Total knee replacement

Two C-shaped pieces of cartilage called menisci (medial and lateral) act as shock absorbers between the thigh bone and the shin bone. Several so-called bursae (fluid-filled sacs) help the knee move smoothly.

The knee joint is vulnerable to injuries which are usually related to playing sports or doing some kind of physical work.

As we use our knees almost every minute of the day, they are at an increased risk for wear and tear, and trauma. If a knee joint wears out that much, or you suffer a serious injury, your orthopedic specialist may recommend partial total knee replacement.

The following risk factors often contribute to problems involving the knee joint:

• Overuse of the joint,
• Degenerative defects brought on by age
• Inflammation, often as a result of rheumatoid arthritis
• Leg axis deviation, frequent patellar dislocations
• Injuries, falls, bone fractures

If conservative therapy fails to bring improvement, you are in pain or have difficulty to carry out everyday tasks, an orthopedic consultation is necessary to find the root cause of these symptoms. During the consultation, your physician will conduct a physical examination, take your patient history, prescribe medication if necessary, refer you for some tests and recommend a treatment plan.

After you’ve been given the necessary medications and fallen asleep, the doctor will make an incision in the knee area. He will remove the damaged parts of the knee joint and replace them with the prosthesis. The knee implant is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis meaning that it attaches to the bone with surgical cement, an artificial material widely used all over the world in dentistry and bone surgery. It is safe and compatible with the human body.

A prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone). Your doctor will make sure that every single part fits perfectly before restoring bloodflow tot he surgical site. The incision will then be closed with stitches or surgical staples. A drain may be placed in the incision site to remove fluid. A sterile bandage or dressing will be applied.

In order to choose a knee implant that fits perfectly it is necessary to undergo a range of tests and examinations. An x-ray – and sometimes a CT scan – is important to get a clear picture of what the knee joint looks like.

As there is a risk of infection associated with knee replacement surgery, your doctor will order some tests to minimize the risk: usually a a blood test, a chest X-ray, abdominal ultrasound, ECG, and blood cross-matching for possible transfusion.You may also need to see some specialists to make sure you are not carrying a virus or infection at the time of the surgery. If you suffer from a chronic condition such as diabetes or high blood pressure you will need to see your physician to have your medication adjusted if necessary. Your surgeon may ask you to stop or start taking certain drugs for a short while before undergoing knee replacement.

The most important part after surgery is rehabilitation. The sooner you start using your knee with the prosthesis in it, the better your chances of a complete recovery. In order to be able to do so, adequate pain control is essential. At Medicover Hospital we use something called EDA tube (Epidural anesthesia) to inject pain relievers directly into the operated area for a few days after surgery to control pain.

The day after surgery, – as soon as the drain has been removed – physiotherapy begins. It is done manually with the help of a trained physiotherapist. The use of a CPM (Continuous Passive Motion) machine plays a key role in successful rehabilitation.

After you’ve spent 3 or 4 days in our hospital you need to be transferred to a facility specialized in rehabilitation to continue physiotherapy until your knee heals completely. You’ll be given medication and detailed instructions upon your discharge to ensure the fastest possible recovery. Learning and practicing therapeutical exercises is extremely important to avoid  problems and difficulties with movement later on.

As with any surgical procedure, there are certain risks associated with total knee replacement surgery. At Medicover Hospital we take surgical protocols very seriously, so undergoing the operation in our facility does not carry more risk than having the surgery in your home country.

Unfortunately, side effects and complications can sometimes occur, this is why it is of utmost importance to undergo various tests and examinations to minimize the risk. If your results suggest certain health issues (chronic diseases, infections) we will advise you to postpone the surgery until those problems have been dealt with.

• The most serious risk is an infection of the surgical site which can range from mild redness appearing on the surface of the skin to deep bone tissue infection. Those with diabetes, obesity or those under steroid medications have an elevated risk of infection after surgery.
• Thrombosis may happen in some cases, however this is not unique to knee replacement surgery, most types of surgical interventions carry the risk of formation of blood clots. If you have varicose veins, you are overweight or have suffered from thrombosis in the past you have increased risk. After surgery, you will be given anti-coagulant injections for a period of six weeks to prevent thrombosis.
• During and after surgery patients are slightly more vulnerable to bone fractures than usual, but the chances of something like this happening are still very low. In case of bone fracture, another surgery, or more extensive surgery is required to repair the broken bones.
• In extremely rare cases nerve damage can occur at the surgical site.
• In case hematoma develops after surgery, a second procedure might become necessary.

Adults of any age can be considered for a knee replacement, although most are carried out on people between the ages of 60 and 80. More people are now receiving this operation at a younger age.

Your orthopedist will decide if surgery is necessary in your particular case. You will be asked to undergo some tests (imaging tests of the knee, chest X-ray, lab test, ECG), and to see your anesthesiologist before your operation. This is to ensure that it is safe for you to undergo surgery under general anesthesia.

To minimize the risk of possible complications due to infection, you will also be asked to obtain a note from the following specialists (issued no more than 4 weeks prior to surgery) stating that you are not carrying any infections:

• dentist
• ENT specialist
• gynaecologist or urologist
• relevant specialist if you suffer from chronic medical conditions

All of our patients are asked to complete a detailed medical history form. It is important to fill out the questionnaire to the best of your knowledge because the answers you provide will help our surgeon decide whether you are eligible for surgery.