Due to advanced age and excess weight, the cartilage structure of knee joint begins to wear and corrode. The process is expedited due to genetic and environmental factors. This corrosion in the cartilage structure is called osteoarthritis of knee. When the disease is not advanced, it is possible to provide treatment with non-surgical methods, however such methods do not recover the worn structures. Osteoarthritis of knee is an irrevocable condition. Just the development can be stopped or slowed down. With non-surgical methods and conservative procedures, it is possible to eliminate complaints such as pain, restricted movement, and difficulty in walking. If osteoarthritis is advanced and the complaints significantly reduce the quality of life, knee replacement surgery may be required.
Total knee replacement is carried out to create an artificial joint by covering the worn joint with special instruments produced with metal and polyethylene and designed for the movement of the joint. The prosthesis is made of special materials. As it is completely compatible with the body, it does not cause any problem in daily life. The person can use her/his knee as it was healthy.
The level and distribution of the forces affecting the knee are very important for design and development of the prosthesis. Forces carried out by the joint increases three times during walking and six times during walking on a hill or stairs. Therefore, active life of the patient is evaluated while designing the prosthesis.
The most common knee disease is osteoarthritis. If this disease is not treated at the early stages, it causes movement restriction and pain in the future. Knee replacement is applied to provide the patient have a painless and moving joint and to maximize the life quality. Other problems seen in the knee include meniscus degenerations and ruptures, ruptures in cruciate ligament, and trauma-dependent cartilage lesions. In addition, if the person is overweight, the load on the knees increases and wear-related problems may cause degenerations in the knee structure.
The knee joint may be deformed due to metabolic diseases, rheumatismal diseases, blood flow disorder, trauma as well as genetic factors.
Who can undergo Knee Replacement?
Knee replacement is carried out for the patients having osteoarthritis. Knee replacement surgery is performed if cartilage structures are completely worn and complaints of the patients support the symptoms. If patients with advanced osteoarthritis have pain and deformity in the knees if they cannot be treated with exercises, physiotherapy, and medication and if they cannot carry out daily activities, such patients can undergo surgery. There is not any age restriction for the surgery. If necessary, knee replacement surgery can be applied to a young person at the age of 18 or a person at the age of 80. There is not rule any age restriction for the surgery. However, knee prosthesis has a usage life, we, as orthopedics physicians, prefer patients at the age of 50 or above. With the development of the technology, lifetime of the prosthesis is increased to 25 years. This time can be longer depending on usage conditions. When lifetime of the prosthesis expires, it can be renewed with surgery. However, in order to prevent the patients from having the second operation in the same area, this operation should be performed at an advanced age and if possible, young patients should be treated with non-surgical methods.
How is Knee Replacement Surgery carried out?
Knee replacement surgery is carried out under local or general anesthesia. During local anesthesia, the patient is awake but cannot feel bawdiness during the operation. Therefore, s/he does not feel any pain. With general anesthesia, the patient is unconscious. Knee replacement surgery takes 1 hour if it is applied to one knee, and if it is applied on both knees, it takes about 2 hours. After a suitable anesthesia method is determined, the knee joint is reached through an incision made on the knee. The worn, deformed cartilage tissue on the contacting surfaces of the three bones constituting the knee joint is dissected and replaced with prosthetic parts of the appropriate size. This prosthesis is attached to the knee joint successfully with a filler called bone cement.
After Knee Replacement Surgery
After knee replacement surgery, the patient stands up on the first day and the exercise process is started with short-distance walking. Drainage attached for first blood discharge is removed next day. The patient is discharged after 3-4 days. The first control examination is performed one week later.
Following points should be paid attention to expedite the recovery process, to have a comfortable recovery process to prevent any complication:
Medication and Physiotherapy
Medication prescribed by the physician should be used regularly to prevent possible infection. In the first follow-up examination, dressing is applied, if necessary sutures are removed. The physiotherapy process starts at the end of second week. Physiotherapy is essential for a good recovery process. Patients can get back to daily life actively after 6 weeks. 2-3 months are required for complete healing.
Avoid Heavy Exercises
Surgery causes sensitivity in the tissue and muscles and the adaptation process of the new prosthesis. Heavy exercises during this process may damage the prosthesis. In addition, heavy exercises damage the muscles and vessels as they are at recovery process.
Even though the surgery is successful unless physiotherapy is started with the assistance of a specialist physiotherapist or if it is not paid attention, permanent and effective results cannot be obtained. The patient should do exercises regularly to get back to daily life as soon as possible.