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Knee Joint Replacements

Knee joint replacement is surgery to replace a knee joint with an artificial artificial joint.. The artificial joint is called prosthesis .

Damaged cartilage and bone are removed from the knee joint. Later, artificial pieces are placed on the knee.

These pieces can be placed in the following locations on the knee joint:

  • Lower end of the thigh bone: this bone is called femur. The replacement part is usually made of metal.
  • Upper end of the shin, what is the large bone in the lower leg: this bone is called tibia. The replacement part is usually made of metal and sturdy plastic.
  • Back of the kneecap: the kneecap is called the kneecap. The replacement part is usually made of a strong plastic.

Knee replacement surgery, also known as knee replacement (ARTH-row-plas-tee), can help relieve pain and restore function in severely diseased knee joints. The procedure involves cutting the damaged bone and cartilage of the femur, the tibia and patella and replace them with an artificial joint (prosthesis) made of metal alloys, high-quality plastics and polymers.

To determine if a knee replacement is right for you, an orthopedic surgeon evaluates range of motion, the stability and strength of your knee. X-rays help determine the extent of damage.

Knee Joint Replacements in Bogotá

Si su rodilla está gravemente dañada por la artritis o una lesión, puede resultarle difícil realizar actividades simples, como caminar o subir escaleras. Incluso puede comenzar a sentir dolor mientras está sentado o acostado.

Si los tratamientos no quirúrgicos como los medicamentos y el uso de soportes para caminar ya no son útiles, es posible que desee considerar la cirugía de reemplazo total de rodilla. La cirugía de reemplazo articular es un procedimiento seguro y eficaz para aliviar el dolor, corregir la deformidad de la pierna y ayudarlo a reanudar sus actividades normales.

La cirugía de reemplazo de rodilla se realizó por primera vez en 1968. Desde entonces, las mejoras en los materiales y técnicas quirúrgicas han aumentado enormemente su eficacia. Los reemplazos totales de rodilla son uno de los procedimientos más exitosos de toda la medicina. Según la Agencia para la Investigación y la Calidad de la Atención Médica, se realizan más de 754,000 reemplazos de rodilla al Año

Ya sea que haya comenzado a explorar opciones de tratamiento o que ya haya decidido someterse a una artroplastia total de rodilla, este artículo lo ayudará a comprender más sobre este valioso procedimiento.

Anatomía de la Rodilla

La rodilla es la articulación más grande del cuerpo y se requiere tener rodillas saludables para realizar la mayoría de las actividades diarias.

La rodilla está formada por el extremo inferior del hueso del muslo (fémur), el extremo superior de la espinilla (tibia) y la rótula (rótula). Los extremos de estos tres huesos están cubiertos con cartílago articular, una sustancia suave que protege los huesos y les permite moverse fácilmente dentro de la articulación.

Los meniscos se encuentran entre el fémur y la tibia. Estas cuñas en forma de C actúan como “amortiguadores” que amortiguan la articulación.

Los ligamentos grandes mantienen el fémur y la tibia juntos y proporcionan estabilidad. Los músculos largos del muslo dan fuerza a la rodilla.

Todas las superficies restantes de la rodilla están cubiertas por un revestimiento delgado llamado membrana sinovial. Esta membrana libera un líquido que lubrica el cartílago, reduciendo la fricción a casi cero en una rodilla sana.

Normalmente, todos estos componentes funcionan en armonía. Pero una enfermedad o una lesión pueden alterar esta armonía, provocando dolor, debilidad muscular y reducción de la función.

Causas comunes de los reemplazos articulares

La causa más común de discapacidad y dolor crónico de rodilla es la artritis. Aunque existen muchos tipos de artritis, la mayoría de los dolores de rodilla son causados ​​por solo tres tipos: osteoartritis, artritis reumatoide y artritis postraumática.

