About Total Knee Replacement
Knee replacement surgery offers a solution for patients that suffer from knee pain that is affecting their everyday lives. Replacing the damaged parts of the knee or the entire knee can increase mobility and function while decreasing pain. The specialists at the University of Utah Orthopaedic Center can help you return to a more active lifestyle or a life that is knee-pain free. Our services include the following:
- Total knee replacement
- Partial knee replacement (uni-compartmental knee arthroplasty)
Ligament Injuries to the Knee
What are knee ligaments?
There are 4 major ligaments in the knee. Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. The four main ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:
Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).
Posterior cruciate ligament (PCL). The ligament, located in the back of the knee, that controls backward movement of the tibia (shin bone).
Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.
Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.
How are cruciate ligaments injured?
The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.
The posterior cruciate ligament (PCL) is also a common ligament to become injured in the knee. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.
What are the symptoms of a cruciate ligament injury?
Often, a cruciate ligament injury does not cause pain. Instead, the person may hear a popping sound as the injury occurs, followed by the leg buckling when trying to stand on it, and swelling. However, each individual may experience symptoms differently.
The symptoms of a cruciate ligament injury may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How are collateral ligaments injured?
The medial collateral ligament is injured more often than the lateral collateral ligament. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.
What are the symptoms of a collateral ligament injury?
Similar to cruciate ligament injuries, an injury to the collateral ligament causes the knee to pop and buckle, causing pain and swelling.
The symptoms of a collateral ligament injury may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How is a knee ligament injury diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for a knee ligament injury may include the following:
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to rule out an injury to bone instead of, or in addition to, a ligament injury.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in bones and a surrounding ligament or muscle.
Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.
Treatment for knee ligament injuries
Specific treatment for a knee ligament injury will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the injury
Your tolerance for specific medications, procedures, and therapies
Expectation for the course of the injury
Your opinion or preference
Treatment may include:
Medication such as ibuprofen
Protective knee brace (for use during exercise)
Ice pack application (to reduce swelling)
Knee Replacement Surgery
When a knee is so severely damaged by disease or injury, an artificial knee replacement may be considered. During knee replacement surgery, joint surfaces are substituted or replaced by prostheses. Nearly 600,000 knee replacement surgeries are performed annually in the U.S. The most common age for knee replacement is between 60 years old and 80 years old.
Who might be a candidate for knee replacement?
The most common condition that results in the need for knee replacement surgery is osteoarthritis, a degenerative, joint disease that affects mostly middle-aged and older adults. Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the knees. Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury can also lead to degeneration of the knee joint. In addition, fractures, torn cartilage, and/or torn ligaments also can lead to irreversible damage to the knee joint over the years.
The decision to replace the painful knee with an artificial one is a joint decision between you and your doctor. Other alternative treatments may first be used, including assistive walking devices, anti-inflammatory medications, injections, and bracing.
What happens before the surgery?
In addition to a complete medical history, your doctor may perform a complete physical examination, including X-rays, to ensure you are in good health before undergoing surgery. In addition, you may also meet with a physical therapist to discuss rehabilitation after the surgery and undergo blood tests (or other tests).
How is a knee replaced with an artificial knee?
Although each procedure varies, generally, surgery to replace a knee usually lasts about 2 hours. After the damaged bone and cartilage of the knee is removed, the orthopedic surgeon will place the new artificial knee in its place.
The most common type of knee prostheses used in replacement surgery is cemented prosthesis. Uncemented prosthesis is not commonly used. Sometimes, a combination of the 2 types is used to replace a knee. A knee prosthesis is made up of metal with ceramic and/or plastic. A cemented prosthesis is attached to the bone with a type of epoxy. An uncemented prosthesis attaches to the bone with a fine mesh of holes on the surface, in order for the bone to grow into the mesh and attach naturally to the prosthesis.
