What is knee replacement surgery?

Knee replacement surgery or knee arthroplasty is an operation to replace damaged part of knee joint with an artificial part of the joint. The artificial part of the joint is made up of metal or plastic materials. Patients with severe knee diseases (like knee osteoarthritis) could not do their daily activities such as walking, climbing stairs, etc.

Knee replacement is the best choice for the patients with knee arthritis or previous severe knee trauma.

Total and partial knee replacement in Iran offered at the best hospitals by experienced and skillful surgeon’s at the most affordable prices.

Arthroplasty means repairing a joint through surgery using artificial components. When a particular cartilage in the body is damaged or destroyed, it becomes painful and cannot be shaken, and as a result, the bones may clump together and break each other, in this case the patient may have severe pain.

In this process, the damaged parts of the cartilage are removed from the thigh and it is replaced with an artificial joint made of high quality metal, plastic and polymer. To find out if this knee replacement surgery is right for you, you should see an orthopedic surgeon to check your age, weight, activity level, knee size and shape and your overall health.

If cartilage damage is in knee joint, the patient feels pain in the knee joint and cannot move the knee well. In this situation, he is photographed standing and his three joints are examined including ankle and hip joints, and the knee joint.

Who is a candidate for a knee arthroplasty?

All types of advanced severe arthritis Osteoporosis arthritis or osteoarthritis is a disease that involves middle age or elder people and may cause fracture of joint cartilage or joint bone. Damage to the cartilage or bone cause joint movement restriction and pain.

Rheumatoid arthritis cause knee joint synovial fluid inflammation and result in joint stiffness and pain.

Joint damage due to trauma or vehicle accident may cause joint cartilage damage. Bone fracture, cartilage or tendon rupture may result in irreparable damage in knee movements.

What is the procedure of total knee arthroplasty?

At the beginning of the surgery, an incision about 15 to 25 centimeters long will be made on the joint position of the knee, providing enough space for the surgeon to reach kneecaps and cutaway surfaces of damaged joints. During the total knee arthroplasty, damaged bones of knee joints are cut away and cartilage from thighbones, knee cap, and shinbone. The second step during this surgery is to replace the damaged parts with a prosthesis, which is an artificial joint made of polymers, metal alloys, or plastic. Type of prosthesis and surgical techniques are chosen by surgeons based on different factors, such as weight, knee size, and shape, overall health condition of the patient, his or her age, and activity level. A typical total knee arthroplasty will take about two hours. This time can be prolonged in the case of unpredicted complications during the surgery.

Knee replacement surgery step by step:

The surgeon starts the operation by a small cut in front of your knee to get access the patella bone.

The patella bone will be removed from the knee joint.

When your knee joint expose directly, the bones diameter and length will be measured by your surgeon and a proper and exact cut will be made in the bones. The metal part of implant attach to the distal part of femoral bone. The attachment graft by bone powder.

The lower part of the implant attaches to tibia bone of the leg and fixed by bone powder. Before putting the patella bone on the knee joint, the surgeon may sleek the patella bone and repair the joint by a plastic material to fix and coordinate the total knee joint.

Finally, the surgeon will flex and extend your knee joint to check accurate function of the knee.

Many factors may influence knee replacement surgery cost:

• Prosthesis (Implant) cost (depends on the type, quality, country of origin, etc.)
• Operation room charges
• The fee charged by the surgeon and anesthesiologist
• Number of the days of hospitalization
• VIP or Private or general hospital room
• Laboratory and radiologic costs
• Medication and used instruments
• Getting knee replacement surgery in general or private hospital
• Unanticipated equipment required during hospital stay.

Before performing knee replacement surgery, the patient will consult with the surgeon and finally choose the best treatment plan.

How much does knee replacement cost in different countries worldwide?

The average total knee replacement cost is 49,500 $ in USA. Partial knee replacement cost is 10-20% lower compared with total knee replacement.

In India, insurance companies cover knee replacement surgery costs so the out of pocket cost for Indian patients is fewer.

The average knee replacement surgery cost in Turkey ranges from 5,514 $ to 16,140 $.

The average knee replacement cost in a private hospital ranges from 9,500 $ to 15,000$ in Dubai.

Causes and reasons of knee replacement surgery:

The main reason for knee replacement surgery is arthritis. Although arthritis has many different types, the most common type of arthritis is of the following three types: Osteoarthritis – Rheumatism –Arthritis

1- Bone Arthritis

This type of osteoarthritis can occur as people age 50 or older, and can occur at a young age, as a result of overwork. Bones wear out and cause pain. If the knee joint is damaged by arthritis or by trauma, very simple activities such as walking and climbing stairs will be difficult for you. It may even be painful to sit or lie down.

2- Osteoarthritis

Knee arthritis is the most important cause of knee joint in people over 40 years of age. Knee arthritis is the most common destructive disease in the joints of the body. In arthritis, the joints become dry and painful. Also, the patient may not use the joint because of the severe pain, so the muscles around the joint weaken and even – the joint movement becomes very difficult. In such a case the knee replacement surgery is necessary.

3- Rheumatoid Arthritis

In rheumatoid arthritis the synovial membrane grows and becomes inflamed and releases a large amount of fluid. Inflammation of the synovial membrane gradually destroys and damages the knee articular cartilage, thereby causing pain and movement limitation of the knee joint.

4-Rheumatism

In this type of nosocomial disease, the joints around knee become thick and swollen. This swelling causes damage to the cartilage and eventually their loss, pain and tightening. Rheumatism is one of the most common types of inflammatory arthritis which in severe cases require knee replacement surgery.

Knee replacement surgery is suitable for people with the following conditions:

People who feel pain or severe stiffness in the knee that they suffer from daily activities such as walking, climbing stairs, getting on and off the car, climbing a chair and etc. will need knee replacement. Persistent knee pain which is felt while sleeping and resting is another symptom. Chronic inflammation of the knee and swelling in these cases will not resolve after taking medication and rest.

