Knee replacement is a permanent solution to debilitating knee pain that is often the result of severe arthritis. It involves resurfacing the affected, arthritic joint, with metal components.
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If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If nonsurgical treatments like medications or injections and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 790,000 knee replacements are performed each year in the United States.
Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this article will help you understand more about this valuable procedure.
Patients over the age of 50 suffering from a form of advanced arthritis of the knee will often benefit most from a long-term treatment, such as knee replacement surgery. For younger patients, Dr. O’Keefe will often consider alternative treatments first.
- Knee Surgery in Minnesota
- ACL/Meniscus Injury
- Knee Replacement Surgery
- Partial vs. Total Knee Replacement
- Partial Knee Replacement Surgery
- Minimally Invasive Knee Surgery
- Custom Knee Replacement (Visionaire)
Causes of Knee Arthritis
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
- Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
- Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
- Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function
What is a Knee Replacement?
A knee replacement (also called knee arthroplasty) might be more accurately termed a knee “resurfacing” because only the surface of the bones are replaced.
There are four basic steps to a knee replacement procedure:
- Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.
- Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
- Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
Is Surgery Right for You?
The decision to have total knee replacement surgery should be a cooperative one between you, your family, your primary care doctor, and your orthopedic surgeon. Your doctor may refer you to an orthopedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.
When Surgery Is Recommended
There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:
- Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
- Moderate or severe knee pain while resting, either day or night
- Chronic knee inflammation and swelling that does not improve with rest or medications
- Knee deformity — a bowing in or out of the knee
- Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries
Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
Minimally Invasive Approach to Knee Replacement
Knee replacement surgery, also known as knee arthroplasty, is a surgical procedure that requires the use of general or spinal anesthesia administered within a hospital or surgery center. Based on the amount and location of joint damage, Dr. O’Keefe will determine whether total or partial knee replacement will offer the best results. Before the procedure, Dr. O’Keefe will meet with the patient to discuss which artificial joint will best fit the patient’s needs. He will consider the patient’s age, weight, activity level, and overall bone health when selecting the type of replacement.
For patients with damage to more than one area of the knee, Dr. O’Keefe will typically recommend total knee replacement surgery. During the procedure, Dr. O’Keefe will often use minimally invasive techniques to remove millimeters of the surface of the femur, tibia and patella with special resurfacing tools before the final implants are placed. He will then shape the surfaces of the lower thighbone and the upper shinbone, before using specialized tools to secure the artificial joint to the reformed bone surfaces.
Partial knee replacement is recommended for patients with damage to only one compartment of the knee joint. During a partial knee replacement procedure, only the damaged areas of the thighbone and shinbone are replaced with a metal and plastic prosthesis. This typically results in less post-operative pain, a quicker recovery and a more natural feeling knee.
Realistic Expectations
An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.
Most people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.
With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.
Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.
Post-Op Recovery and Rehabilitation
Total knee replacement patients are typically required to stay in the hospital for at least 2-3 days, to ensure proper recovery; however, partial knee replacement patients are frequently able to return home the same day. Following surgery, Dr. O’Keefe recommends patients use a walker, cane, or crutches for support until joint strength has returned, to help with mobilization and walking after surgery. Patients are instructed by physical therapists on which device will work best for them while still in the hospital. To help patients return strength and mobility to the treated knee, Dr. O’Keefe will create a custom physical therapy routine that will include both at home exercises and scheduled training with a physical therapist.
Outpatient Knee Replacement (EXCEL Program)
For healthy patients, outpatient knee replacement is a great option. At Twin Cities Orthopedics this is part of the EXCEL program. Patients undergo concierge type treatment at one of Twin Cities Orthopedics state of the art ambulatory surgery centers with onsite care suites. Despite being called “outpatient” knee replacement, patients typically stay overnight in their care suite and receive personalized treatment with their own physical therapist and nurse. Patients are discharged home the following morning and are seen back in the clinic in 2 weeks. A wonderful advancement in the field of orthopedics.
Knee Replacement in Minneapolis, MN
Specializing in minimally invasive surgery, Dr. Patrick O’Keefe provides the highest quality orthopedic care to patients suffering from knee pain in the Minneapolis area. Dr. O’Keefe is renowned for his state-of-the-art treatment of osteoarthritis and rheumatoid arthritis. For more information about knee replacement surgery, schedule an appointment with Dr O’Keefe at his Blaine, Coon Rapids, or Otsego offices at (763) 441-0298.
