An injured or diseased knee can make daily activities painful or unbearable.. For patients who want to stay active, knee replacement or reconstruction surgery may be the best option to regain quality of life.
Reconstructive knee surgery is now one of the most common procedures performed in orthopedic medicine., with an estimate of 100.000 operations per year.
Damage to the ACL (Anterior cruciate ligament), the most common injury, occurs in athletes who play basketball, football, tennis or soccer, or in the skiers. An MRI helps reveal the extent of damage.
Alterations of the mechanical axis, the sequelae of traumatic injuries and osteoarthritis are the causes that most frequently require surgical reconstruction of the knee. According to the degree of alteration, different surgical procedures are performed, among which are arthroscopy, mechanical axis aligning osteotomies, single compartment replacement prostheses and total knee replacement. The indications for each of these procedures depend on the type and degree of injury.. Until now, these treatments are not considered to be definitive or curative of osteoarthritis and mainly seek to improve the clinical conditions of the patient and reduce the evolutionary process of joint degeneration as much as possible.. Even total knee replacement, which is considered a definitive surgical procedure, is temporary due to its natural tendency to loosen and wear out.
If your knee is severely damaged by arthritis or an injury, simple activities may be difficult for you, like walking or climbing stairs. You may feel pain even while sitting or lying down.
If non-surgical treatments such as medications and wearing walking supports no longer help, maybe you would want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity and help you return to normal activities.
Knee replacement surgery was performed for the first time in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacement is one of the most successful procedures in all of medicine. According to the Agency for Research and Quality of Health Care, more of 600,000 knee replacements are done every year.
The knee is the largest joint in the body and healthy knees are required for most daily activities..
The knee is made up of the lower end of the thigh bone (femur), the upper end of the shin (tibia) and the kneecap. The ends of these three bones where they touch are covered with cartilage, a soft substance that protects bones and allows them to move easily.
The menisci are located between the femur and the tibia. These C-shaped wedges act as “shock absorbers” that cushion the joint.
Long ligaments hold the femur and tibia together and provide stability. Long thigh muscles give strength to the knee.
All other surfaces of the knee are covered by a thin lining called the synovium.. This membrane releases a fluid that lubricates the cartilage, reducing friction to practically zero in a healthy knee.
Usually, all these components work in harmony. But illness or injury can distort this harmony, with the result of pain, muscle weakness and reduced function.
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by only three types: osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.
ACL surgery is the surgical reconstruction or replacement of the anterior cruciate ligament (LCA) knee. Thigh bone (femur), the warm (tibia) and the kneecap (ball joint) join together to form the knee joint. Ligaments connect these bones to each other. Your ACL is a type of knee ligament. It is a band of fibrous and resistant connective tissue that stabilizes the knee.
Injuries requiring ACL reconstruction or replacement are common, especially among athletes. ACL Reconstruction Surgery May Help Restore Range of Motion, the stability and pain-free function of a knee joint after an ACL injury.
ACL surgery is a common but important surgery with risks and possible complications. You may have less invasive treatment options. Consider getting a second opinion on all of your treatment options before having ACL surgery.
Types of ACL surgery
Injured or torn ACLs do not heal well when the ligament is sewn back together. However, ACL reconstruction surgery uses a connective tissue graft to reconstruct or replace your injured ACL. Both ligaments and tendons are connective tissues. Your body heals around the graft over several months.
Types of ACL surgery procedures include:
Allograft reconstruction. An allograft is a piece of connective tissue from a cadaver, usually a tendon. Allografts come from a tissue bank. Allograft reconstructions require only one incision and cause less pain than an autograft fusion. Nevertheless, there is a small risk of serious infection, including HIV and hepatitis.
Autograft reconstruction. An autograft is a piece of your own connective tissue. Doctors usually take an autograft of a part of the patellar tendon (ball joint). This is the gold standard for ACL autograft reconstruction. Your patellar tendon will heal on its own and the missing part will grow back over time. Other autograft sites include the hamstring and quadriceps tendons.. These sites do not heal as reliably as your patellar tendon. An autograft requires an additional large incision, lengthens surgery time and causes more postoperative pain than allograft reconstruction.
Reconstruction with synthetic or artificial graft. Artificial ligament graft materials have been studied in trials, but they haven't worked as well as human tissue grafts. Synthetic grafts are still experimental at this time.
Xenograft reconstruction. A xenograft is a piece of connective tissue extracted from non-human animal sources. Actually, medical scientists are conducting human trials of xenograft reconstructions.
Other procedures that can be performed
Meniscectomy is the surgical repair or trimming of a torn meniscus . Your knee has two menisci. They are made of cartilage and work as shock absorbers for the knee joint.
Other ligament reconstructions. Your knee contains four ligaments, including your ACL. Other knee ligaments may also need reconstruction depending on your injury..
