KNEE REPLACEMENT
WHEN DO I NEED A KNEE REPLACEMENT?
Many conditions lead to cartilage damage in the knee joint (osteoarthritis, inflammatory arthritis, osteonecrosis, post-traumatic arthritis, etc). Patients should exhaust non-operative treatments before considering surgery (exercise program and physical therapy, analgesics such as Tylenol and anti-inflammatory medications, knee injections (cortisone or viscosupplementation), weight loss, a gait aid, and activity modification). If these modalities fail to improve symptoms, consultation with an orthopedic surgeon is necessary to evaluate suitability for a partial or total knee replacement.
WHAT IS A KNEE REPLACEMENT?
A knee replacement (arthroplasty) is a surgical procedure used to replace damaged cartilage in the knee joint with a femoral and a tibial orthopedic implant. This is one of the most successful surgeries in all of medicine: restoring mobility, relieving pain, and improving quality of life for the patient.
PARTIAL VERSUS TOTAL?
When the arthritis is limited to the inner (medial) compartment of the knee, a partial (unicompartmental) knee replacement may be preferable. This is where only the affected half of the knee is replaced and has the advantages of a shorter surgery, faster recovery, fewer complications, and a more natural moving knee (since all the ligaments and tendons are preserved). In contrast, patients with advanced arthritis affecting the entire knee should undergo total knee replacement.
PREPARATION FOR SURGERY
Once indicated for knee replacement, we suggest patients optimize their health and fitness to ensure a rapid recovery from surgery. Patients should maintain a healthy body weight and nutrition, continue physical therapy and exercise to maintain strength in the periarticular muscles, and stop smoking. Any medical conditions such as high blood pressure, diabetes, and sleep apnea should be appropriately treated before surgery.
ARTHRITIC KNEE X-RAY
SURGICAL PLANNING
X-RAY AFTER KNEE REPLACEMENT
SURGICAL PLANNING
A knee replacement requires careful surgical planning and preparation. Once a patient is indicated for knee replacement, special x-rays are obtained that allow for digital calibration. A surgical plan is prepared using templating software which ensures optimal implant selection, postoperative alignment, and estimates the implant sizes and position. Dr Hart will select the surgical implants that best suits the anatomy, activity level, age, and expectations of the patient.
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MORE ABOUT THE SURGERY
Surgery is performed in a state-of-the-art accredited surgical facility to ensure utmost sterility and success of the procedure. The vast majority of patients will undergo regional anesthesia and pain block which avoids the need for a respirator and provides optimal surgical conditions for rapid recovery. With Dr Hart, the surgery takes about two hours and meticulous effort is made to preserve the integrity of the bone and soft tissues. Patients start mobilizing shortly after the procedure and usually walk with a walker or crutches within a few hours of the surgery. About 50% of Dr Hart's primary knee replacements are performed as day surgeries. A multimodal strategy is used for pain control and most patients resume their regular daily activities by 4-6 weeks. Sports and running are permitted after 3 months. Dr Hart encourages his patients to live active lives and resume whatever sports and activities they enjoy most.
HOW LONG DOES A KNEE REPLACEMENT LAST?
Since the first knee replacements in North America in the 1970’s, there have been tremendous advances in surgical technique and implants. Most national registries demonstrate typical implant survivorship above 90% twenty years after knee replacement. Dr Hart follows all his patients and is a leader in revision knee surgery in the event a reoperation is needed.
RISKS & COMPLICATIONS
Knee replacement surgery is a tremendously successful surgery and is performed on over 75,000 patients in Canada per year. Careful surgical planning, meticulous technique, and preoperative optimization help mitigate the risk of a complication. Nonetheless, there are still occasional complications following surgery which include infection, loosening, fracture, damage to a nerve or blood vessel, or a medical complication. These risks are variable from patient to patient and will be discussed in more detail at your preoperative consultation.