  • Osteoartritis. Este es un tipo de artritis de “desgaste y rotura” relacionada con la edad. Por lo general, ocurre en personas de 50 años o más, pero también puede ocurrir en personas más jóvenes. El cartílago que amortigua los huesos de la rodilla se ablanda y se desgasta. Luego, los huesos se frotan entre sí, causando dolor y rigidez en la rodilla.
  • Artritis Reumatoide. Esta es una enfermedad en la que la membrana sinovial que rodea la articulación se inflama y se engrosa. Esta inflamación crónica puede dañar el cartílago y eventualmente causar pérdida de cartílago, dolor y rigidez. La artritis reumatoide es la forma más común de un grupo de trastornos denominados “artritis inflamatoria”.
  • Artritis postraumática. Esto puede seguir a una lesión grave en la rodilla. Las fracturas de los huesos que rodean la rodilla o los desgarros de los ligamentos de la rodilla pueden dañar el cartílago articular con el tiempo, causando dolor en la rodilla y limitando su función.

La cirugía de reemplazo de rodilla (artroplastia) es una operación común que implica reemplazar una rodilla dañada, desgastada o enferma con una articulación artificial.

Los adultos de cualquier edad pueden considerarse para una artroplastia de rodilla, aunque la mayoría se realiza en personas de entre 60 y 80 años.

Una operación más pequeña llamada reemplazo parcial de rodilla tiende a realizarse en personas más jóvenes de entre 55 y 64 años, donde se espera que la articulación artificial deba rehacerse dentro de los 10 años.

Un reemplazo de rodilla (también llamado artroplastia de rodilla) podría denominarse con mayor precisión “rejuvenecimiento” de la rodilla porque solo se reemplaza la superficie de los huesos.

Hay cuatro pasos básicos para un procedimiento de reemplazo de rodilla:

  • Prepara el hueso. Las superficies de cartílago dañadas en los extremos del fémur y la tibia se eliminan junto con una pequeña cantidad de hueso subyacente.
  • Coloque los implantes metálicos. El cartílago y el hueso extraídos se reemplazan con componentes metálicos que recrean la superficie de la articulación. Estas partes metálicas pueden cementarse o “encajar a presión” en el hueso.
  • Vuelva a allanar la rótula. La superficie inferior de la rótula (rótula) se corta y se repara con un botón de plástico. Algunos cirujanos no reparan la rótula, según el caso.
  • Inserte un espaciador. Se inserta un espaciador de plástico de grado médico entre los componentes metálicos para crear una superficie de deslizamiento suave.

Knee Joint Replacement
Knee Type Joint Replacements

Knee Joint Replacements in Colombia

Types of knee replacement

Knee prostheses are classified according to how the affected bones are replaced, differentiating between total knee replacement, unicompartmental or review. Here we will see the differences and how they are fixed to the bone.

How is a knee replacement?

In the section What is the knee and when do I need a prosthesis? we have defined the knee as the joint between the lower part of the femur and the upper part of the tibia (and also of the patella with the femur). Prosthetics are used to restore function and restore function to the area and therefore have different components.

Knee prostheses are classified based on how the affected bones are replaced, but the most common are known as total knee replacement (PTR). The TTRs are attached to the tibia by means of a metal tibial tray and to the femur through condyles, also metallic. Between them there is a piece called an insert and made of a plastic (polyethylene) that facilitates the articulation of the femur and tibia. If the surgeon considers it appropriate, you can also replace the articular part of the patella with a polyethylene component.

The fixation of the components to the bone can be using bone cement or seeking the integration of these to the bone (depending on the bone quality of the patient).

Knee_total_prosthesis

When a knee replacement is needed

Knee replacement surgery is usually necessary when the knee joint is worn or damaged., so your mobility is reduced and you feel pain even while resting.

