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Total Knee Replacement in case of Knee Osteoarthritis

SYMPTOMS

For some time now you have felt that something is wrong with your knee. Be it after an earlier injury, because of osteoarthritis for unknown reasons, or because of a rheumatic disease. The resilience of your knee joint has decreased in recent months, and your quality of life is severely restricted. You now have pain during the first steps in the morning until you have broken your knee in. Then after a better phase, the symptoms appear with increasing frequency during the day. The knee then feels stiff. You have observed swelling and decreased joint mobility. Perhaps you have noticed a change in the shape of your leg. It is time for something to be done.

EXAMINATION

A slight limp is visible, the shape of your leg has often changed in the X or O direction. Swelling is palpable, as well as tenderness in typical places. Mobility is usually reduced, and first and foremost full extension of the knee joint is no longer possible. Changed contours indicate so-called osteophytes, which are typical bony thickening at the joint edges. In the movement tests, we often notice typical scraping noises, an indication of the lack of a smooth joint surface. X-rays show the classic signs of osteoarthritis (narrowed joint space, osteophytes, and possibly cyst formation in the bone) in more than one of the compartments of your knee joint.

LEGENDE

1 -X-ray normal right knee front view
2 -X-ray right knee front view with advanced joint space narrowing on the in-side

TREATMENT

The symptoms can be alleviated with medication and physiotherapy, especially with the first episode of illness or when the goal is to increase your weight- bearing capacity in the short term. Knee osteoarthritis symptoms have been shown to respond well to body weight reduction (in case of obesity). Your knee may respond positively to “lubricant” injections (i.e. Viscosupplementation/Hyaluronic acid).

SURGICAL PROCEDURE

Experience has shown that if your symptoms and the typical signs of osteoarthritis, on the X-ray images, match there is a good chance that we can help you by implanting a total knee replacement. The aim is to reduce pain and swelling, to restore the leg axis that you were previously used to and at the same time to maintain mobility, possibly even improve it slightly. With modern knee replacement systems, these goals can be achieved with a high degree of security while at the same time maintaining the stability of your joint. If you take good care of your new joint after a successful operation, you can be sure that you will enjoy it for years to come. Operation length: 1 .5 – 2 Hours.

 

LEGEND

3 -X-ray right knee with replacement front view
4 -X-ray right knee
5 -Model of the Attune Knee Replacement

We usually do not provide prosthetic restoration for the back of your patella (kneecap). The reasons:

  • The type of prosthesis we use has a kneecap-friendly shape. Anterior knee pain is therefore very rare after the
  • The kneecap component is the part of a total knee replacement which experiences the most complications. We want to spare you these
  • If you fall on your knee with a knee cap replacement, the resulting fracture is extremely difficult to treat. Above all, we want to minimize this risk for more active people.

RISKS

You will be treated by experienced surgeons. Still, it’s like flying – no surgery is without risk. The risks of this operation can be summarized as follows:

  • Risk of infection: 1%
  • Likelihood that a blood transfusion is required: less than 1%
  • Damage to relevant blood vessels: 1%
  • Damage to relevant nerves: 1%
  • Thrombosis/Embolism: 2 – 3 %
  • Chance that you completely forget about your knee: after 1 year approx. 50%
  • Chance that you are doing much better, but not perfect: approx. 40 – 45%

HOSPITAL STAY

Our in-house physiotherapy will help you get back on your feet from day one. The aim of the first phase: minimal pain, minimal swelling. You can already start exercising, using the motorized continuous passive motion device, actively with the therapist. After 5 – 7 days you are ready to leave the clinic, the signs are: minimal pain, a good wound, good mobility, moving well with the crutches, in short: you have your knee and the situation under control.

DISCHARGE

You will be discharged or, if you have received an appropriate approval from your insurance company, you will go to one of our partner rehab clinics. The aim of the next phase: regain strength and further improve the knee joint mobility. You will be supported by physiotherapy, as well as the necessary medication for swelling against pain and for thrombosis prophylaxis. About 12 -14 days after the operation, the stitches will be removed by your family doctor. After 6 weeks, you will feel comfortable on your feet again and will be able to walk without crutches. It takes some time to be predominantly symptom free, usually 6 – 12 months.

QUESTIONNAIRE

In our practice, we will ask all patients who receive a knee prosthesis from us to fill out a questionnaire. This questionnaire includes questions about complaints and functionality in everyday life. This gives us valuable information regarding your course of treatment.

You will receive this questionnaire before the operation and at regular intervals after the operation (6 questionnaires within 5 years). Participation in this project is of course voluntary and does not affect your therapy.

 

 

pdf for download: Total knee replacement