TOTAL KNEE REPLACEMENT
Total Knee Replacement Surgery
The knee is a joint between the end of the thigh bone (the femur) and the top of the shin bone (the tibia). The knee cap (the patella) glides over the end of the femur when the knee moves. In a healthy joint, a layer of smooth hyaline or articular cartilage covers and cushions the bone ends. It is the presence of the cartilage, working together with muscles, tendons and ligaments, that allows a healthy knee to bend knee easily, without pain or discomfort.
Arthritis-particularly osteoarthritis, the “wear and tear” type of arthritis that is the most common form of arthritis–is a condition in which there is damage to this articular cartilage within the knee joint. Other types of arthritis that can affect the knee joint include rheumatoid arthritis, post-traumatic arthritis- in which a previous knee injury results in damage to the cartilage- and less common causes such as psoriatic arthritis and osteonecrosis. These conditions can all result in progressive damage to the cartilage, ultimately causing the bones to rub together (“bone-on-bone” arthritis) and leading to pain and stiffness.
In a total knee replacement surgery, the objective is to replace the damaged cartilage within the knee. The cartilage within the knee joint is replaced with a prosthesis made of metal and plastic. These artificial parts or implants allow the joint to move smoothly, so the patient experiences pain relief and a better quality of life. Knee replacement surgery, as the definitive treatment for knee arthritis, has become one of the most popular orthopaedic surgical procedures in the world. It is truly the only “cure” for knee arthritis.
Knee Arthritis Treatment Options
Advanced arthritis of the knee symptoms (pain, stiffness, limited motion, decreased walking and standing tolerance) can gradually worsen to the point where the arthritis interferes with day-to-day activities. For some patients, the symptoms from arthritis can eventually become so significant that they cannot walk or function without severe pain. For patients whose symptoms have reached this point, surgical intervention via joint replacement surgery can return patients to the lifestyle they used to enjoy, typically with minimal or no knee pain.
Total or Partial Knee Replacement
The knee joint itself is divided anatomically into three compartments, the medial compartment, the lateral compartment, and the patello-femoral compartment (knee-cap). Total Knee Arthroplasty (TKA) or replacement is recommended when there is significant damage to two or three of the knee compartments, causing disabling pain, deformity and/or limited knee motion. Partial Knee replacement is typically recommended when just the medial or lateral compartment of the knee is damaged.
Total Knee Replacement Surgery
The technique of knee replacement has and continues to evolve, with changes and new techniques being introduced on a regular basis. Dr. Davis has made significant adjustments and changes to the surgical process itself to improve both the early and long-term functional outcomes of knee replacement.
In his ongoing effort to deliver the best surgical outcomes, Dr. Davis has continued to seek other surgical technique improvements to benefit his patients. Efficient surgery, with minimized trauma to the tissues around the knee, allows Dr. Davis to perform knee replacement surgery in the least invasive way possible- both physically and emotionally to the patient.
Pre-operative Medical Evaluation
Prior to any surgical procedure, a medical evaluation is recommended. This evaluation is usually performed by a patient’s primary care physician, arranged in conjunction with our office. Evaluation will include a physical examination, EKG and basic laboratory tests. This type of evaluation will allow us to establish a good picture of a patient’s baseline medical health–and allow us to recommend specific areas that could be optimized prior to surgery.
Occasionally, medical concerns are identified that need attention and treatment prior to surgery. Patients with diabetes are of particular concern. There is substantial research to suggest that diabetic patients are at increased risk for complications. This increased risk can be reduced if the patient is compliant with their blood sugar control.
Obesity is another medical challenge for some patients. Obesity is defined based on a patients’ “Body Mass Index” or BMI for short. A BMI over 40 increases the risk for infection after joint replacement surgery. If a patient is unsuccessful, through a combination of diet and exercise, at losing weight to get their BMI below 40, bariatric surgery may need to be considered.
Patients with underlying lung, heart, kidney or liver problems may need consultation with a specialist in one or more of these areas prior to surgery. Further testing may be needed depending on a patient’s individual circumstance.
Tobacco use is another cause of concern. Smoking have been shown to increase the risk of complications after many orthopaedic surgeries, including joint replacement and spinal surgery. The best advice is for the patient to stop smoking. Help from your primary care physician can be obtained to assist in this goal.
Our goal is to minimize the risks associated with surgery–this includes reducing the medical risks that our patients may be exposed to.
Before & After Photos (examples)
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