cleaning after joint replacement surgery there is no need to take antibiotic prophylaxis. For major dental work after a joint replacement ( such as root canal etc) I recommend a single dose of 2gm amoxicillin 1 hour before provided you are not allergic to amoxil.
COLONOSCOPY, Prostate, Bladder or Gynaecological procedures after joint replacement :
Routine colonoscopy without any major biopsies or risk of bleeding do not require prophylactic antibiotic cover.
Surgery to the bladder, bowel, gynaecological and prostate surgery require a single intravenous antibiotic dose that is administered by the surgeon at the time of the procedure. Please advise them that you have a joint replacement.
Some other things about replacements:
All knee replacements have some numbness on the outer side of the wound. This is unavoidable as there is a skin nerve that goes directly across the skin incision and hence is purposefully cut in order to open up the knee joint. It is a minor nerve and the numbness will tend to lighten up over time but is never completely eliminated.
All knee replacements click. This is normal. It is simply the metal and polyethylene parts touching each other and is no cause for alarm. It is how the joint functions. The clicking noise will tend to get quieter over time.
Hip Replacements can occasionally click at the extreme of motion. No cause for alarm. Some ceramic on ceramic hip bearings can squeak (rare) again no cause for alarm.
Intraoperative stability is important in hip replacements. Rarely one may need to tension the hip which can lead to a leg length discrepancy. Various techniques are used to minimise this possibility.
The key to a successful recovery is motivation to mobilise and to do the exercises the physiotherapist will show you. Hip and Knee replacement surgeries have excellent outcomes provided the patients assist in a motivated recovery.
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