Patellar realignment is the surgical repositioning of the patella.
Synovectomy is the surgical removal of part of an inflamed synovium. Synovial membranes are tissues that line the joints, including knee.
ACL surgery is a major surgery that reconstructs or replaces an anterior cruciate ligament (LCA) torn at knee. Your doctor may only consider ACL surgery if it suits your needs and lifestyle..
Your doctor may recommend surgery to treat complete ACL tears in the following cases:
Active adults who want to get back to heavy work or sports that require pivoting, to turn, twisting or harsh lateral knee movements.
Combined injuries when other knee injuries are present with a ACL tear
Older children or adolescents whose growth plates have closed. ACL surgery carries the risk of damaging the growth plate in younger children. This can lead to growth problems. Your child's surgeon may recommend delaying or modifying ACL surgery to reduce the risk of growth plate damage..
Symptoms of functional instability that include knee pain or a knee that gives way during daily activities. This increases the risk of further damage to the knee..
Non-surgical treatment may be a reasonable option when these conditions are not met.. Non-surgical treatment may be a good option for older people with a low level of activity. Ask your doctor about all of your treatment options and consider getting a second opinion before undergoing ACL surgery..
Knee replacement is a type of arthroplasty. Arthroplasty literally means “surgical repair of a joint” and involves surgical reconstruction and replacement of degenerated joints, using artificial body parts or prosthetics.
When the articular cartilage of the knee is damaged or worn, becomes painful and the knee is difficult to move. Instead of sliding over each other, bones rub and crush.
With a prosthesis, the patient will feel less pain and the knee will move properly.
You will only need a knee replacement if your knee hurts., rigidity, instability or loss of function that affects your life and daily activities.
On a healthy knee, the ends of the thigh and shin bones are covered with hard cartilage that allows the bones to move easily with each other. Arthritis damages hard cartilage and makes it thin. In some places, cartilage can wear down so your bones rub against each other and wear out.
In a knee replacement operation, the worn ends of the bones and any remaining hard cartilage are removed and replaced with metal and plastic pieces. Plastic acts like hard cartilage, which helps the joint to move freely. The interlocking parts of the artificial joint allow the knee to bend while making it more stable.
You will not necessarily need a knee replacement if you have knee arthritis. But it may be worth considering if your knee is damaged by arthritis and pain., the disability or stiffness is having serious effects on your daily activities.
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very severe. This may be because:
The four main types of knee replacement surgery are:
There are several types of replacement knee joints, as well as different surgical methods. Your doctor and orthopedic surgeon should help you choose the best option for you, taking into account the condition of your knee and your general health.
Most total knee replacement operations involve replacing the joint surface at the end of the thigh bone. (femur) and the surface of the joint at the top of the shin (tibia).
A total knee replacement may also involve replacement of the lower surface of the patella. (ball joint) with a soft plastic dome. Some surgeons prefer to preserve the natural patella if possible, but sometimes it will be necessary to make the decision during the operation.
If you have had a previous operation to remove the patella completely (patelectomy), this will not prevent you from undergoing a knee replacement, but it may affect the type of replacement part (prosthesis) what does your surgeon use.
New parts are usually cemented in place. If no cement is used, the surface of the component facing the bone is textured or coated to stimulate bone growth over it, forming a natural union.
Another common technique is to use a moving plastic bearing that is not firmly attached to metal parts.. This can help reduce wear and tear on your new joint., although it has not been shown to provide better long-term results.
If the arthritis affects only one side of the knee, usually the inner side, partial replacement may be done (unicompartimental) on your knees.
There are three compartments of the knee: inside (medial), the outside (lateral) and the kneecap (femororrotuliana). If the arthritis affects only one side of the knee, usually the inner side, a mid-knee replacement may be done (sometimes called unicompartmental or partial replacement). Because this involves less interference with the knee than a total knee replacement, generally means faster recovery and better function.
Partial knee replacements can be done through a cut (incision) smaller than a total knee replacement, using techniques called minimally invasive or minimally invasive surgery. A smaller incision can further reduce recovery time.
Partial knee replacement is not suitable for everyone because you need to have strong and healthy ligaments within the knee. Sometimes, this will not be known until the time of surgery.
Research shows that people who have a partial knee replacement are more likely to have their knee checked than people who have a total knee replacement; approximately 1 decade 10 need additional surgery after 10 years. Although the operation involves less interference with the knee, often a more complex operation than total knee replacement. Therefore, your surgeon may prefer to offer you a more predictable total knee replacement.
Partial knee replacement can be considered at any age. For younger people, offers the opportunity to preserve more bone, which is helpful if you need revision surgery at a later stage. For the elderly, partial knee replacement is a less stressful operation with less pain and less risk of bleeding. Nevertheless, the result of the surgery depends on the type of arthritis, more than his age.