The prosthesis (artificial knee) is comprised of the following 3 components:
Tibial component (to replace the top of the tibia, or shin bone)
Femoral component (to replace the two femoral [thighbone] condyles and the patella groove)
Patellar component (to replace the bottom surface of the kneecap that rubs against the thighbone)
While undergoing surgery, the patient may be under general anesthesia or awake with spinal or epidural anesthesia.
Knee replacement surgeries usually require an in-hospital stay of several days. Even while in the hospital, the patient usually begins physical therapy exercises to begin regaining range of motion in the knee. Physical therapy will continue at home. Pain medication also will be administered to keep the patient comfortable.
The incision will have stitches or staples that will be removed after a few weeks.
Frequently Asked Questions About Total Knee Replacement
- What is total joint replacement/arthroplasty?
- Who needs a total joint replacement?
- How do I know if I need surgery?
- Why have a total joint?
- What does the surgery involve?
- Will I need a blood transfusion?
- How long will I be in the hospital?
- What therapy do I have to do?
- What are the major risks to the surgery?
- What if I get an infection?
- What are total hip precautions and how long do I have to follow them?
- What happens when I leave the hospital?
- What do I do at home while recovering?
- How long do I take narcotics?
- When can I drive?
- When do I see my surgeon after surgery?
- Who do I call if I'm having problems after surgery?
- How long do total joints last? Will I need another surgery?
- What lifelong activities can I do or not do?
- Why do I have to have x-rays every two years?
- Why do total joints wear out?
- Why should I take prophylactic antibiotics for the rest of my life?
Total joint replacement is when a manufactured prosthesis made of titanium, chrome cobalt and polyethylene is used to replace an arthritic hip, knee and sometimes the ankle, shoulder, elbow or wrist.
Someone who has moderate to severe arthritis, significant limits on normal daily activity and severe pain they can no longer live with.
If you have pain that is not managed by anti-inflammatories (NSAIDS) or your pain limits your daily activities, you may want to consider surgery.
A total joint replacement can help you return to more normal activities and relieve your pain (95% successful).
The surgery, called total knee arthroplasty (TKA), involves the removal of small slices of bone from the ends of the bone, which are then capped with metal components. Then a polyethylene (plastic) liner is locked in between the metal components.
You may, but we no longer need you to donate your own blood in advance.
In general, for an uncomplicated total knee or hip, the hospital stay is about one to three days after surgery.
Starting the afternoon after surgery you will have physical therapy and in the days after that you will have it twice a day. This includes exercises: learning to sit, stand and walk with your new total joint. Patients usually take a few steps the first day, then walking around your room and so on. After you leave the hospital, you will have a list of the exercises you have learned to continue yourself at home. Many patients will receive physical therapy at home.
The major risks include the following:
- Blood clot: We reduce risk of this by using blood thinners (Enoxaparin, Aspirin, or Coumadin), T.E.D. hose (compressive stockings) and compression boots on your feet to increase circulation.
- Infection: You are given IV antibiotics before and after surgery.
- Nerve, blood vessel damage: We work close to important vessels and nerves, and take extreme care to not to injure these structures.
- THA dislocation: You can avoid this by following total hip precautions.
- Medical complications: Can occur with existing or new medical problems
Infection if very rare, but a difficult complication. Read more about joint infection after replacement.
Avoid internal and external rotation of the operated hip—keep knees and toes straight ahead. Avoid flexing hip past ninety degrees (for six weeks). It’s best to follow precautions for life. Please no excessive stretching/yoga. Your THA could dislocate anytime even 10–20 years after surgery. But this is less of a concern for hips with very large femoral heads. The larger the head, the less chance for dislocating.
You will usually need 24-hour help for a week. If you don't have adequate help at home, you should consider a rehab facility or extended care facility. You can check with your insurance to see who is approved, but the final plans will be made with our case management team while you are in the hospital.
