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Knee joint replacement - Overview

Alternative Names

Total knee replacement; Knee arthroplasty; Knee replacement - totalĀ 

Definition of Knee joint replacement:

Knee joint replacement is surgery to replace a painful damaged or diseased knee joint with an artificial joint (prosthesis).

Description:

The operation is done while you are asleep and without pain (general anesthesia) or with a numbing medication put in your back (spinal or epidural anesthesia).

The orthopedic surgeon makes a surgical cut over the affected knee. The kneecap (patella) is moved out of the way, and the ends of the thigh bone (femur) and shin bone (tibia) are cut to fit the prosthesis. The undersurface of the knee cap is cut to allow the surgeon to place an artificial piece.

There are now implants for men and women to account for differences in anatomy. It is not yet known whether these implants will last longer or perform better than non-gender-specific knee replacements.

The two parts of the prosthesis are placed onto the ends of the femur, tibia, and undersurface of the patella using a special bone cement. Usually, metal is used on the end of the femur, and plastic is used on the tibia and patella for the new knee surface. However, surgeons are now using newer surfaces, including metal on metal, ceramic on ceramic, or ceramic on plastic.

In some cases, a mini-surgical cut may be used to avoid cutting the tendon on the front of the knee. This may allow for faster, less painful recovery, but it has risks because of the difficulty of the surgery and the lack of a clear view for the surgeon.

A foley catheter may be inserted during surgery to monitor the function of your kidneys and hydration level. This will be removed on the second or third day after surgery. You will be encouraged to try to walk to the bathroom with help.

Indications:

Knee joint replacement may be recommended for:

  • Arthritis of the knee and decreased knee function caused by arthritis
  • Inability to sleep through the night because of knee pain
  • Knee pain that hasn't responded to other therapy (including medication, injections, and physical therapy for 6 months or more)
  • Knee pain that limits or prevents activities
  • Some tumors involving the knee

Knee joint replacement is usually not recommended for:

  • Current knee infection
  • Morbid obesity (over 300 pounds)
  • Paralysis of the muscles in the front of the thigh (quadriceps)
  • Poor skin cover around the knee
  • Severe mental dysfunction
  • Severe peripheral vascular disease or nerve problems (neuropathy) that affect the knee
  • Terminal disease (for example, cancer that has spread)
  • Reviewed last on: 5/5/2008
  • Andrew L. Chen, MD, MS, Orthopedic Surgery and Sports Medicine, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

References

Roberts VI, Esler CNA, Harper WM. A 15-year follow-up of 4606 primary total knee replacements. J Bone Joint Surg Br. 2007;89:1452-6.

Greene KA. Gender-specific design in total knee arthroplasty. J Arthroplasty. 2007;22:27-31.

Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007; 33(1): 71-86.

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