Knee pain and arthritis and stiffness is treated with a variety of methods. This includes medications, physical therapy and exercises, weight loss methods and surgery to replace the worn out cushions between the joint spaces.
It is when all other medications and therapies fail that patient may consider a Total Knee Replacement or TKR. This involves replacement of the worn out joint with artificial prosthetic joint.
This operation is usually performed under general anesthesia wherein patient will be rendered unconscious during the operative procedure. This operation can also be done under spinal or epidural anesthesia. A cuff like tourniquet is placed on the thighs just before the incision. When inflated this aids in reducing the blood flow to the operative site and reduces the risk of bleeding.
There are basically two approaches to a TKR :
- One is the classical method
- Another is the newly developed Minimally Invasive Surgery (MIS)
Procedure of classical approach to TKR:
- In classical TKR an eight to twelve inch incision is made in the front or side of the knee.
- The muscles are cut open and the joint cavity is exposed.
- The damaged parts of the joint including the lower part of the femur, upper part of the tibia are removed or sawed off.
- The prosthesis or the artificial joint is a metallic or plastic replica of the lower part of the thigh bone and upper part of the tibia.
- The new implants are sealed on the sawed off edges with the help of bone cement.
- Some implants are uncemented. These can be set over the edges of the sawed off bones in a press fit system.
- Prosthetic cartilage is placed between the prosthetic ends of the femur and tibia.
Procedure of minimally invasive TKR surgery:
- Minimally invasive surgery as the name suggests involves a smaller incision of three to five inches.
- Here the surgeon works the implant through a smaller opening.
- This leads to less pain and more rapid recovery.
TKR is a very successful surgery and with proper accompanying physical therapy it can provide much relief. This mimics the original joint and allows a free movement of the joint. Benefits of this operation are remarkable in terms of freedom from pain, improved range of movement of the knees, improved sleep and better quality of living.
Since, there is no movement, won’t it have high risk of clotting after the operation?
Early mobilization not only prevents formations of blood clots but also rapid recovery. Blood thinning medications are also prescribed if patients are prone to develop blood clots and these may be continued even after the discharge.
On discharge patient may need crutches, walker or a cane to walk. After around six to eight weeks they will be able to walk with minimal assistance.