The two partial joints of the knee, the knee cap and the knee fillet joint, as well as the complex ligament and the articular cartilage of the knee work together to cope with the sometimes heavy loads in sports and everyday life and to ensure the necessary mobility.
If these structures are damaged in the course of life due to wear or injury, orthopedic trauma treatment can restore the knee joint to function properly.
Knee surgery is one of the most demanded procedures among orthopedic operations. There are many reasons why your knee ceased functioning normally and depending on them you may need different treatment. Specialized orthopedic and trauma centers in Germany offer to their patients various interventional and non invasive methods depending on kind and degree of disease or traumatic condition.
According to Federal Service for National Statistics, the number of patients requiring treatment of orthopedic conditions multiplied by 2.5 during the last 25 years.
The most widespread traumas and conditions of knees are:
- Gonarthrosis – arthrosis of knee joint;
- Tear of crucial ligament;
- Meniscal tear;
- Damage of cartilaginous tissue;
- Knee dearticulation.
Our core competencies include surgical and non-surgical treatments for knee fractures, knee joint wear (arthrosis), knee joint infections and sports injuries, in particular ligament, tendon and meniscal tears. We attach particular importance to a detailed diagnostic clarification with the help of the most modern examination techniques.
Focus and specializations in knee joint treatment
- Surgical reconstruction and stabilization of broken bones in the area of the knee joint,
- Implantation of knee prostheses (partial and full prostheses) as well as replacement prosthesis operations,
- Treatment of knee and prosthesis infections
- Minimally invasive, arthroscopic-assisted ("keyhole technique") surgery for sports injuries (cruciate ligament, lateral ligament, meniscus, cartilage, etc.),
- Joint-preserving axis correction (conversion osteotomy) of the tibia and thigh in the event of early arthrosis development in the knee joint,
- Treatment for instabilities of the kneecap,
Operative spectrum and treatment procedures
- Partial and total endoprostheses of the knee joint,
- Revision arthroplasty and infectious surgery,
- Transfer osteotomies (proximal tibia and distal femur,
- Arthroscopic-assisted reconstruction of the anterior and posterior cruciate ligament with tendon grafts, including cruciate ligament-preserving reconstruction (dynamic intraligamentary stabilization),
- Minimally invasive reconstruction of the collateral ligaments,
- Treatment of multi-ligament knee injuries after knee dislocation (ligament bracing),
- Arthroscopic treatment of meniscal tears (partial meniscectomy, meniscal suture), meniscal transplantation,
- Patello-femoral stabilization,
- Treatment of cartilage damage, cartilage transplantation,
- Reconstruction and osteosynthesis of fractures close to the knee.
The most common knee joint diseases and their treatment
Arthrosis of the knee joint (joint wear) leads to knee pain and restricted movement. Treatment is conservative in the early stages, i.e. not operational. This includes physiotherapy, pain medication and pain relieving and anti-inflammatory knee infiltration (injection into the knee joint).
Artificial joint replacement (endoprosthesis) is the treatment of choice for advanced osteoarthritis and corresponding suffering. Depending on the location and the severity of the joint wear, partial or full dentures are used. The affected joint surfaces on the thighs and lower legs are replaced with a surface replacement made of metal (cobalt-chromium alloy). In between and on the back surface of the kneecap, a plastic insert made of polyethylene serves as a sliding surface replacement. After the operation there is rapid rehabilitation, which is significantly supported by our physiotherapists. On the first day after the operation, the first attempts at walking with walking sticks are made and rapid progress is usually made so that the patient can leave the hospital after a few days. The use of walking sticks is recommended for about four to six weeks, whereby the operated knee can usually be loaded up to the pain limit.
Our core competencies include surgical and non-surgical treatments for knee fractures, knee joint wear (arthrosis), knee joint infections and sports injuries, in particular ligament, tendon and meniscal tears. We attach particular importance to a detailed diagnostic clarification with the help of the most modern examination techniques.
Loosening / infection
If after years of wear and tear a loosening of the prosthesis components turns out to be the cause of the pain, a replacement operation of the prosthesis is necessary. If an infection of the prosthesis can be ruled out during the previous clarification, this procedure is usually carried out in a single operation.
Infection of a knee prosthesis is an emergency and should be treated quickly. If the infection is diagnosed in the acute stage, a prosthesis-preserving procedure may be initiated, i.e. the joint is opened and cleaned surgically, but the prosthesis is not removed. In the case of chronic or recurring infections, the prosthesis must be removed in a first step. A temporary placeholder made of cement serves as a temporary restoration, which is used during the same operation after the prosthesis has been removed. Then the treatment with antibiotics is in the foreground. After 6-12 weeks of antibiotic therapy, a new artificial joint can be implanted in a second operation.