The most common reason for knee replacement surgery is osteoarthritis . Other health conditions that cause damage to the knee include:

  • Rheumatoid arthritis
  • hemophilia
  • gout
  • disorders that cause unusual bone growth
  • bone death in the knee joint after blood supply problems
  • knee injury
  • knee deformity with pain and loss of cartilage

Types of knee replacement surgery

There are 2 main types of surgery:

  • Total knee replacement: both sides of the knee joint are replaced
  • Partial replacement (half) on your knees: only one side of the joint is replaced in a smaller operation with a shorter hospital stay and recovery period

Other surgery options

There are other types of surgery that are an alternative to knee replacement, but the results are often not as good in the long run. Your doctor will discuss the best treatment option with you.. Other types of surgery may include:

  • Arthroscopic lavage and debridement: a small telescope is inserted (arthroscopy) in the knee, which is then washed with saline to clean any bone or cartilage fragments.
  • osteotomía: the surgeon cuts the shin and realigns it so that its weight is no longer supported by the damaged part of the knee
  • mosaicoplasty: a keyhole operation that involves the transfer of hard cartilage plugs, along with some underlying bone from another part of the knee, to repair the damaged surface

Types of knee implants

What types of knee prostheses are there on the market?

A knee replacement is used to prevent pain and restore function to patients suffering from joint wear and tear.. Depending on the type of wear, of the stability of the soft tissues or the existence of previous surgeries, you may be a candidate for the implantation of one or another type of knee replacement. Among the most common, we can name the following.

Knee-prosthetic_types

  • Unicompartmental knee prosthesis: Its main indication is the treatment of knee osteoarthritis that only affects one side of the joint., as not the whole knee is affected, prosthetic replacement should be limited to damaged regions. Nevertheless, many surgeons do not use it because it does not prevent the progression of the disease to the other side and because there is not much experience in its use. Its components are the same as in a total prosthesis, but only for one half of the knee.
  • Total knee prosthesis: It is the most common type of knee replacement. It consists of a complete replacement of the two articular surfaces and, As we already mentioned, it is made up of the following components:
    • Tibial tray: Made of metal (usually cobalt chrome or titanium alloys), fixes the prosthesis to the proximal tibia.
    • Femoral component: Attaches to the distal femur and acts as a friction surface, so it is usually made of chrome-cobalt.
    • Insert: It is located between the two anterior components and acts as a friction surface together with the femoral component. It is usually made of polyethylene.
    • Patellar component: It is not used in all cases and its use depends on the personal preferences of the surgeon. It is usually made of polyethylene.
  • Revision knee prosthesis: They are the systems used when it is necessary to replace an already implanted prosthesis. In the simplest cases, primary full dentures can be placed, but there are also implants specifically designed for these complex procedures. In revision surgeries there are usually stability problems and lack of bone. Biological products or additional prosthetic elements such as stems or supplements are used to fill bone defects.. More constricted prosthetic designs and even hinge-type knees can be used to stabilize the joint.. The revision knees can also be used in other types of cases in which there has been a great loss of bone mass, how can tumors be.

What type of total knee replacement (PTR) exist?

We commented that total knee replacement (PTR) are the most commonly used. But even within the PTR we can distinguish some types:

  • CR prosthesis (with crossover retention): For its implantation it is not necessary to remove the posterior cruciate ligament. This makes biomechanics more natural and more bone is preserved..
  • PS prosthesis (stabilized posterior): It is used when it is not possible or not desired to preserve the posterior cruciate ligament. Its function is replaced by the use of a post that stabilizes the prosthesis. Although it consumes more bone, many surgeons prefer the reliability of mechanical joint stabilization.
  • CS prosthesis (crossed sacrificed or ultracongruent): Both crusaders are sacrificed, but stabilization is achieved with a tighter polyethylene. It makes it possible to use an intermediate option between the two previous options and they confer superior stability without resecting the cruciate and with less bone consumption..
  • Rotary platform prosthesis: The polyethylene is not fully attached to the tibial tray and allows some rotational movement relative to it. Theoretically, this spreads the torsional movements between two different surfaces, reducing wear, the risk of loosening and improving the patient's proprioception. Nevertheless, the little clinical experience does not allow to elucidate if all of the above is true and, what's more, additional risks are introduced such as dislocation or possible damage to the polyethylene.

