People with arthritis will eventually need a total knee replacement if they fail the other more conservative measures. These treatments include medications (anti-inflammatory medicines and analgesics), physical therapy, topical agents (arthritis rubs), intraarticular glucocorticoid injections (cortisone shots given into the knee joint), viscosupplements (lubricant injections into the knee joint), arthroscopy, and bracing.
Patients who have received the full gamut of conservative medical treatment and who continue to have either severe pain or loss of function, are considered candidates for total knee replacement.
The traditional method of total knee replacement involves making an incision through the large muscle located at the lower end of the inside of the thigh and slightly above the inside part of the knee- the vastus medialis obliquus (VMO). This large muscle is a stabilizer of the patella (kneecap) and one complication of knee replacement is patellar instability.
More recently, minimally invasive techniques using a smaller incision are becoming popular.
Prior to surgery, a careful evaluation of the patient’s medical history is made. Since there is the chance that there will be blood loss, the patient may require either “banking” of their own blood or injections of erythropoietin (a hormone) to help stimulate red blood cell production.
What occurs with knee replacement is that the surface of the femur (upper leg bone) and the surface of the tibia (lower leg bone) are replaced with metal and plastic implants which are cemented in. For the operation to be successful, the surgeon will require adequate visualization of the operative site, proper sizing of the components, and proper alignment of the limb.
The postoperative period involves extensive rehabilitation and takes anywhere from four to ten weeks before a patient will be "as good as they’ll be." Complications of the procedure include patellar instability, infection, blood clots, excessive blood loss, prolonged pain, and loosening of the replacement parts.
In patients who have two bad knees, it is a good idea to get them both done at the same time, if possible.
Finally, it is important that there is coordination between the patient’s primary physicians and the orthopedic surgeons. This is particularly true in patients with other medical problems that require attention. oftentimes, medicines will have to be montored, discontinued temporarily, or changed before surgery.
Careful attention to detail including the preoperative management, the actual surgery, and the post-operative rehabilitation will ensure a good result in most cases.
Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: http://www.arthritis-treatment-and-relief.com
Written By: Nathan Wei