Sports injuries (ligaments and meniscus)
Bands (ligaments) and two menisci in the knee ensure stable joint guidance with all movements. Ligaments and menisci can be injured in sports accidents. The anterior cruciate ligament and the lateral ligaments (inner and outer ligament) are most frequently affected by the ligaments. Depending on the extent of the injury (strain, partial rupture, total rupture), therapy is carried out without (conservative) or with surgery. The meniscus tear also often occurs in sports accidents, but can also happen due to minor accidents. Depending on the shape of the tear and the age of the tear or the patient, the meniscus is sutured or partially removed.
Surgical treatment of these injuries is largely arthroscopic (keyhole technique) and therefore minimally invasive. Certain multiple injuries (multiple ligaments affected) or more complex reconstructions of sidebands sometimes require an open procedure.
Torn tapes can either be sewn or replaced. In the case of meniscal injuries, the injured part is either sewn or removed. The decision is made individually depending on the injury pattern and the patient. The tear of the anterior cruciate ligament is one of the most common surgical indications. The suture of the anterior cruciate ligament through dynamic intraligamentary stabilization (Ligamys) should be done within 3 weeks after the accident. A cruciate ligament replacement plastic can also be performed later. The injured ligament is removed and reconstructed with a tendon (semitendinosus) of the rear thigh muscle group ("hamstrings"). Alternatively, the tendon of the anterior thigh muscle, the kneecap or donor tendons are used.
A misalignment of the leg axis, popularly known as the X or O legs, leads to an uneven load on the various parts of the knee joint. This can lead to pain from overwork or even premature cartilage wear. The leg axis can be corrected to relieve pain and stop cartilage wear. Depending on the individual malposition, the correction is made on the upper or lower leg, in each case close to the knee joint. The axis correction is precisely planned and simulated with a special computer program before the operation. With the operation, in which the bone has to be partially sawn through, the axis correction is carried out according to the previous planning. The new position is then fixed with a plate and screws (like a broken bone) so that the bone can heal in this position.
How knee joint is organized?
When we move during walking and straighten legs or bend, our knee joint is actively working. This is a very flexible connection tissue between the hip and the shin. A healthy knee has the connection of three bones:
- Thighbone (Femur)
- Shin bone (Tibia)
- Knee-cap (Patella)
These bones are covered with smooth cartilaginous tissue in the area of connection and are kept together with the help of ligaments, muscles and tendons. There’s space between bones filled with meniscus that absorb pressure and distribute load evenly.
How knee joint is disrupted?
Disrupt of knee joint can be caused by different reasons. Most often, it is connected with mechanical damage, arthrosis, inborn deficiency in limb development and other rheumatic diseases.
Gradually, cartilaginous tissue of knee joint wears down. Since it cannot regenerate by itself, it wears and disrupts permanently. When the cartilaginous tissue of the knee joint is worn down considerably and bones almost get in contact without being protected by cartilage, every motion causes severe pain.
During such condition, doctors initially prefer traditional knee joint treatment methods. These include physical therapy, wrapping, baths and pain-killers. If these methods don’t bring considerable results, doctors resolve to implantation of an artificial knee joint – patient’s knee joint is replaced by an implant.
What an artificial knee joint is?
An artificial knee joint replaces smooth natural surface of bones composing it. Such implant consists of a thighbone component, meniscus imitator and upper shin bone component. All above mentioned components are designed to bear a high load, which is why high-quality materials are used for production.
The parts for thighbone and shin bone covering are made of metal alloys, mostly – titan or chrome with cobalt. These materials are highly durable and are not typically rejected by human body, just like polyethylene meniscus.
How to Prepare to Knee Surgery?
Knee surgery is quite common and does not require any specific conditions. You need to have an operating field prepared and be ready for anesthesia.
The following types of anesthesia are used for knee surgery: endotracheal, intravenous, conduction, and spinal anesthesia. Regional anesthesia with anesthetics like Novocain or Lidocaine can also be used, but it is less common. A proper type of anesthesia is considered based on the surgery type and its extent. Minimally invasive interventions are most often performed under conduction or spinal anesthesia. But whenthe knee joint is replaced, general anesthesiawith muscle relaxants is more suitable, in order to provide easier access to the site of surgery.
Tip: Be serious about choosing the right anesthesia type to ensure minimal negative impact of medications on the body, as you need to reserve all its energy for recovering from surgery. Doctors should not just agree with those patients who often ask for general anesthesia,even with minor interventions, because medications anesthetics can dramatically weaken even a young and healthy body, not to mention the patients with chronic pathologies, and those over 60 years of age.
Make the most of the time remaining before surgery to improve your general health as much as possible. Because the fitter you are before the operation, the faster you will be fit after the operation. Stop smoking. Reduce alcohol consumption as much as possible. Reduce your overweight, eat healthily. Improve your overall fitness, moderately strengthen your muscles. This can reduce the risk associated with each operation.