Types-of-total_ knee-prostheses

Are you considering a total knee replacement? There are a few different types of knee implants that are used in this procedure.. The different types are classified according to the materials that rub against each other when you flex your knee.:

Metal on plastic . This is the most common type of implant. Features a metal femoral component that mounts over a polyethylene plastic spacer attached to the tibial component. Commonly used metals include cobalt-chromium, titanium, zirconium and nickel. Metal on plastic is the least expensive type of implant and has the longest history of safety and implant life. Nevertheless, A problem that can occur with plastic implants is an immune reaction caused by tiny particles that wear away from the spacer.. This can cause the bone to break, causing the implant to loosen and fail. Advances in manufacturing have greatly reduced the wear rate of plastic.

Ceramic on plastic . This type uses a ceramic femoral component instead of metal (or a metal component with a ceramic coating). Also mounts on a plastic spacer. People who are sensitive to the nickel used in metal implants can get the type of ceramic. The plastic particles from this type of implant can also cause an immune reaction.

Ceramic on ceramic . The femoral and tibial components are made of ceramic. Ceramic pieces are the least likely to react with the body. Nevertheless, ceramic joint prostheses can make a squeak when walking. In rare cases, can break under strong pressure into pieces that must be removed surgically.

Metal on metal . The femoral and tibial components are made of metal. Metal-on-metal implants have been used much less frequently in recent years due to concerns about traces of metal leaking into the bloodstream. The metal comes from the chemical breakdown of the implant hardware. All metal implants were originally developed to provide longer lasting joint replacements for younger people, but traces of metal can cause inflammation, pain and possibly organ damage. Metal-on-metal implants can be considered only for young, active men, because they can last longer than other materials. Women of childbearing age cannot receive these implants because the effects on the fetus are unknown..

Knee Joint Replacement Procedure

A total knee joint replacement is an operation to remove damaged parts of the knee joint and replace them with metal and plastic parts.. The goal of surgery is to relieve pain and restore joint function.

Severe knee pain or stiffness that limits daily activities (for example: to walk, climbing stairs, sit and get up from chairs) is the main reason knee replacement surgery may be recommended. Other reasons are knee pain at rest and knee deformity. These problems are likely the result of the osteoarthritis o la rheumatoid arthritis .

Most people who have a total knee replacement have between 50 Y 80 years. Nevertheless, Eligibility for knee replacement surgery is based primarily on a person's level of pain and disability, not in your age.

An orthopedic surgeon will evaluate the need for a knee replacement based on your medical history and symptoms., physical exam (especially range of motion, stability, knee strength and alignment), blood test, X-rays or MRI scans (MRI). damaged knee.

A knee replacement is a major operation and there are many things to discuss with your surgeon., including risks and benefits of surgery.

An artificial knee joint (prosthesis) has smooth surfaces that replace worn surfaces within the knee joint. The prosthesis is made of metal alloys and hard plastic components that fit together during surgery. The procedure usually takes a few 2 hours.

The surgery begins with an incision in the front of the knee joint.. The surgeon will expose the knee joint, loosen the surrounding muscles and ligaments and pull the kneecap out of place. Worn surfaces within the joint, including the back of the kneecap, are removed and the ends of the bones are precisely reshaped. Later, the components of the artificial knee joint are attached to the ends of the bone with specialized bone cement and attached. The muscles and ligaments are repositioned and, if required, ligaments are adjusted to achieve the best possible knee function.

joint replacement

Arthroscopy

This technique consists of repairing tears in the soft tissues around the knee., the hip, shoulder and other joints. Damaged cartilage is repaired and broken pieces of cartilage are removed.

Replacement arthroplasty

An arthritic joint surface is replaced by an orthopedic prosthesis.

