Replacing a diseased knee joint
Every step you take involves the use of your knee, so the pain of a diseased or damaged knee can make a person feel discouraged about life. Even something as small as squatting down to get a newspaper can cause pain. But you don’t have to do this all the time; orthopedic surgeons are able to perform knee replacements on many of these patients. The procedure is safe and effective, and for many patients, having the surgery means being able to resume pain-free activities. We’ll help you understand what knee replacement surgery can mean for you, and we can also answer many of your questions.
Problematic knee joints
No matter what your age, problems with your knee joint can affect the activities you love. Pain and stiffness can lead to limitations in daily tasks. These conditions can also get progressively worse over time. Pain in the knee can be caused by.
1. a more severe knee injury that has not been properly treated
2. Chronic diseases of the knee joint
3. Wear and tear caused by years of constant use of the knee joint.
Purpose of surgery
You don’t have to live with knee pain for the rest of your life. A total knee replacement can reduce knee pain. During the surgery, the faulty knee joint is replaced with an artificial joint (prosthesis). The surgery does not make you younger, but it can provide real benefits.
Benefits of knee replacement
After surgery, your mobility will be easy. The vast majority of patients will be able to enjoy the following benefits.
1. Greatly reduced or eliminated joint pain, although the surgical pain will only be relieved for a few weeks.
2. Increased leg strength. Without knee pain, you will be able to move regularly, which will increase muscle strength.
3. Improve quality of life. You will be able to perform daily tasks and low-intensity activities comfortably after surgery.
4. Gain the ability to move freely. Most knee replacements last for many years.
Removal of the diseased knee surface The knee joint is replaced by an artificial joint
How the knee joint works
A normal knee joint can easily flex, absorb pressure, and glide smoothly. This allows you to walk, squat, and rotate without pain. When the knee joint is diseased, it loses its ability to cushion pressure. This results in pain when you move. Sometimes the diseased knee also feels painful and swells when at rest.
A healthy knee
A healthy knee is a hinge joint that connects the femur to the tibia. A healthy knee joint has a smooth tissue covering that allows it to move freely.
1. Cartilage: It is a smooth, soft layer of tissue. It covers the end of the femur and tibia as well as the inner surface of the kneecap. It is able to absorb pressure when normal and allows the joint to glide freely.
2. Ligament: is another soft tissue. It maintains the normal position between the bones of the knee joint.
3. Muscle: Makes the joint and leg move.
4. Tendon: holds the muscle to the bone.
Diseased knee joints
When one or more parts of the knee joint are diseased, joint movement will be affected. Over time, the cartilage begins to break down or wear away. As the cartilage does not repair itself, the damage gradually worsens. Initially, only a little stiffness is felt, and then pain occurs when the bone rubs directly against the bone.
Osteoarthritis
Normal use over the years can also cause cartilage to break down and wear away (osteoarthritis). Exposed bone rubbing against each other will cause roughness and indentations. If there is excessive weight bearing or abnormal force lines, such as inversion or valgus of the knee, the increased forces on the knee joint can accelerate wear and tear.
Inflammatory arthritis
Chronic diseases such as rheumatoid arthritis and gout can cause swelling and heat in the joints. Disease progression will cause cartilage destruction and joint stiffness.
Traumatic arthritis
Traumatic injuries can damage the knee joint. If not treated properly, the joint may be subjected to additional stress. Over time, the cartilage will wear away (traumatic arthritis).
Is surgery right for you?
Your doctor will try to reduce the pain in your damaged knee with medication and may also use a knee arthroscope to treat it. If none of these work, a total knee replacement is worth considering. You will need a thorough examination and x-rays, and your doctor will evaluate the condition of your damaged knee. In developing a treatment plan, your doctor will consider what procedure is best for you.
Medical history
Include all previous medical conditions. You should tell your doctor about any injuries or illnesses in the knee, any causes of increased pain, any other joint problems, and any bleeding or anesthetic problems.
Physical Examination
The doctor will thoroughly examine your knee to determine the extent of the swelling and check the strength, stability, and range of motion of the muscles, ligaments, and joints. It will also be checked for other problems that can cause pain in or around the knee, such as a compressed lumbosacral nerve root.
X-rays
X-rays provide a picture of the diseased knee, showing changes in the shape and size of the joint. Bone spurs, bone cysts, and depressions can be seen where the cartilage has worn away. x-rays can also help the doctor determine the exact placement of the prosthesis.