Knee Surgery for Arthritis
Arthritis is a main enemy of the joints. If you open Medical Encyclopedia you can find a few dozen of types of the disease. Osteoarthritis and rheumatic arthritis are the most common of them causing degenerative changes of the joints.
Osteoarthritis is a condition when cartilage, which is natural damper of our joints, wears out and reduces in sizes causing the bones rubbing against each other, which produces pain, swelling and stiffness. If you have knee osteoarthritis you may experience continuous pain when moving, climbing stairs and even sitting or lying. Mild osteoarthritis can be treated with conservative methods but from moderate to severe stages surgery is often recommended option.
Osteotomy of the Knee
Osteotomy is cutting and alignment of the bone that allow to balance pressure in the knee joint and get rid of pain. The procedure is normally recommended for patients from mild to moderate degree of the disease, especially for those who have the joint affected only from one side and who are too young to have total knee replacement. It helps to support natural function of knee joint and increase its lifespan. Sometimes reshaping and shifting of the bone helps delaying replacement surgery for years.
Knee replacement Surgery
When your knee joint severe worn out, you have persistent pain and traditional treatment is not effective you may need total or partial knee replacement. Knee replacement surgery is a leader among replacement surgeries worldwide. Modern technologies allow replacing your degenerative joint with implant of your choice that gives immediate relieve and significant symptom reducing.
Some patients may need revision surgery, which as a rule require for replacing old prosthesis with new and modern one. In this case, it is necessary not only to change joint implants but also to clean everything around, especially, when patients have old metal prosthesis that gives debris.
Trauma Knee Surgery
Arthritis is not the only reason for restorative knee surgery, as many problems are caused with injuries and other damages such as permanent overloading of the joints as result of intense sportive exercises.
Torn Ligaments Surgery
Torn ligament is a problem of athletes but also they can be result of any other accident. There are four ligaments around knee joint and all of them may need reconstructive surgery. Anterior cruciate ligament (ACL) is a most often candidate for the surgery which can be done both with classic surgery and minimally invasive methods.
Microfracture Knee Surgery
Microfracture surgery is one of the modern methods to restore torn meniscus. Traditionally, damaged meniscus is cut but presently many surgeons in Germany apply a technique stimulating natural growth of cartilage. It is possible by drilling micro fractures in the bone that provoke build of new cartilage.
Knee Joint Puncture
Puncture of the knee joint is one of the simplest procedures on the knee. It is performed for arthrocentesis, or collecting a sample of synovial liquid, which is further used for diagnosis, and to administer drugs directly to the site of the problem. Puncture is performed under local anesthesia with a special needle.
A knee injection is not a difficult procedure. It is performed in a treatment roomon a couch, in a sterile environment. In any case, the procedure should only be done by a doctor who knows exactly how and where to introduce the needle for a therapeutic or diagnostic puncture.
Indications for Knee Puncture
Knee joint puncture is used to:
- Remove blood accumulated due to hemarthrosis
- Remove pus or exudate from the knee joint cavity
- Introduce an antibiotic that will help to eliminate an inflammation caused by bacteria
- Inject anestheticand painlessly fix joint dislocation;
- Introduce air into the knee, which may help to eliminate adhesion and restore motor function
- Introduce a corticosteroid to relieve arthritis.
A doctor can decide if puncture is advisable only after complete examination of the knee joint.
When puncture is contraindicated
A doctor should not do a procedure if any wounds, rashes, and plaques indicating psoriasis are present at the spot where a needle is to be introduced.
Performing jointpuncture in despite of these signs can lead to severe joint infection.
Puncture is also contraindicated in people with bleeding. If a patient with this disease has strong indications for knee puncture, he or she should receive some medications before the procedure.
Puncture for Diagnosis
In some cases, puncture helps to accurately and correctly establish a diagnosis. A doctor puts a needle into the joint and extracts fluid substance from the articular cavity. This liquid is examined to determine the nature of the inflammatory process.
Diagnostic puncture is performed in order to find:
- If any “joint mouse” or “rice bodies” are in the joint
- If the meniscus is damaged
- If any accumulation in the knee during the inflammatory process after getting an injury.
In order to diagnose meniscus damage, oxygen is injected into the joint under high pressure.
When pus, blood or exudate is discovered in the knee with the help of a knee injection, it is possible to treat it immediately. First, the discharge is removed, then, the joint capsule is washed and a medication is administered.
Puncture for Therapeutic Purposes
Puncture of the knee is used not only for diagnosis, but also for treatment. Treatment of knee joint disorderscan be much more effectiveand safe when medications are delivered into the joint. For example, in case of oral drug administration, there may be side effects of the digestive system. Topical ointments may be less effective, as they are not completely absorbed into the tissues and assimilated in the body. For treatment of knee disorders, a medication is injected with a needle directly into the affected area. If blood or pus accumulates in the knee, they can be removed with a syringe in seconds.
