KNEE REPLACEMENT SPECIALISTS

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Knee replacement surgery is a safe and effective procedure that is now communally done in an outpatient setting.

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have significantly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. The procedure has advanced so much that it is often now performed in an outpatient setting.

Cause

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older but may occur in younger people. The cartilage that cushions the bones of the knee softens and wears away, and the bones then rub against one another, causing knee pain and stiffness.

osteoarthritis and bone spurs

Osteoarthritis often results in bone rubbing on bone. Bone spurs are a common feature of this form of arthritis.

  • Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common disorder termed “inflammatory arthritis.”
  • Post-traumatic arthritis. This can follow a severe knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Description

A knee replacement (also called knee arthroplasty) might be more accurately termed a knee “resurfacing” because only the surface of the bones are replaced.

There are four basic steps to a knee replacement procedure:

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone are replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

illustrations of severe osteoarthritis and knee replacement

(Left) Severe osteoarthritis. (Right)The arthritic cartilage and underlying bone has been removed and resurfaced with metal implants on the femur and tibia. A plastic spacer has been placed in between the implants. The patellar component is not shown for clarity.

Is Total Knee Replacement for You?

The decision to have total knee replacement surgery should be a cooperative one between you, your family, your primary care doctor, and your orthopedic surgeon. Your doctor may refer you to an orthopedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.

When Surgery Is Recommended

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

  • Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs.  It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
  • Moderate or severe knee pain while resting, either day or night
  • Chronic knee inflammation and swelling that does not improve with rest or medications
  • Knee deformity — a bowing in or out of the knee
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

A knee that has become bowed as a result of severe arthritis.

Total knee replacement may be recommended for patients with bowed knee deformity, like that shown in this clinical photo.

Candidates for Surgery

There are no absolute age or weight restrictions for total knee replacement surgery.

Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

The Orthopaedic Evaluation

An evaluation with an orthopedic surgeon consists of several components:

  • Medical history. Your orthopedic surgeon will gather information about your general health and ask you about the extent of your knee pain and your ability to function.
  • Physical examination. This will assess knee motion, stability, strength, and overall leg alignment.
  • X-rays. These images help to determine the extent of damage and deformity in your knee.
  • Other tests. Occasionally blood tests or advanced imaging, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your knee.

x-rays of a healthy knee and a knee with osteoarthritis

(Left) In this x-ray of a normal knee, the space between the bones indicates healthy cartilage (arrows). (Right) This x-ray of a knee that has become bowed from arthritis shows severe loss of joint space (arrows).

Your orthopedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement is the best method to relieve your pain and improve your function. Other treatment options — including medications, injections, physical therapy, or other types of surgery — will also be considered and discussed.

In addition, your orthopedic surgeon will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery.

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