Knee Replacement – What Are the Options?

Jul 16, 2021 | Articles

As little as twenty years ago, knee replacement surgery was still something of a novelty. Today, however, almost everyone knows someone who has undergone this procedure, invariably with a gratifyingly positive outcome. While pain and swelling in this joint are indications of an underlying problem, it is essential to establish the nature of the problem before one can determine whether surgery will be necessary. Technology and cultural changes have seen many become more sedentary, experiencing discomfort when faced with physical challenges, and regular exercise is often the best therapy.

Typically, a knee replacement is only indicated for patients with persistent pain despite treatment with oral analgaesics or systemic steroids and difficulty with bending and walking. The underlying cause of these symptoms might be an old injury but is more often due to osteoarthritis. In health, the femoral and tibial heads are protected by a layer of cartilage, which allows frictionless articulation between the two surfaces. When that layer becomes damaged through injury or eroded by osteoarthritis, a prosthetic joint is often the best option.

Considering a Knee Replacement?

Opting for a knee replacement poses two questions. Firstly, will it be necessary to replace both parts of the joint or just one? While the latter may be a less debilitating option, many surgeons recommend treating the heads of both bones as renewing only one component could subject the others to additional wear. The second question relates to the choice of surgical technique.

The standard procedure involves fully exposing the joint, which results in extensive scarring, added recovery time and a heightened risk of bleeding and infection. However, surgeons with the necessary skills and experience employ a minimally invasive technique when performing knee replacements. A tiny incision provides access for an arthroscope, enabling surgeons to monitor their movements while two or three equally small incisions act as portals for the surgical instruments. The arthroscopic technique is not suitable for all patients but offers the benefits of minimal scarring, faster healing and less risk of complications.

In each case, the surgeon first removes any damaged bone and cartilage before attaching an implant to the femoral and tibial heads. A plastic spacer inserted between ensures smooth articulation between the bones and the patella to complete the total knee replacement.

Worldwide, millions of these procedures are carried out every year, bringing relief from pain and improving mobility to patients who might otherwise become dependent on a wheelchair. Anyone in South Africa who may be facing this type of surgery should note that the orthopaedic unit of the Wilgers Life Hospital in Pretoria has gained the status of a national and international referral destination for patients requiring a shoulder, hip or knee replacement.