Therapeutic puncture is done to:
- Remove the blood accumulated in the joint cavity as a result of hemorrhage or injury
- Injectantibiotics to relieve inflammation in the joint
- Introduce anesthetics to correcta joint dislocation without pain
- Introduce oxygen into the knee to restore the motor activity of the knee joint
If puncture has not been performed timely, a hematoma will dissolve slower and itcan lead to knee inflammation with fever and overall deterioration of a patient’s health.
Joint Puncture Explained Step-by-Step
Thanks to the knee anatomy– the patellais located slightly forward – the procedure is very simple and easy. A patient lies on his back with a tight bolsterunder the knee. From the lateral side, a needle is inserted at the middle part of the patella to the depth 3cm. If a puncture is done to the lower part of the joint, the procedure will be painful. The technique of puncture has its own nuances.
Before the procedure, the knee is disinfected. Skin is treated with a solution of iodine and alcohol.
- To introduce oxygen, use a thin needle – 1 mm in diameter. To remove pus or blood you need a needle with a diameter at least2 mm.
- The skin at the injection site should be stretched aside to prevent infection from getting into the blood.
- The needle should be moved slowly until it reaches the articular capsule. After it is also punctured, the needle will move easier. In order not to damage articular cartilage,the needle should not be injected deeper than 3 cm.
- Depending on the type of procedure, medication is injected into the joint or liquid is aspirated from the articular cavity with a syringe witha volume from 10 to 20 grams.
- At the end of the procedure, the puncture site should be wiped with a sterile napkin; a tight bandage is applied on top.
Puncture is a specific procedure, so it is very dangerous for health and knee mobility if you try to perform it by yourself.
Knee Ligament Surgery
Ligament repair is required when ligaments are torn or damaged. You may need stitching with special suture materials. Ruptures can occur with dislocationsand fractures.
First aid if you got an accident: if you suspect a torn ligament, before meeting a doctor, give rest to your knee: to restrict movements in the joint is necessary to get rid an edema, reduce pain and prevent further injuring. Bandaging is also useful. It is very important to apply cold in the very first moments after an injury. This narrows the blood vessels, reducing edema and hemorrhage to the inner tissues.
Anterior Cruciate Ligament Tear
Most often, anterior cruciate ligament (ACL) is torn.
Conservative Treatment for torn ACL
With a complete tear of the ligament, this kind of treatment is not highly effective, but it can be assigned in elderly patients if the joint is relatively stable.
Usually,a treatment course includes:
- Electrotherapy (Functional Electric Stimulation (FES), InterferentialTherapy, etc.) or ultrasound therapy (Phonophoresis) for 10 days (a standard course includes 10 procedures, and it is important to receive them without gaps) to eliminate pain and swelling and prepare the joint for exercise therapy.
- Compresses with ointments(e.g., Lyoton, Voltaren).
- Massage to reduce pain and swelling.
- Physical exercises:at the beginning, withlow intensity andwithout direct pressureto the joint (for example, lying exercises), and, then,more intense exercises to build musclesaround the knee, and strengthen the thigh muscles and lower leg muscles.
The recovery time is approximately 1.5-2 months of regular workouts, but,again, everything depends on the gender and age of the patient, and individual features of the body.
Surgical Treatment for torn ACLis performed up to one week after an injury or six weeks after. This is becausea hematoma is formed within one week after an accident and a lot of blood accumulates in the joint, which complicates surgery.
In essence: a graft (a new ligament) is fixed in the knee joint with titanium screws. Tissues for transplantation can be obtained from several sources. Most often, the graft is taken from the patellar ligament that is located between the patella and tibia. The tendons of the posterior thigh also can be used for the graft.Sometimes, the tendon of the quadriceps muscle,located between the patella and femur, is used, which makes the treatment of the torn ACL somewhat more physiological.
Ligament reconstruction can be performed using open access or with an arthroscope, an endoscopic device that allows less traumatic surgical interventions.
Arthroscopy for ACL repairincludes the following:incision or puncturing tissues; introducingsurgical tools and a camera; cleaning the joint; removingthe torn ligament andcutting the meniscus; taking a graft for a new ligament;makingthenew ligament; fixing the ligament in the joint.
Here you can find a more extended description:
- For arthroscopic surgery, a spinal anesthesiais usually used.Although medication is injected into the spinal canal, this method is absolutely safe, despite myths about “the risk of spinal column damage and, as a consequence, paralysis”that have no any scientific basis.
- Cleaning the joint. When a trauma occurs inside of the joint, ligaments are torn. And when the ligaments are ruptured, the meniscus is often also damaged and has to be cut during surgery to remove torn edges. The old ligament and other unnecessary fibers are “nipped off” by a special tool, releasing a space in the joint.