Treatment Planning
Your doctor uses the results of the exam and labs to develop a treatment plan that is right for you. Depending on the age and extent of the damage, the best solution is offered to you. Artificial joints can last for many years and can be renewed as they wear out. However, if you are younger, your doctor may recommend postponing surgery and using medications or arthroscopy to manage symptoms until a joint replacement is appropriate.
Preparing for surgery
Perhaps there are some small changes you should make at home before surgery that will make recovery easier afterwards. Remember to address medical and dental conditions and stop smoking before surgery to reduce the risk of surgery and improve the likelihood of recovery.
Preparation at home
To make life easier and safer after surgery, you should reduce indoor hazards while limiting the number of trips up and down the stairs. Keep things in easy reach, have some canned or frozen foods on hand, and remove things that are easy to trip over.
Arrange for help
Someone will need to take care of you for a few weeks after surgery. Planning ahead of surgery can prevent anxiety during recovery.
See your doctor
You will need an electrocardiogram to determine which anesthetic can be used. You will also have a chest x-ray as well as laboratory tests, and your doctor will tell you about any problems that are found. High blood pressure and diabetes will need to be treated before surgery.
Medication status
It is very important to tell your doctor about all the medications you take, including occasional use. Some have an effect on anesthetics, others such as aspirin and ibuprofen can increase bleeding. To avoid problems, some medications need to be stopped before surgery.
Complete dental treatment
Address problems with your teeth and gums before surgery. Otherwise, bacteria can enter the bloodstream from the mouth and infect the new joint. This will slow down the recovery and the joint prosthesis must be removed in case of severe joint infection.
Storage of autologous blood
Sometimes, blood transfusions are needed to compensate for the loss of blood during surgery. Donated blood is screened to reduce the possibility of transmitting HIV, hepatitis and other diseases. However, you may want to be able to store your own blood before surgery and have it returned to you at the time of surgery to reduce the risk. Your doctor will discuss with you about preoperative blood preparation.
Knee replacement surgery
You will want to arrive at the hospital a few days before your surgery. Sometimes, pre-operative tests need to be completed within a few days before surgery. Follow your doctor’s instructions to complete your preoperative preparation. When you arrive at the hospital, there are several forms to fill out and the anesthesiologist will tell you about the problems. It is normal to be a little nervous, but you should know that this is a common procedure that usually has good results.
Pre-operative preparation
You will be told when to stop eating and water before surgery. If there are medications that need to be taken daily, ask if they can be continued on the morning of the surgery. In the hospital, your temperature, pulse, breathing and blood pressure will be checked. An infusion line will need to be established to allow for fluids and medications to be administered during the procedure.
Risks and complications
As with any surgery, there are possible risks and complications associated with knee replacement. They include.
1. various reactions to anesthetic drugs
2. blood clots
3. damage to adjacent bone, blood vessels, and nerves
4. dislocation of the patella
5. Infection
6. Loosening of the prosthesis in the distant future
Surgical procedure
After the surgeon is ready, you will be taken into the operating room. Anesthesia is first administered, which allows you to sleep through the procedure or numbness from the waist down. Then, an incision is made in front of the knee joint and the diseased bone is removed and replaced with a new joint. The incision is then sutured closed.
Preparation of the bone
The bony surface of the diseased joint will be cut and shaped to fit the prosthesis. The size and force line of the prosthesis will be checked at this time.
Assembling the new joint
Once the prosthesis fits, the various components are placed on the femoral, tibial and patellar surfaces, which make up the new joint.
In the recovery room
After surgery, you will be taken to a post-anesthesia recovery room or sent directly back to your room. You will be monitored closely and given pain medication. You may also have a catheter and wound drainage tube left in place. A CPM (continuous passive mobilizer) may be used in the knee area to move the knee joint and prevent stiffness.
A brace may be used to immobilize the knee early after surgery to reduce pain and prevent knee flexion.
During hospitalization
After you wake up, you will return to your hospital room. Your family and friends may come to visit you. You will feel pain from the incision, and you will need to be able to answer exactly how much pain you feel in order to achieve the best pain relief. Soon the physiotherapist will start treatment, so follow what they teach you for a faster and safer recovery.