A patella replacement involves replacing only the bottom surface of the patella and its groove (trochlea) if these are the only parts affected by arthritis.
It is possible to replace only the lower surface of the patella and its groove (trochlea) if these are the only parts affected by arthritis. This is also called patellofemoral replacement or patellofemoral joint arthroplasty..
The operation has a higher failure rate than total knee arthroplasty, which may be due to arthritis progressing to other parts of the knee. Some surgeons recommend a total knee replacement as the results are more predictable. Others believe that the rest of the knee joint is best preserved if it is not affected by arthritis..
The operation is only suitable for approximately 1 decade 40 people with osteoarthritis . Nevertheless, the outcome of patella replacement may be good if the arthritis does not progress and is a less important operation that offers faster recovery times. More research is needed to understand which people will likely do well with this operation..
A complex knee replacement may be needed if you are having a second or third joint replacement on the same knee, or if your arthritis is very bad.
Some people may need a more complex type of knee replacement. The usual reasons for this are:
These knee replacements generally have a longer stem, allowing the component to fix more securely in the bone socket. Components can also lock into the center of the knee to form a hinge for added stability. Additional pieces of metal and / or plastic to make up for any bone removed or badly damaged.
This type of operation may be necessary if you have a second or third joint replacement in the same knee., and it might be better early on if you have very severe arthritis.
There are several possible advantages of knee replacement surgery. These include:
Research has shown that four out of five people who have had knee replacement surgery are happy with their new knees. For those people who are not happy, the main cause of dissatisfaction is ongoing pain that may not be due to a problem with the operation. This is more risky if you have relatively minor joint damage (which can still cause severe symptoms) before the surgery.
This operation, which is done through keyhole surgery, involves drilling holes in exposed bone surfaces with a drill or pick. This stimulates the growth of new cartilage from the bone marrow.. The technique is not recommended for advanced arthritis.
This is an operation that can help younger patients. It consists of cutting the shin crosswise, creating a wedge to deflect load from the arthritis affected area. Osteotomy can be considered as a way to postpone a knee replacement operation. Nevertheless, can make it difficult to perform a successful total knee replacement later on, especially if during osteotomy the surgeon has to cut the medial collateral ligament on the inner surface of the knee.
On rare occasions, if the outside of the knee is affected by arthritis, this operation is performed at the end of the femur to shift the load inward.
Exercise and sports are recommended after knee replacement, in addition to contact sports, which can weaken the cementum and cause loosening of joint components. Recreational sports, including golf, tennis and skiing, will be possible gradually depending on how fit and sporty you were before the operation. Cycling is a great way to build strength and mobility after knee surgery.
It is very important to exercise the main muscle groups around the knee., both before and after a knee replacement. You can download a selection of exercises designed to stretch, strengthen and stabilize the structures that support your knee. Try to do these exercises regularly, for example, during 10 minutes six to eight times a day. Nevertheless, it is important to find a balance between rest and exercise so as not to overwork the knee. It is a good idea to check with your doctor or physiotherapist on specific exercises before starting.
Total knee replacement, also called total knee replacement, is a surgical procedure in which worn or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the warm (shin bone) and the kneecap (ball joint). The meniscus, the soft cartilage between the femur and the tibia, serves as a cushion and helps absorb shock during movement. Arthritis (joint swelling), Injuries or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve symptoms..
There are three common reasons for the procedure:
Osteoarthritis : this type of arthritis is age-related, caused by normal wear and tear on the knee joint. It mainly affects patients older than 50 years, but younger people can have it.
Osteoarthritis is caused by inflammation , gradual and eventual degradation and loss of cartilage in the joints. Over time, cartilage wears down and bones rub. To compensate, bones often get thicker, but this produces more friction and more pain.
Rheumatoid arthritis : also called inflammatory arthritis, the membrane around the knee joint becomes thick and swollen. Chronic inflammation damages cartilage and causes pain and stiffness.
Postraumatic arthritis : this type of arthritis is due to a serious knee injury. When the bones around the knee break or the ligaments break, this will affect the cartilage of the knee.
Knee surgery may be suitable for patients who experience:
If the other available treatment options have not worked, surgery may be the best option.
Knee replacement can be total or partial.
Total knee replacement (TKR) : surgery involves the replacement of both sides of the knee joint. It is the most common procedure.
The surgery lasts between 1 Y 3 hours. The individual will have less pain and better mobility, but there will be scar tissue that can make it difficult to move and bend the knees.
Partial knee replacement (PKR) : partial replacement replaces only one side of the knee joint. Less bone is removed, so the incision is smaller, but it doesn't last as long as a full replacement.
PKR is suitable for people with damage to only one part of the knee. Postoperative rehabilitation is easier, there is less blood loss and a lower risk of infection and blood clots.
The hospital stay and recovery period are usually shorter and there is a greater chance of more natural movements.
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