- The types of the new ligament:made from the patient’s own tissues (it can be taken from the tendons of the inner thigh or from the patellar ligament); combined (made from lavsan and biological tendons or ligaments); completely artificial (from lavsan). Only a doctor can decide on the type of the ligament, and his choice depends on the weight and age of the patient, and his life activities.
- The ligament is fixed with titanium bolts, with one end of the ligament attached to the femur, and another one– to the tibia.
Surgery duration and how long you stay in a hospital: the surgery lasts no more than 1.5 hours. After this, the patient spends 2-4 hours in the intensive care unit, until the anesthesia wear off. The patient is discharged with crutches on the third day after surgery.
Torn Lateral Ligament Repair
A tear of the lateral knee ligaments is characterized by a lower intensity of clinical symptoms, but it also involves pain, swelling in the injured limb, and discomfort. What you have to be aware: there are no any possibilities of spontaneous relief if you have torn ligaments. On the contrary, with time, fibrous deposits may appear, which may lead to the risks of unpleasant sensations in the knee all over the life.
When one is diagnosedwith a torn knee ligament, treatment can be prescribed only by a doctor.
Choosing a method of treatment (conservative or operative) depends on the individual characteristics of a patient, including sex, age, andthe way of life: treatment may differ for professional athletes, people who lead the active lifestyle, and those who are far from being sportive. An opinion of the patient is also taken into consideration.
Conservative treatment is possible only with lateral ligament rupturesof the grades I and II. It is mostlyprescribed to elderly patients (over 55-60 years), as well as the patients who do not engage in sports. But, at the same,the patients are informed that if, after some time,knee pain and instability does not go away, surgery may be an option.
Immediately after an injury, Electrotherapy and ultrasoundcan be applied to alleviate pain and relieve swelling. Additionally, various ointmentsand compresses can be useful, as well as light massage. Treatment of torn ligaments does not take much time, even together with rehabilitation, thanks to modern methods.
Perhaps, the doctor will prescribe wearing an orthosis, and orthopedic device to maintain stability in the joint before and after exercising, while walking outside, etc.
Surgical treatmentis usually prescribed for isolated tears of the grade III, especially if there is a detachment of the superficial medial collateral ligament from the tibia (the ligaments may tear in different locations, and treatment also depends on it).
Surgery is an advisable option for all professional athletes who need to recover and be ready for competitionsin a limited time, and also for the patients who failed with conservative treatment, have persistent pain and apparent instability in the joint.
A method of surgery depends on the time elapsed after the injury. If it is still up to 3 weeks, then,a torn ligament is sewed. With the significant disintegration of ligament fibers, the ligament is strengthened by the fascia or tendon of the adjacent muscles. In this case, the treatment of knee ligamentrupture takes more time, and the risk of complications associated with infections also increases.
After 3 weeks, the ends of the torn ligamentscan no longer be brought together, since they contract, and now they can be repaired with the help of arthroscopy using artificial materials.
Arthroscopy is a minimally invasive or spare operation on knee joint. According to German online statistics collection websites, arthroscopic meniscus and cartilage operations are on the second place after the most widespread surgical procedures in German clinics. Orthopedic surgeons in Germany perform about 305.000 similar operations which proves a high level of their knowledge and professional skills.
Arthroscopy is based on using a special video device – arthroscope. Technically, an arthroscopic operation on a knee joint does not require making big cuts: a few small incisions are made for the instruments to get inside patient’s body. Arthroscope is equipped with lenses and light emitted diodes. Light is shot via an optic fiber wire, knee space is lightened, and camera transmits video signal on computer screen. Precision of the picture reaches 95-100% which allows the surgeon to make the right joint analysis and plan the future actions.
This technology has the following advantages:
- the surgery does not cause trauma;
- it allows making a precise and high-quality diagnosis of knee;
- rehabilitation period shortens considerably (3-4 months maximum);
- it helps to save money.
Indication for the procedure:
- Pathologic defects of cartilage.
- Chronic instability of knee cap.
- Meniscus damage.
- Inflammation of synovial membrane caused by unknown reasons.
- Spontaneous aseptic necrosis, intra-articular bodies, etc.
Keyhole surgery on knee cap is used torn o solve various problems starting from knee cap cleaning and finishing by reconstruction of torn ligaments.
Arthroplasty is a surgery to replace, restore or reconstruct articular surfaces of joints. In modern traumatology and orthopedics, arthroplasty can be classified as follows:
Open reduction is used to re-align bony fragments of fractured joints if they located on the articular surface or very close to it. This procedure involves osteosynthesis, a fixing of the fragments by different devices, such as rods, screws, plates, etc., made of hypoallergenic materials. This immobilization of the joint provides the minimal negative consequences after a fracture.
