You have tried everything… rest, ice, anti-inflammatories, injections and therapy — but your knee pain persists.
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Your physician has recommended a knee replacement and you are curious about your options. You have a million questions and you are very nervous. Facing major reconstructive surgery can be very daunting.
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Hopefully this section will assist you in answering some of those lingering questions regarding knee replacements … hopefully I will improve your level of understanding about knee replacements … and most importantly, hopefully you will learn about most all options available to people facing a possible knee replacement procedure.
A knee replacement is performed for severe osteoarthritis. Usually an X-ray is all that is necessary to determine if severe arthritis is present. MRI’s are rarely necessary. More important than the fact that your Xray reveals severe arthritis is the fact that it must be symptomatic. That means your knee pain must be severe. There are plenty of people walking around with rather severe arthritis and do not even know it, or they have been told they have it but it has no impact upon their life. They clearly do NOT require a knee replacement.
Should I Have A Knee Replacement?
This is a question that only you can answer. You may have severe osteoarthritis on X-ray—and you may have pain; but perhaps the pain is not particularly limiting or bothersome and pills, rubs, balms, or whatever help you maintain an active lifestyle. Well my friend, you may not need your knee replacement— yet. If you visit the Surgical Decision Making Aides I have in a separate section, it can help you determine if surgery is the right choice for you. A surgeon should not tell you that you NEED a knee replacement. It is merely one of the options available. Because it is an elective operation, the decision to go ahead with surgery should be a “shared decision making process.” The folks at WebMD have put together a program to help you think through the decision making process to see whether or not a knee replacement is the right option for you at this particular time. The government has come out with a long, but thorough presentation about knee replacements. If you are seriously considering surgery, it is well worth your time and effort to check out.
I Have Decided To Have A Knee Replacement, What Are My Options?
Knee replacement technology and knowledge continue to advance. Some are true breakthroughs and represent a big leap forward — and some new technology is somewhat of a “gimmick.”
Prosthetic design has some a long way over the last few years. Although far from producing a knee replacement that behaves like the “normal” knee you had as a healthy 20-something, the knee prosthetics produced today more accurately recreate the anatomy and function of your normal knee. Older designs acted simply as a hinge. Today the prosthetics are designed to behave a bit more like the knee you used to have. We still have a ways to go to get to the perfect knee replacement, but today’s options are far better than those that were available 10 years ago.
There is a lot of discussion and controversy over gender-specific knee replacements. Most newer systems available are gender-sensitive and offer the surgeon numerous sizing options so the knee prosthesis we choose at the time of surgery fits your knee appropriately.
Total knee replacement or partial knee replacement
A knee has three compartments. If the arthritis affects only one or two of the compartments, different replacement options become available. Aside from the choice of the appropriate prosthesis to use, surgeons also have the option of replacing only a single compartment of the knee (unicompartmental arthroplasty), if the arthritis is localized to only one compartment. We also have the option of replacing only two compartments of the knee. The benefit of a partial knee replacement is that your ligaments will not need to be removed like they are in most TOTAL knee replacements. Theoretically, your knee will function on a more “normal” level after a partial knee replacement.
Surgical approach or incisions have changed significantly over the past 5-7 years. Most patients can have their knee put in through a muscle-sparing (no cutting of muscle) “sub-vastus” approach. Patients who have this form of knee exposure experience a much more rapid return of function in the early post-operative period. There is typically less atrophy and less weakness associated with this approach as well.
Computer Assisted surgery
Computer Assisted surgery has become very popular lately. We utilize the Stryker Computer Navigation System. Utilizing the computer navigation system allows us to place the prosthesis in your knee much more precisely than we could using older “freehand” techniques. I personally see no reason why every joint isn’t put in with this technology; it takes just a few more minutes and can make a great surgeon even better — and more accurate!
As an Aside
Yourself, your children or your grandchildren might enjoy this website where they can actually perform a knee replacement. It can be enjoyable and make an otherwise very stressful moment a bit more tolerable. Stick with the cartoon version.
What Are The Risks of a Knee Replacement?
The reasonably foreseeable risks of a knee replacement include, but are not limited to: infection, stiffness, patella instability, persistent pain, nerve or blood vessel injuries, a feeling like the replacement is loose or unstable, blood clots in the legs, pulmonary emboli (blood clots that travel to the lungs), the need for revision surgery if the prosthesis loosens or becomes infected, and perhaps even Chronic Regional Pain Syndrome. You are treated with antibiotics to minimize risk of infection. You are treated with medications and compression boots to minimize risk of blood clots, and you work with a physical therapist to minimize risks of stiffness. Despite our efforts, complications can and do occur. You should review these at length with your surgeon.
What are the best options for your Knee Replacement needs?
Know your options. Contact me if you have any questions about Knee Replacements.
Contact Howard Luks, MD