Our Summary

This research paper discusses the increasing number of total knee replacements being performed in the United States. The main reason these surgeries fail is due to instability in the knee after surgery, which can often be attributed to poor balance in the knee joint. The paper reviews the structure of the knee and key principles of knee replacement surgery, such as the alignment of the limb, the positioning of the femur (thigh bone), and the use of implants. It then discusses surgical techniques that can be used to achieve the best possible balance in the knee joint. Lastly, the paper looks at the impact of modern technology on knee replacement surgery, including computer and robotic technologies. The aim is to provide surgeons with a deeper understanding of these issues to improve the results of knee replacement surgeries.

FAQs

  1. What is the leading cause of failure in total knee arthroplasties?
  2. What techniques can surgeons use to achieve ideal sagittal balance and coronal balance during a knee replacement?
  3. How do advanced technologies like computers and robotics impact total knee arthroplasty balancing and alignment?

Doctor’s Tip

One helpful tip a doctor might tell a patient about knee replacement is to follow a rehabilitation program diligently to strengthen the muscles around the knee and improve range of motion. This will help ensure a successful recovery and long-term success of the knee replacement surgery. It is important to listen to your physical therapist and follow their recommendations for exercises and activities to support your knee during the healing process.

Suitable For

Patients who are typically recommended for knee replacement surgery are those who have severe knee pain and stiffness that limits their daily activities, have failed to improve with non-surgical treatments such as physical therapy and medication, have arthritis that has significantly damaged the knee joint, and have difficulty walking or climbing stairs. These patients may also have deformities in their knee joint, such as bow-legged or knock-kneed alignment, which can further contribute to their knee pain and instability. Ultimately, the decision to undergo knee replacement surgery is made in consultation with a surgeon, taking into consideration the patient’s overall health and lifestyle goals.

Timeline

Before knee replacement:

  1. Initial consultation with an orthopedic surgeon to discuss symptoms, medical history, and treatment options.
  2. Pre-operative appointments for physical examination, blood tests, and imaging studies.
  3. Education on the procedure, risks, and post-operative care.
  4. Pre-operative physical therapy to strengthen the surrounding muscles and improve range of motion.
  5. Clearance from other medical specialists if necessary.

After knee replacement:

  1. Hospitalization for the surgery and initial recovery period.
  2. Physical therapy and rehabilitation to regain strength, flexibility, and mobility.
  3. Pain management and medication as needed.
  4. Follow-up appointments with the surgeon for monitoring and adjustments.
  5. Return to normal activities and daily living, with gradual improvement in knee function over time.
  6. Long-term follow-up to monitor the stability and function of the replaced knee.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with knee replacement surgery?
  2. How long is the recovery process and what can I expect in terms of pain management and rehabilitation?
  3. What type of implant will be used for my knee replacement and why?
  4. How will you ensure proper alignment and balance of my new knee joint during surgery?
  5. Will computer-assisted navigation or robotic technology be used during my knee replacement surgery?
  6. How long can I expect my new knee joint to last before needing a revision surgery?
  7. What restrictions or limitations will I have after my knee replacement surgery?
  8. Will physical therapy be necessary after the surgery and for how long?
  9. What signs or symptoms should I watch for that may indicate a complication with my new knee joint?
  10. What can I do to optimize the success of my knee replacement surgery and recovery process?

Reference

Authors: Mercuri JJ, Schwarzkopf R. Journal: Bull Hosp Jt Dis (2013). 2019 Mar;77(1):45-52. PMID: 30865864