Resection arthroplasty. In the course of this operation, a resection (excision) of one of the working surfaces of the joint is performed to introduce a tissue complex including ligaments and fascia. This type of operation preventsankylosis and facilitates conditions for restoring the motor activity of the joint. This also includes arthroplasty of the joint articulation, in which ceramic implants covered with bioactive glass-ceramic are used.
Resection of the knee joint is a large-scale surgery, which is indicated in case of purulent-inflammatory diseases of the knee and knee fractures. This intervention involves the removal of not only the joint itself, but also the damaged part of the bone. Most often, after this, another operation follows, such as joint replacement or an amputation of the lower third of the thigh. This is a complex and demanding surgery.
Knee cartilage repair. This intervention is performed to remove defects and ossification of cartilage. Defects are eliminated with the help of special pastes and solutions that, after hardening, have nearly the same density as hyaline cartilage. Surgery is followed by medication with drugs helping to restore the cartilage layer of the joint.
Knee Joint Cyst Removal. Removal of ganglion cysts of the knee joint does not cause any difficulties and lasts about 30-40 minutes. Baker’s cyst is a bit apart from the others.
Also, one of the types of surgery is intervention to replace the patella.
Total Knee Replacement (Arthroplasty)
Prosthesis of the knee joint is a replacement of a biological joint with an implant, which is made of special alloys and polymers. The implants are produced in a variety of sizes and materials in order to fit to the individual featuresof each patient, including sensitivity to implant components. To date, such artificial joints can almost completely restore the function of the lower limbs. In some cases, only the joint surface can be replaced.
Indications for total knee arthroplasty
Indications for knee replacement are considered by atrauma surgeon or an orthopedist, based on the examination results and the patient's complaints. The doctor should discuss with a patient everything concerning the forthcoming knee replacement in details.
The patient should be informed about all the pros and cons of the surgery, existing alternative treatments and possible complications associated with this particular type of surgical intervention.
Total knee arthroplasty: Procedure
Knee joint replacement is elective surgery, which means it scheduled and planned in advance and performed when a patient is duly prepared. After a replacement is considered, first, the patient is thoroughly examined. The results of examination allow make a conclusion onthe patient's overall health andcarry out preoperative preparations based on patient’s individual data.
After the examination and preparations, the surgery date is scheduled. The operation is performed under general or spinal anesthesia.All the nuances of anesthesia,oncoming surgery and subsequent rehabilitation are discussed with the patient in advance.
Surgery is performed by a team of orthopedic and trauma surgeons. There are several options how to perform surgery: with a tourniquet to stop bleeding during the procedure, without a tourniquet, and partiallywith a tourniquet. Each option has its own supporters and opponents.
A decision on the type of anesthesia is taken by an anesthetist together with the patient. Standard uncomplicated surgery lasts for 1.5-2 hours. In the postoperative period, intensive therapy, pain management, and wound dressings are carried out. For prevention of infectious complications, the patient receives antibacterial medications.
To prevent thrombotic complications, the patient is prescribed to takedrugs of the class of low molecular weight heparins. Elastic bandaging and foot movements immediately after surgery are also recommended.
Postoperative Complications and How to Deal with Them
In the postoperative period, the patientwithout fail should bein a hospital on an inpatient basis, under medical supervision. After surgery,anticoagulant therapy can be assigned. Another important component of postoperative rehabilitation is electro- and mechano-therapy that can last from two months to six. In case if the patient strictly follows all the prescriptions of an attending doctor, at the end of the rehabilitation period, he or she can return to normal life and lead an active physical activity in the future.
In the postoperative period, due to damage to the periarticular and intraarticular structures during surgery, fluid accumulates in the knee and it is hurt. This is normal and not considered as a complication if the fluid accumulation accompanied by edema of the tissues around the patellatogether with pain doesnot last longer than expected. These symptoms should be diminished in approx. 3 days, and, by the second week, they tend to cease completely. In the early period, doctors drain the wound and give an antiseptic treatment to reduce puffiness and pain. Extra measures include:
- Limb immobilization by orthopedic means.
- Keeping the leg in an elevated position when the patient is in bed.
- Applyingdry cold.
- Anti-inflammatory drugs.
If edema does not decrease, it is a sign that inflammation is still progressing, and, perhaps, there is local infectious pathogenesis that not only prevents restoring mobility, but also can lead to more complex consequences. For example, if you have got a newly implanted joint, infection can cause the rejection and implant deformation, which may require a revision surgery (removal of the faulty implant) and prolonged antibiotic therapy. If the edema is associated with an excessive synovial fluid and blood in the joint, you will need a joint puncture to remove theexudate.