Recovery involves the following:
First four to six weeks: Do your physical therapy exercises; keep the wound clean: no ointments or lotion on the wound; wear your T.E.D. hose for those four weeks; take blood thinners (Coumadin managed by the anti-coagulation service); walk as tolerated with crutches/walker; transition to a single crutch/cane as tolerated.
Next six weeks: Continue exercises, walk, use a stationary bicycle; use a crutch/cane until walking without a limp; return to work part time or full time as tolerated (as early as four to six weeks from surgery); you may return to full activity when ready except for running/jumping activities; kneeling on a TKA may be difficult but won’t damage it.
The best lifelong activities at this point are walking, swimming and biking.
Only as long as you need them, but usually about 5–14 days from the day of surgery; then Tylenol will usually handle the pain.
Usually three to four weeks after surgery; (Make sure you have control of your leg, no spasms, off pain medication and use caution.)
Staples will be removed two weeks from surgery. You will also be seen six weeks after surgery, six months, one year and two years for the rest of your life. X-rays will be obtained at six weeks and yearly (even if you live out of town we like to see copies).
The nurse/MA who works with your surgeon, and your post-operative instructions will give you a phone number to use. If you feel like it’s an emergency, please call the clinic immediately or the University Hospital operator to have the orthopedic resident on call paged:
If it is after 5 pm, go to your nearest emergency department.
Today, total joints last 15–20 years depending on the amount of activity (demand) and your general health. You may need another surgery depending on how old you are and how much wear and tear you put on your total joint.
We advise patients to resume just about everything, especially walking, swimming and bicycle riding. We discourage repetitive jumping and running, yoga or excessive stretching.
Because when a total joint starts to wear out, we can often see changes on the x-ray before you feel symptoms. We can better determine the need and time for revision (another operation).
The metal components can loosen over time, but often the cause of wear is from the bearing surface. Your immune system attacks the particles from the bearing surface, but also melts bone away. We are using a metal liner (metal-on-metal), ceramic-on-ceramic and cross-linked polyethylene liners that wear less than what we had years ago.
Because total joints are made of metal and are at risk for infection when bacteria circulates through your bloodstream. If your joint becomes infected, it requires more than two additional surgeries. Therefore, take antibiotics with any bacterial infection as prescribed by your family physician. We strongly recommend that you take antibiotics for all dental and invasive procedures for the rest of your life. (This is usually just four tablets one hour before the procedure. You will get more detailed information about which one to use following surgery.)
Adult Reconstruction, Femoroacetabular Impingement, Hip Arthroscopy, Hip Preservation, Hip Replacement, Joint Replacement, Knee Replacement, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Periacetabular Osteotomy, Physician Assistant, Surgical Dislocation
|University Orthopaedic Center||(801) 587-7028|
Adult Reconstruction, Hip Replacement, Hip Revision, Joint Replacement, Knee Replacement, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Patello-Femoral Arthroplasty (PFA), Uni-Compartmental Knee Arthroplasty
|University Orthopaedic Center||(801) 587-7109|
Adult Reconstruction, Joint Replacement, Orthopaedic Surgery, Orthopaedic Trauma
|University Orthopaedic Center||(801) 587-7109|
Adult Reconstruction, Femoroacetabular Impingement, Hip Arthroscopy, Hip Dysplasia, Hip Preservation, Hip Replacement, Hip Revision, Joint Replacement, Knee Preservation, Knee Replacement, Labral Tear, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Patello-Femoral Arthroplasty (PFA), Periacetabular Osteotomy, Surgical Dislocation, Uni-Compartmental Knee Arthroplasty
|University Orthopaedic Center||(801) 587-7109|
Adult Reconstruction, Femoroacetabular Impingement, Hip Dysplasia, Hip Preservation, Hip Replacement, Hip Revision, Joint Replacement, Knee Replacement, Labral Tear, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Periacetabular Osteotomy, Surgical Dislocation, Uni-Compartmental Knee Arthroplasty
|University Orthopaedic Center||(801) 587-7109|