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One of the types of surgeries that can help ease symptoms in patients with arthritis of the knee is known as a total knee replacement. This article outlines eight things you should know about total knee replacement.

Patients with arthritis of the knee suffer from knees that are painful, stiff and have limited range of motion. Unfortunately, there is no cure for the disease, though there are several treatments that can help ease symptoms and improve functionality. Many patients will respond adequately to medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs).

However, some people don’t respond to medication and will have to undergo surgery. Specifically, some patients with arthritis of the knee will have to undergo a type of surgery known as a total knee replacement. Here are the eight things you should know about total knee replacements.

1. A total knee replacement replaces the end of your thighbone, the top of your shinbone, and the cartilage in between

In a healthy person, the end of your thighbone and the top of your shin bone are coated with hard cartilage, which is a substance that allows your bones to slide and move against each other. However, in patients with arthritis, the cartilage becomes thin and wears away, causing your two bones to touch and rub against each other.

In a total knee replacement, surgeons will replace the ends of your bones as well as the remaining cartilage with metal and plastic components. The plastic is like a hard cartilage, which allows your bones to move freely again.

2. There are four basic steps during a total knee replacement

  • First, the surgeon will have to prepare the bone which includes removing the damaged cartilage surface at the ends of the thighbone and top of the shin bone.
  • Second, the surgeon will position the metal implants that will replace the removed cartilage and bone in order to recreate the surface of the joint.
  • Third, the surgeon will resurface the kneecap. The undersurface of the kneecap will be cut and resurfaced with plastic. However, some surgeons skip this step.
  • Fourth, the surgeon will insert a plastic spacer between the metal components to create a smooth and gliding surface.

3. You don’t need a knee replacement just because you have arthritis of the knee

Many patients are able to manage their condition well with a combination of medication(s) and physical therapy alone. Thus, you won’t necessarily need to get a knee replacement just because you have an arthritic knee. However, if you continue to experience significant pain, disability, stiffness or other arthritic effects, then it is an option worth considering.

4. How well your knee replacement works can depend on when you get it

Most patients who end up getting a knee replacement are over the age of 60. However, if you develop arthritis early on and have to undergo a knee replacement at an earlier age, then there is a higher chance that you will eventually need to do further surgery such as a revision. Therefore, some doctors believe that you should wait to get a knee replacement. On the other hand, there is also evidence that the outcome of your surgery may be better if you don’t wait too long before your knee becomes stiff or deformed.

5. You might not be eligible for a total knee replacement

Some people are not eligible for a total knee replacement, despite the fact that their arthritis is severely affecting their daily life. Patients who are not eligible for a total knee replacement include those whose thigh muscles are not strong enough to support the new knee joint and those patients who have deep or long-lasting open sores in the skin surrounding the knee as that increases the risk of infection.

6. There are several advantages to getting a total knee replacement surgery

These advantages include being finally free of pain, increased mobility and a better quality of life as everyday activities and exercises become easier. A total knee replacement surgery can be quite advantageous as research has shown that four out of five people who get this surgery are happy with their new knees. Furthermore, patients who are unhappy attribute their unhappiness to the continuing pain, which is likely not due to the operation but instead due to minor joint damaged that already occurred before the surgery.

7. There are several different disadvantages to getting a total knee replacement surgery

One of the disadvantages is the fact that replacement or new knees tend to wear out over time, which causes problems when it comes to movements and numbness. The implants can also become loose over time. Additionally, total knee replacement is not as effective if you get them in the early stages of the disease and a better outcome is expected if it is conducted in patients with advanced arthritis.

Furthermore, most patients claim that a replacement knee is not as good as a natural knee as the majority of patients say that an artificial joint feels about three-quarters normal. Also, knee replacements or implants cannot bend as much as your original knee and thus, can be uncomfortable when people do things like kneel. The artificial knees can also cause clicking or clunking which you may become aware of. Some patients further experience numbness on the outside of the scar, which gets better over two years but the feeling never goes back to normal.

8. You may need to have a repeat operation

Research has shown that knee replacements can last as long as 20 years or more, however, younger patients are more likely to need to undergo a repeat operation later on in life. This is especially true in patients who are overweight, do heavy manual work, run, or play vigorous sports.

  • Harris, William H., and Clement B. Sledge. "Total hip and total knee replacement." New England Journal of Medicine 323.11 (1990): 725-731.
  • Laskin, Richard S. "Total knee replacement for patients with patellofemoral arthritis." Clinical orthopaedics and related research 367 (1999): 89-95.
  • Bongartz, Tim, et al. "Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis." Arthritis Care & Research 59.12 (2008): 1713-1720.
  • Newman, John H., Christopher E. Ackroyd, and Nilen A. Shah. "Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis." The Journal of bone and joint surgery. British volume 80.5 (1998): 862-865.
  • Photo courtesy of SteadyHealth

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