A range of movements should gradually increase and restore completely by the end of the 6th week. If the amplitude of knee flexion/ extension is not reaching the norm, then it can be qualified as a failure of physical rehabilitation due to mistaken actions of the doctors or the patient. If the leg cannot bend or is not fully straightened, it may be a result of a contracture of the joint that has developed due to the adhesions between the tendons and nearby tissues. If timely noticed, the condition can be is improved by manual stretching and a long, intensive exercise therapy, functional electric stimulation, etc. In case of severe pathology, surgery aimed muscular mobilization and excision of cicatricial fusion with subsequent rehabilitation is the only option.
It should be noted that the life of knee implants is limited. An implant can last 15-20 years, sometimes a little longer.
Mostly, total kneearthroplastyis successful and allows us to achieve quite positive results in restoring the motor function. But it is worth to mention that there are some exceptions. Negative body response to the anesthesia is one of possible complications during the operation and after the surgery. Also scars or extensive hemorrhage may appear after surgery. However, the most dangerous consequence is the infection of in the joint cavity. And with the following revision operation the risk of infection increases. In case of this complication, surgeons have to remove the infected implant.
Recovery after Knee Surgery
The recovery period depends on method, kind of problem treated and patient’s health. The recovery after knee surgery is considered as quite easy, patients start working next day after total knee replacement, but in some cases of injuries it is not the same. In any case, it can take from few weeks till several months for complete rehabilitation. This time can be reduced by using minimally invasive technique.
- First days you should take simple measures to avoid complications
- You should start moving immediately after surgery (starting from moving in your bed and continuing walking)
- You will need crutches or other supporting devices for 1-10 days
- You should start exercising and increase load gradually
- You will need physiotherapy for weeks or even months after surgery
- You should observe yourself and report to your physician.
For successful and quick rehabilitation you need:
- Tailored planning of rehabilitation procedures based on a particular condition and individual features of a patient.
- Day-by-day schedule, including all the aspects of treatment, such as medication course, procedures, and physical exercises.
- Well balanced, gradual and correctly apportioned physical activities.
- Careful monitoring how the patient receives all treatment and recovery procedures.
Each patient needs an individual recovery program after knee surgery, specially developed for him by a medical team, including a surgeon, a rehabilitation doctor, a neurologist, a physiatrist, and others if needed. That means there is no single rehabilitation scheme for all patients. The main purposes of rehabilitation:
- Encouraging an early physical activity of the patient.
- Prevention of respiratory system congestion after surgery.
- Stimulation of regional blood circulation and lymph drainage in the lower limbs.
- Reduction of exudate in the knee;
- Rapid elimination of pain syndrome;
- Prevention of muscle weakness, contractures and tissue adhesion.
- Stimulation of metabolism and tissue regeneration.
- Prevention of infectious in the operated tissues.
- Recovering of limb motor functions.
A doctor will explain to you how to rehabilitate your knee after surgery. Do not try on your own! Incompetent treatmentmay be dangerous, remember this if you do not want your knee hurt and cannot move normally after surgery.
In a hospital, you will be trained how to bandage your leg correctly. First, bandaging is done by nurses, but upon returning home, you will have to do it yourself. Be attentive to everything that the medical staff teachesyou, while you are still in a clinic or rehabilitation center.
How to Improve Your Knee after Surgery
You may start exercising in the supine position from 12-24 hours after surgery and continue till 3-7 days. The frequency of repetition and the daily number of sessions is determined by a physiatrist.
- Carefully raise the operated leg, lifting it by 20 cm over the horizontal surface. The healthy leg is bent at the knee. Hold the raised leg for 5 seconds, and, then, gently return it to the original position. Both legs are slightly bent; the heels rest on the bed surface.
- Strain your thigh muscles. When counted to ten, relax. Hands are along the body; the torso is relaxed.
- Perform an isometric contraction of the gluteal muscles, keeping tension 5-8 seconds. Do until the light burning appears.
- Lying on the back with a rolled towel under the foot, try to bend your leg. The ligaments of the popliteal zone and the muscular structures of the lower leg should be strained. After 5 seconds, relax. The main thing is not to make a greater effort, but to increase the load smoothly.
- The legs rest on the bed straitened. Move your feet up and down, while keeping your heel on the bed. It is useful to alternately move your legs apart, sliding on the sheet. Doveryslowly.
Easy exercises are gradually supplemented with more difficult ones. Here are some examples.
- Stand by the wall or next to a chair to have a support. Slowly raise the straightened operated limb forward till 45 degree. Keep your leg in this position for 5 seconds, and gently return it to the original position. Do not forget to hold the support with your hands.
- Do the same exercise as the previous one, but move your foot to the side. With your hands on to the back of the chair, extend the limb aside (without jerking!) and slightly raise it up. Holdon for a few seconds and return to the initial position. Keep your balance.
