Knee Surgery
Knee injuries, osteoarthritis, and age-related knee issues are common in the United States. As of 2014, approximately 4.7 million people, roughly 1.5 percent of the nation’s population, had total knee replacements.
Osteoarthritis is still one of the leading causes of knee replacements, but injury and age-related issues are also driving the increase in knee replacements and knee surgery.
Modern minimally invasive surgical techniques and advancements in implant and replacement technology have made total knee replacement and knee surgery popular procedures due to the improvements in quality of life they offer. People are taking advantage of these procedures more often so they can remain active and pain-free longer.
Arthroscopy of the Knee Joint
For patients with knee injuries or degenerative conditions affecting the knee, minimally invasive arthroscopy is often the preferred surgical method when the procedure is applicable. Not every injury can be treated with arthroscopy, but patients who are candidates will experience faster recovery and less disruption to their day-to-day life.
Total Knee Replacement (TKR)
In some situations, especially for patients who have osteoarthritis or arthritic knee joints, a minimally invasive surgical solution won’t adequately address the underlying knee problems. During a total knee replacement (TKR) procedure, an orthopaedic surgeon will remove the damaged sections of bone and replace the bottom of the femur as well as the top of the shin (tibia) and the knee cap (patella) with metal and plastic prostheses.
TKR is most commonly recommended for older patients who are experiencing knee joint pain or have difficulty moving due to joint degeneration. Due to its invasive nature, total knee replacement is generally a last resort after alternative, less-invasive treatment options have been exhausted.
Dr. Barbour is a highly experienced orthopaedic surgeon with more than two decades of experience. He has performed many successful total knee replacements and is happy to consult with patients and provide solutions that may help address their knee problems.
Other Scenarios in Which a TKR May Be Appropriate
In addition to treating arthritis, a total knee replacement may be recommended for patients who have suffered:
- Significant trauma or fracture
- Overuse injuries or damage due to obesity
- Severe infections
- Connective tissue disorders
- Rheumatoid arthritis or other inflammation problems
The Impacts of Arthritis
In an arthritic knee, the cartilage that lines the joint is either dangerously thin or entirely degraded
The extent of cartilage damage and the severity of inflammation varies on a case-by-case basis and is dependent on the stage of arthritis
For some patients, the capsule of the arthritic knee will be swollen, or the joint space is irregularly shaped and too narrow to allow for a natural, pain-free range of motion
In some cases, bone spurs, or excessive bone buildup, can occur around the edges of the joint
Anterior Cruciate Ligament (ACL) Reconstruction
The anterior cruciate ligament (ACL) is one of the primary stabilizing ligaments in the knee. It runs through the center of the leg along its length from the femur to the tibia.
Many patients, especially athletes, and people with physically demanding jobs, undergo ACL surgery after an injury due to the ligament’s inability to heal on its own. Your orthopaedic specialist will likely attempt several alternative methods of treatment to repair a damaged ACL before resorting to surgery.
After the initial injury, the knee and leg should be treated with rest, ice, and elevation. Some people with ACL injuries can regain adequate stability without surgery through physical therapy and strength training of the surrounding muscles.
ACL reconstruction is a procedure that can be accomplished through minimally invasive arthroscopic knee surgery. If other knee structures, such as the articular cartilage that lines the joint or other ligaments in the leg, are damaged during the same incident or injury, they can also be addressed during ACL surgery.
Our doctors utilize both the ACL reconstruction hamstring tendon method as well as the ACL reconstruction patellar tendon method depending on the patient, their age and activity level, and the speed with which they need to regain.
Common ACL Injuries
Injuries to the anterior cruciate ligament often occur in contact sports or accidents when running or hiking such as twisting the knee or landing awkwardly. ACL injuries are commonly accompanied by a loud popping sound and swelling within hours of the injury. The most common effects after the injury’s initial symptoms have subsided will be instability when walking or running or having the knee give away when putting weight on it.
Unicondylar Knee Replacement
Depending on the knee injury and the patient, a partial knee replacement procedure performed using modern arthroscopic surgical technology may be an adequate, less-invasive alternative to traditional knee replacement.
Unicondylar knee replacement has become increasingly effective for treating unicompartmental arthritis and requires significantly smaller incisions than in previous generations of the procedure. During the arthroscopy surgery, only a portion of the knee joint is replaced, unlike a total knee replacement which requires the replacement of parts of the femur, tibia, and patella.
Advantages and Disadvantages of Partial Knee Replacement with Arthroscopy
If you are a candidate for unicondylar knee replacement and your procedure is successful, you should experience an improved range of motion and reduction in pain similar to a total knee replacement.
The less invasive nature of arthroscopic surgery also provides benefits such as:
- Faster recovery
- Less blood loss – transfusion is rarely required
- Knee will feel more normal due to less replacement
- Less need for physiotherapy
Candidates for this procedure will, in most cases, be able to maintain a more active lifestyle following the surgery
Who Is a Good Candidate for Unicondylar Knee Replacement?
- Patients who are over 50 years of age
- Those who wish to live a more active lifestyle but are encumbered by limited mobility and knee pain
- Patients who only require replacement of one compartment as confirmed by x-ray and other diagnostics
- You may not be a good candidate for partial knee replacement if your:
- Arthritis affects multiple compartments
- Knee or legs suffers from severe angular deformity
- Arthritis is inflammatory/rheumatoid
- Knee is unstable
- Have undergone a previous osteotomy
- Participate in contact sports or are employed in a physically demanding field
Revision Knee Replacement
Not all knee replacement surgeries are successful. Patients who have had unsatisfactory knee replacement results may require a revision knee replacement, which means all or part of your previous knee replacement procedure must be corrected. The extent of the corrections can range from minor to complete, depending on the patient.
The most common indicator that a revision knee replacement may be necessary is continued or worsening pain.
Signs a Knee Revision May Be Necessary
Plastic wear: If your knee replacement was performed with plastic components to replace portions of the femur and tibia or the plastic insert has worn, these may need to be replaced.
Instability: Some patients do not regain stability or begin to lose it again over time. If you feel unsafe when walking due to instability and you’ve previously had a knee replacement, you may benefit from a revision procedure.
Loosening of components: If the replacement components of the tibia, patella or femoral implants from a previous total knee replacement are loosening, a knee replacement revision procedure may be needed. Loosening is common over time, which is why regular follow-up appointments are necessary after replacement.
Infection: If a patient is suffering an infection due to the implants from a previous knee replacement procedure, they may need to undergo a revision procedure to address it.
Osteolysis: In some cases, bone can be destroyed due to particles being released into the knee joint, which will likely require knee replacement revision surgery.