CPM is used to maintain the mobility of the knee joint
On the ward
On the day of surgery and for the first few days, you will be closely supervised. The following equipment may be used.
1. CPM to maintain mobility of the knee joint.
2. A bed suspension bar to help lift your body when you change position.
3. Special stockings or a foot pump to reduce the risk of blood clots, and possibly medication to prevent blood clots.
Pain relief
For the first few days, pain medication may need to be injected or administered. Even then, there will be a little pain. If the medication does not work at all, be sure to tell the nurse.
Active control pain management
Active pain control gives you control over the use of pain medication. When you push the pain pump button, the pain medication enters your body through an intravenous channel. It provides consistent pain relief, and because of its built-in safety settings, you won’t use too much medication.
After surgery, you should actively practice ankle flexion and extension as soon as the anesthesia returns.
Special treatment
During your hospital stay, you will learn techniques that will help you return to your normal life. You will learn how to strengthen your legs and walk. To make movement easier, use some pain medication before moving around.
Gaining Strength
Physical therapy programs usually begin with gentle movement. You will learn ways to increase blood flow and control swelling. Exercising your quadriceps to strengthen your legs can protect your joints by making them more stable. Exercises also help you reach your goal of pain-free weight bearing.
Walking again
If you have enough strength, you will be able to stand a day or two after the surgery, at the discretion of your doctor, of course. However, the infusion remains in place and using a walker may be a bit inconvenient. Don’t worry, the physiotherapist will help you and teach you to feel how much weight your new joint can carry. With practice, you will soon be able to walk with the help of a walker.
How to walk with a walker
Start walking with the aid of a walking frame, and when your weight is stable, switch to a bilateral axillary cane. Place the walker 20 cm in front of your body and step the operated leg first, then follow the non-operated leg. So on and so forth.
How to go up and down stairs
When going up the stairs, first step the healthy leg up the steps, then step the operated leg up the steps, when going down the stairs, first move the double crutches to the next step, then step the operated leg down the steps, and finally step the healthy leg down the steps. How to walk with the double crutches by putting your body weight on your hands, not your armpits, and taking the surgical leg first while moving the crutches forward, and then taking the healthy leg to the front of the double crutches
After any surgery, there can be a build-up of fluid in the lungs. Deep breathing and coughing up sputum can prevent the development of pneumonia. You should do this often – at least a few times an hour. A spirometer can be used to help you breathe deeply.
Rehabilitation
Whether at home or in a rehabilitation facility, it is important that you take care of your new joints. Practice movements that will increase strength and range of motion. For the best recovery, you should avoid risky movements and return to the hospital for regular checkups. Return to activity slowly; a little stiffness in the knee is normal at the beginning.
Increase muscle strength
Stronger leg muscles reduce the forces on the knee joint, which can sustain the joint for longer.
Quadriceps exercises
The easiest and simplest way to do this is to practice straight leg raises. Hook your toes back hard, bounce the muscles in front of your thighs and calves, bounce your knees straight, lift your thighs slowly off the bed, then lower them slowly, and so on.
Increase joint movement
Seated knee flexion exercises
It can make the new joint flexion more smooth. Follow the learned movements to practice knee flexion and extension.
1. Sit in a chair and place a towel under the new joint.
2. Extend your leg as straight as possible and maintain the movement to a count of 5.
3. Then bend the knee joint as much as possible and maintain the movement for a count of 5.
4. Keep repeating.
Review
A post-operative review will allow your surgeon to determine how well your joint is healing. The incision sutures are usually removed 2 weeks after surgery.
Go to the hospital when you have the following symptoms.
1. increased pain in the knee joint.
2. pain or swelling in the lower leg or thigh.
3. unusual redness, heat or pus flowing from the incision site
4. difficulty breathing or chest pain.
5. Fever over 38℃.
Avoid dangerous activities
Some activities can increase the pressure on the new joint, which can cause the prosthesis to wear faster. Care should be taken to protect the new joint.
Do not twist the knee joint and do not engage in high-intensity activities such as running, jumping, race walking or playing basketball when you turn but do not move your foot.
Avoid twisting the knee joint, you should move your foot first and then turn around
Recovery activities
Practice walking daily to increase strength. Gradually increase your activity level each week. You can drive or return to office work one month after surgery. If the work is more intense, you will need to take 3-4 months off before working. Total knee replacement is a larger surgery, so it takes several months to really recover.