Joint rejuvenation

For knee joints, it is a unicompartmental or partial knee replacement. Implants are inserted into only one of the three compartments of the knee: the medial compartment (interior), lateral (exterior) o femororrotuliano (frontal). In the rejuvenation of the hip joint, a metal cup replaces the hip socket while the damaged hip ball is reshaped and finished off with a metal prosthesis.

Osteotomía

A bone is cut and removed, or a piece is added near a damaged joint. In the knee, an osteotomy shifts weight from an arthritic area to a healthy area. In the hip it is used to correct hip misalignment or dysplasia.

Synovectomy

Inflammatory arthritis affects the lining of the joints, synovium, and damages the cartilage and surrounding joints. In this procedure the affected synovium is removed.

Arthrodesis or fusion

Hardware such as pins are used, plates or rods to fuse two or more bones in the affected joint to create a continuous joint. As the bones grow together, stabilize the joint and hold it in place.

Total joint replacement (TJR) or total joint arthroplasty

The damaged joint is replaced with an implant constructed of plastic components, metal, ceramic or carbon coated. The implant works like the original joint.

Minimally invasive TJR

Like in TJR, this technique also replaces damaged joints, but with smaller incisions. It's about less cutting and reattachment of muscle.

Joint review

The life of an implant is 15 a 20 years. Those who acquire them at a young age may eventually need a second replacement, known as revision.

The relatively long-term efficacy of a joint replacement procedure provides a better quality of life. Painless movement, increased strength of the joints, easier management of daily activities and independence are possible.

Joint replacement means removing part or all of a damaged joint and installing hardware to allow the limb to move without pain or limitations.. The replacement hardware is called a prosthesis. These are made of plastic, metal, ceramic or a combination of these materials. Most joint replacements are done to treat arthritis damage to the knees or hips.. Orthopedic surgeons perform the procedure under general anesthesia.

The decision to replace a joint depends on several factors:

  • How severe are the symptoms? Moderate to severe pain, stiffness and limited function of the joint may indicate the need for a new joint.
  • How severe is the joint damage? An x-ray or other imaging test can show if the bone and cartilage in the joint have deteriorated.. The joint can also go out of alignment. Moderate to severe joint damage is an indication for joint replacement.
  • Does the joint problem limit daily activities and compromise a person's quality of life? This also indicates that joint replacement may be beneficial..

Like any major operation, joint replacement surgery carries the risk of possible complications. For example, there are small risks that you may have a reaction to the anesthesia, develop a blood clot or get an infection.

Knee Joint Replacements BOGOTA

Knee Joint Replacements

Knee joint replacement surgery can be performed under spinal or general anesthesia. This will be discussed with the surgeon and anesthetist prior to surgery and a decision will be made on which is the most appropriate..

At the end of the surgery, a tube will be inserted to drain excess fluid from the new joint. Later, the surgeon closes the layers of tissue and skin with stitches and a dressing is placed around the knee.

Antibiotics are given during and after the operation to prevent the development of an infection in the new joint.. A blood transfusion may also be necessary.

Measures may be prescribed to prevent blood clots and reduce swelling of the legs.. These may include compression stockings, inflatable leg protectors (compression boots) and blood thinning medications. Movement of the foot and ankle immediately after surgery is also recommended to stimulate blood flow in the leg muscles., which also helps prevent leg swelling and blood clots.

Frequently Asked Questions about: Knee Joint Replacements

Common Questions and Answers about Knee Joint Replacements

Knee replacement, also called arthroplasty, is a surgical procedure that replaces a damaged knee, with a prosthesis (an artificial joint). This surgery may be considered in people who have severe arthritis or a severe knee injury..

Total knee replacements, are usually performed in patients who have severe changes of osteoarthritis (joint wear). Many of the patients who have artificial knees are older than 55 years, although this procedure can also be performed in younger people.