- Lie down on your back; put a cushion under the operated knee. With support on the cushion, straighten the leg. Keep the straightened position for about 5 seconds, and, then slowly return the leg to its original position. Do this smoothly to prevent chance injuries.
After 2-3 weeks you can do more active exercises, as following:
- Semi-squats near the chair (do not bend your knee at an angle more than 90 degrees) Try to stand on your entire feet.
- Stretching exercises, for example, flexing the knee while holding the foot in your hand and lifting it to the buttocks. If you, at the same time, move the pelvis forward, the stretching effect will increase.
- Resistance exercises using a rehabilitation expander or a rubber tourniquet. You can come up with a lot of exercises with a tourniquet.
- Step (from the front and side) on the step-platform transferring body weight to the operated leg with its further straightening. Alternate the legs when doing this exercise.
- Riding a stationary bikewithan easy mode of pedal resistance, and, then, gradually increasing it to an average and heavy mode. This is the best simulator for rehabilitation.
- Walking on a treadmill: begin with a slow pace for 10-minute, then, gradually increase the speed and time; aqua gymnastics and swimming in the pool. We recommend practicing in the pool.
While exercising, listen to your own feelings: you must control the threshold of acceptable pain, not exceeding it. Overloading is not allowed! Unbalancedeffortscan lead to a painful edema. How long it will last, depends on how much harm you caused the knee. But what is really not good, swelling and pain will slow down the recovery of the joint.
Knee pain: where exactly is the pain in the knee?
First of all, it is important to pinpoint and define the knee pain. Where, how and when exactly do they occur?
Depending on the location, a distinction is made between four different types of knee pain: the front, the outer and the inner and the popliteal pain.
The anterior knee pain affects the front of the knee joint, thigh and lower leg and kneecap.
The popliteal pain refers to pain that occurs at the back of the knee joint in the popliteal fossa.
Internal knee joint pain is when the inside of the knee joint, the inner knee joint gap and the inner thigh and lower leg are affected.
Analogously, the external knee joint pain originates from the outside of the knee joint and affects the outer knee joint gap as well as the outer thigh and lower leg.
Furthermore, a distinction is made between two types of knee joint pain: acute and chronic knee pain.
The acute knee pain often occurs suddenly and only last a short time (a few hours to several days), while the chronic knee pain usually creeping and persist for a long time (six weeks to three months).
In order to be able to define knee pain accurately, it is also important to know when exactly they occur. Thus, knee pain can occur either with specific movements and stresses on the knee joint, such as when climbing stairs and walking, or even at a standstill with a bent or stretched knee.
What are the 5 most common causes of knee pain?
In order to be able to successfully treat knee pain, the causes of the pain in the knee must first be clarified. The pain can be caused, for example, due to diseases, injuries, malpositions and over- and wrong strain of the knee. While in younger people, the knee pain is often caused by injury and growth, in older people usually wear and tear is the reason for the suffering.
The most common cause of disease-related knee pain is knee osteoarthritis (gonarthrosis). It involves the wear of the articular cartilage and the consequent loss of lubricity of the knee joint, resulting in the painful rubbing of the articular surfaces.
In addition, inflammatory diseases such as knee arthritis (gonarthritis), i.e. inflammation of the knee joint, and rheumatoid arthritis of the knee joint (joint rheumatism) may be responsible for knee pain.
The most common knee injuries include the cruciate ligament tear and meniscal tear.
Overload and overuse are usually the result of being overweight or exercising excessively.
In addition, knee deformities such as X- or O-legs as well as knee instability and the stiff knee can be the cause of severe knee pain.
Why is a proper examination of knee pain so important?
In order to understand which of the causes listed above is responsible for a patient's knee pain, either the family doctor or an orthopedic specialist performs a thorough physical examination with a variety of exercise tests and a patient history taking a first visit to the doctor.
It is important that the doctor, after talking with the patient, knows exactly what type of knee pain is, where and when they occur, and whether they are predominantly exposed to stress or retired.
In addition, the doctor can further reduce knee pain by asking patients about their pre-existing conditions, existing knee injuries and accidents.
Subsequently, x-ray examinations, ultrasound examinations (sonography) and magnetic resonance imaging (MRI) can be used to more accurately visualize and assess the bony structures of the knee joint as well as the ligaments, menisci and articular cartilage. If an inflammatory cause of knee pain is suspected, knee joint puncture may also be performed, taking joint fluid for further laboratory analysis.
How long does the procedure, hospitalization and rehabilitation take?
Depending on the type of prosthesis and the individual circumstances, one calculates for the operation with one to two hours.
The inpatient stay after the procedure is usually two to three weeks. The physiotherapist begins mobilization on the first day after the operation. Following the hospital stay, an intensive rehabilitation phase follows in a corresponding rehabilitation clinic or on an outpatient basis. It usually takes about three months, in rare cases up to a year after surgery, until you can walk normally.