Deformity of the knee, which is quite obvious, sometimes leading to bracing or cracking of the legs.

Types of knee arthroplasty (partial, total)

In knee joint replacement, the fractured end of the bone and any remaining cartilage are removed and replaced with metal and plastic parts. Plastic acts like stiff cartilage and helps the joint to move freely. Also, the interconnected parts of the knee joint allow you to bend your knee and also to hold its steel.

1- Total (Complete) knee replacement

Most knee arthroplasty surgery involves a superficial joint replacement of the femur and a superficial joint in the tibia. Complete knee replacement may involve replacing the surface below the knee socket (patella) with a flat plastic prosthesis. Some surgeons prefer to preserve the normal patella of the knee where possible, but sometimes this decision must be made during surgery.

2- Integrated (partial) knee joint replacement

If arthritis affects only one side of your knee, partial replacement of the knee joint is usually performed for the inner part. The knee consists of three parts: the middle, lateral, and knee bowl. If arthritis affects only one side of your knee, it is usually possible for the inner part of the knee to be replaced (partial replacement). Since this method has less interference with the knee than the full knee replacement method, it has a faster recovery and better performance. Partial knee replacement can be done by making a smaller incision than the complete knee replacement procedure and also a minimally invasive procedure. A smaller incision may reduce recovery time.

What are the risks and side effects of total knee arthroplasty?

Similar to other medical procedures, the total knee arthroplasty has its risks and side-effects. These risks include:

• Blood clots in the lungs or the leg vein which is named DVT or pulmonary embolism (PE).
• Heart attack or MI
• Stroke or CVA
• Nerve damage
• Infection in surgical site

Infection is one of the most dangerous and frequent risks of total knee arthroplasty. If it happens, the infected parts should be removed during another surgery, and antibiotics are prescribed as follow up treatment. After the elimination of infection, another surgery is needed to install a new knee joint.

When should you decide to have knee replacement surgery?

In cases where the knee joint has suffered a lot of damage, usually the last way to get rid of the resulting pain is to have knee replacement surgery. The decision to have joint replacement surgery is not the sole responsibility of the orthopedist. This is a collective decision in which the patient and his family must also be involved.

In the following conditions, knee replacement may be helpful to the patient:

• Severe pain in the knee joint that restricts daily activities such as walking, climbing stairs, and sitting and getting up from a chair.
• Moderate to severe knee pain, even at rest.
• Knee pain with deformity and deviation of the knee.
• Knee pain with dry joint movement.
• Pain is not reduced with anti-inflammatory drugs.
• Do not tolerate painkillers or side effects caused with them.
• Lack of knee healing with other surgeries.

What are the expectations of knee replacement surgery?

It is very important that before the surgery, the patient should know what benefits this operation has for him and what problems he can not solve and what problems it can cause for him. More than 90% of people have significantly reduced pain after a knee replacement and are better able to perform daily activities. Of course, this surgery can never make your knee look exactly like a healthy knee. After surgery, you can do activities such as walking, swimming, cycling, driving, climbing stairs or climbing. Activities such as brisk walking, hill climbing, skiing, tennis, lifting objects weighing more than 25 kg are not suitable for the artificial joint, and activities such as running, jumping and impact exercises are very dangerous for the artificial joint.

Recovery and rehabilitation period after knee replacement surgery

Many people are concerned about the length of time they can recover from a knee replacement. 98% of people who use this treatment can continue their daily activities after surgery without any problems. Complications from surgery are very low, about 2%. This surgery is one of the most common surgeries with successful results. The recovery period after surgery usually takes about 12 weeks. Of course, depending on the lifestyle, the recovery period may take between 6 and 12 months.

Step 1 (Days 1 to 7): Stay in the hospital

After surgery, the patient stays in the hospital for some time to be evaluated by a doctor, physiotherapist, or orthopedic surgeon. The patient can then return home to continue his recovery.

Step 2 (Week 1 to 3): Start the rehabilitation program

In the first few weeks after surgery, the patient is unable to walk without the use of assistive devices such as crutches or walkers. The patient also has difficulty performing simple activities such as sitting, walking or climbing stairs and driving. At this stage, the knee becomes painful and stiff. A special rehabilitation program will be used to improve joint function. Your doctor will also prescribe painkillers to control the pain.

Step 3 (Week 3 to 6): Program to increase strength and range of motion and practice walking

In the third to sixth weeks, a rehabilitation program will be performed under the supervision of a physiotherapist using walking and light cycling. At this stage, the patient sees the most progress in improving range of motion and increasing strength, and more stability will be felt in the knee joint. There may still be pain and limited movement at this stage. Activities such as walking, sitting, and climbing stairs may still be difficult for the patient and may require assistance in performing these movements.

Step 4 (Weeks 6 to 12): Improve performance without the need for tools

At this stage, there is a significant improvement in the range of motion of the knee joint and the patient’s muscular strength, and the patient is able to perform daily activities without causing pain. In the sixth to twelfth week, the patient can use the stairs without the use of assistive devices. It is also easier for the patient to use a replaced knee joint. At this stage, the patient can perform all the basic activities needed during the day.

Step 5 (Week 12 onwards): Ability to perform recreational and sports activities and the possibility of performing job duties

At this stage, with the help of a rehabilitation program, the patient can perform recreational and sports activities as well as occupational tasks that require a lot of physical force.

Step 6 (six months after surgery): Complete the healing process

At this stage, the healing process after the knee replacement is complete. Even after this step, the strength and range of motion of the knee joint may increase for several months.

References

https://my.clevelandclinic.org/

https://medscape.com

https://webmd.com