  1. Comply with established medication schedules , (blood thinners and pain relievers).
  2. You will be able to return to work in three months, if you comply with the medical recommendations
  3. You should not drive a car until two months after the check-up appointment.
  4. Follow the recommendations that the physiotherapist gives you in terms of exercises and mobilization in general. When you get up, walking or exercising always use tennis shoes that give you greater stability.
  5. Avoid: cross your legs, raise the legs to more than 90 degrees, etc
  6. Comply with established medical controls.
  7. Always carry out your activities accompanied, avoid falls.
  8. Remember not to gain weight, since this decreases the duration of your prosthesis
  9. Keep the incision clean and dry. If you notice any inflammation, increased pain, incision side drainage, redness around the incision or general fever, consultation for emergencies.
  10. Stitches are removed in two weeks.

It is the metabolic and systemic deterioration of the body as a consequence of immobilization or prolonged bed rest and the use of medications. The deterioration is observed in the first 24 hours of immobilization.

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.

  • Osteoarthritis. This is a type of arthritis of “wear and tear” age related. It usually occurs in people of 50 years of age or older, but it can happen in younger people too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against each other, causing knee pain and stiffness.
  • Rheumatoid arthritis. This is a disease in which the synovium surrounding the joint becomes swollen and thickened.. This chronic inflammation can damage cartilage and eventually cause cartilage loss., pain and stiffness. Rheumatoid arthritis is the most common form of a group of disorders called “inflammatory arthritis”.
  • Post-traumatic arthritis. This can develop after a serious knee injury. Fractures of the bones around the knee or tears to the knee ligaments can damage articular cartilage over time., causing knee pain and limiting knee function.

A knee replacement (also called knee replacement) could be more accurately called a “resurfacing” knee, because only the surface of the bones is actually replaced.

There are four basic steps to a knee replacement procedure.

  • Bone preparation. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of the underlying bone.
  • Positioning of metal implants. The removed cartilage and bone are replaced with metal components that recreate the surface of the joint.. These metal parts can be cemented or “pressurized driveways” on the bone.
  • Patella resurfacing. The surface under the kneecap is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
  • Insert a spacer. A medical grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

There are several reasons why your doctor might recommend knee replacement surgery.. People who benefit from total knee replacement surgery often have:

  • Severe knee pain or stiffness with limitation of daily activities, including walking, climbing stairs, sit and get up from a chair. You may have trouble walking more than a few blocks without significant pain and may need to use a cane or walker.
  • Moderate or severe knee pain while resting, both day and night
  • Chronic inflammation and swelling of the knee that does not improve with rest or medications
  • Knee deformity (an outward or inward bowing of the knee)
  • They do not experience substantial improvement with other treatments such as anti-inflammatory drugs, cortisone injections, lubricant injections, physical therapy or other surgeries

Before we saw that knee prostheses have elements that hold it to the bone, how are the tibial tray, the femoral component and the patella.

There are two ways to anchor each of these components to the bone:

  • Cemented fixation: Bone cement is used around the prosthesis that, when setting, holds the implant to the bone. It has the advantage of providing immediate restraint that allows the patient to be mobilized as soon as they tolerate it, regardless of bone quality. In return, cement can degenerate over time.
  • Cementless fixation: The surfaces of the prosthesis are covered with porous materials that mimic the texture of the bone and allow it to intermingle with the coating, thus fixing the implant. It has the advantage of being a more natural fixation than that provided by cement, but its success depends on the patient's previous conditions.

Although your surgeon will choose the type of fixation that best suits your case, the most common is to use bone cement in the tibial tray and in the patella, placing the femoral component uncemented.

In total knee replacement, the tibial tray secures the prosthesis to the tibia and the femoral component (or femoral condyles) does the same with the femur. Between the two is the polyethylene insert, that avoids friction between the two previous pieces, that are metallic.

Polyethylene is normally attached to the tibial tray and slides relative to the femoral component, which is manufactured in chrome-cobalt due to its low coefficient of friction.

If the surgeon decides to implant the patellar component (the patellar), this also glides with the anterior part of the femoral component.

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