joints in their hips, knees, shoulders and elbows that make these feats possible. Later in life, many take up jogging or choose to play soccer or rugby, adding further to the stresses and strains on those same joints. However, while some will remain relatively active well into old age, many others will develop chronic pain and swelling in one or more joints that can only be resolved with a hip or knee replacement.
There are several reasons someone might need to undergo this type of procedure, but the most common is a condition known as osteoarthritis. In health, a layer of cartilage covers the articulating surfaces of the knee joint and ensures smooth, frictionless movement while protecting the bone beneath.
In osteoarthritis, one or both cartilage layers become eroded, exposing the bone, which can become chipped. In time, the build up of particles results in pain, inflammation and swelling, which, untreated, can severely compromise joint movement.
Knee Replacement Options
Unlike a kidney or heart transplant, where a healthy, compatible organ from a donor is used to replace the diseased organ, restoring a damaged or diseased knee joint involves using prostheses (manufactured parts). Sometimes, only one of the bone surfaces is affected, but most orthopaedic surgeons favour total rather than partial replacement.
In knee arthroplasty, the surgical term for a knee replacement, the damaged heads of the femur (thigh bone} and the tibia (shin bone) are first removed. These are then replaced with metal prostheses secured in place with special bone cement or inserted into the medullary cavities and left to fuse with the healthy bone tissue. In addition, the surgeon may adopt one of two approaches.
- Open surgery: In this approach, the entire joint is exposed,
- Minimally invasive surgery: In this technique, the surgeon makes three or four tiny incisions. One is used to insert an arthroscope to provide a brightly-lit, magnified view of the joint, and the others serve as portals for the surgical instruments.
The latter approach limits the risk of blood loss and infection and shortens recovery time but is generally reserved for younger subjects. More recently, the introduction of robot-assisted surgery allows surgeons to align the femoral and tibial heads more accurately, further improving mobility and extending the life of the prostheses.
Either way, total knee replacement (TKR) is one of the most successful interventions in orthopaedic history. It offers relief from sleepless nights due to debilitating pain that eventually becomes resistant to painkillers and gradual loss of mobility that leaves many imprisoned in their homes.
In 2023, around 3,6 million people worldwide underwent this procedure, escaping a life of constant pain and restoring their quality of life.
Avoiding a Knee Replacement
Maintaining good posture, losing weight, and mild exercise, but avoiding exercises and tasks that place excessive strain on your knees can help. However, osteoarthritis is not primarily the result of wear and tear. Some people are predisposed to the condition. If you are losing sleep due to worsening knee pain, it would be wise to consult an orthopaedic surgeon to review your options.