In 1938, a London-based surgeon named Philip Wiles became the first person to successfully replace a damaged joint with a functional prosthesis. On that occasion, the femoroacetabular or hip joint was the focus of attention. However, since then, his pioneering efforts have inspired others to achieve equal success in developing similar methods to perform shoulder and knee replacement surgery.
Today, knee arthroplasty, the medical term for the joint replacement procedure, ranks as the most successful orthopaedic intervention of all time. Worldwide, more than 3,5 million patients undergo some form of arthroplasty each year, and almost 75% of those require attention to their tibiofemoral or knee joint.
Why Might You Need Surgery?
Problems with this joint tend to be most common among those aged 55 and over but are becoming more frequent among younger subjects. In the absence of a traumatic injury, the first signs are generally pain and swelling, but a knee replacement may not be necessary for several years, if at all. In some cases, exercise and physiotherapy will be all that is necessary for a full recovery.
However, if your pain worsens and persists even when you are sitting or lying down, or if your mobility is becoming impaired and prescription painkillers cease to provide relief, it is time for the next step. Inevitably, your doctor will refer you to an orthopaedic specialist who, based on your medical history, a physical examination, X-rays and other medical imaging techniques will, almost certainly, recommend knee replacement. The procedure offers a means to banish the pain and resume an active life.
There are several possible causes for these symptoms. The most common of these is a condition called osteoarthritis, in which the protective coating of cartilage on one or more of the articulating surfaces becomes worn, leading to bone damage. Fragments of bone and cartilage impede the joint’s smooth movement, leading to further damage and causing the pain and swelling typical of this progressive condition. Generally, this condition is age-related, but an injury such as a fracture or torn ligament can also trigger the onset of osteoarthritis and the need for a knee replacement.
Rheumatoid arthritis is another common condition that can sometimes require a patient to undergo arthroplasty. In this case, though, the pain and swelling are not due to physical wear and tear. Instead, the symptoms result from an immune reaction that mistakenly targets the joints. Unlike osteoarthritis, which most often only affects one joint, the autoimmune effects are more widespread. Rheumatoid arthritis generally affects both knees plus the hands and feet, and patients may also experience fever and fatigue.
About Your Procedure
When performing a knee replacement, open surgery is no longer the sole option. A newer minimally invasive procedure is now available, although it may not be suitable for all patients, and surgeons require special training in the technique. While the standard approach entails making a long incision to expose the entire joint, the newer option typically employs three tiny incisions. One provides access for an arthroscope with which the surgeon can view the joint’s interior. The others act as portals for the surgical instruments.
Regardless of the chosen access method, performing a knee replacement will involve removing the damaged articulating surfaces and fitting prosthetic parts to replace them. The process involves three to four steps. The first is to prepare the femur and tibia by removing the damaged cartilage plus a little underlying bone from their articulating surfaces. Step two involves positioning the metal implants that will form the new surfaces and securing them with special cement. Some prostheses can be press-fitted into the bone and will gradually fuse with it. Next, a button-like plastic liner may be attached to the patellar undersurface, if indicated. To complete the knee replacement, the surgeon will insert a plastic spacer between the two metal prostheses. The spacer ensures they engage smoothly.
After a sufficient period in the recovery room, you may either return home or spend between one and three days in the hospital. Either way, soon after your operation, you will need to start exercising your knee. With suitable pain medication and physiotherapy, you should be able to resume your normal day-to-day activities within three to six weeks.
However, you will have to avoid jumping and jogging in future, as the impact could threaten the integrity of your prosthesis. If it becomes damaged would need a further operation to repair your knee replacement.
To ensure that you get the highly skilled and experienced hand of a specialised surgeon, simply contact us today for more information.