Total Knee Replacement

What is Total Knee Replacement?

Total knee replacement is a procedure in which the degenerative or damaged surfaces of the knee joint are replaced with metal and plastic. Total knee replacement, which is also referred to as total knee arthroplasty, is essentially a resurfacing of the worn original cartilage.

Knee Arthritis

The knee joint is formed by three bones, including the end of the femur (thigh bone), top of the tibia (shin bone) and the patella (kneecap). Between these bones there is smooth cartilage and two menisci that serve as cushion and shock absorbers during motion. Arthritis (inflammation of the joint), injury, or other diseases can damage this protective layer, causing extreme pain and difficulty in performing daily activities.

Indications for Total Knee Replacement

The goal of knee replacement is to alleviate pain and to restore function of the knee. Surgery is most commonly indicated for severe osteoarthritis. With osteoarthritis, the joint cartilage gradually wears away, which often affects us all as we age. Your doctor may advise total knee replacement if you have osteoarthritis and any of the following:

• Severe pain that limits your daily activities (such as walking, getting up from a chair or climbing stairs)
• Moderate-to-severe pain that occurs during rest or awakens you at night
• Chronic inflammation and swelling that is not relieved with rest or medications
• Failure to obtain pain relief from medications, injections, physical therapy or other conservative treatments
• A knee deformity (knock knees or bowlegged)

Total Knee Replacement Procedure

• To begin the procedure, an incision is made over the affected knee to expose the underlying joint. Using your anatomy and pre-surgical imaging, less than 1 cm of bone is removed from the end of the femur (thigh bone) and top of the tibia (shin bone). This is why Dr. Mitchell commonly tells patients that knee replacement should be called “knee resurfacing,” because only small amounts of bone are removed.
• After the bone is removed, trial implants are inserted to ensure appropriate balance and range of motion of the new knee.
• Once satisfied with the trialing process, real femoral, tibial, and patellar implants are opened and inserted. This process can be done with or without bone cement.
• The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed, and a sterile dressing is placed.

Postoperative Care Following Total Knee Replacement

Rehabilitation begins immediately following surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. You will initially require crutches or a walker for safety purposes. You can wean from these devices as soon as you (and your therapist) feel that it is safe to do so. Physical therapy is a crucial part of your recovery and will have both in home and in person components.

Risks and Complications of Total Knee Replacement

The possible risks and complications associated with total knee replacement surgery include:

• Knee stiffness
• Infection requiring antibiotics and/or further surgery
• Blood clots (deep vein thrombosis)
• Nerve and blood vessel damage (skin numbness is most common)
• Ligament injuries
• Patellar (kneecap) dislocation
• Implant failure over time
• Loosening of the implant

If you would like to have additional information on knee treatments or would like to learn more about total knee replacement, please contact Joseph Mitchell, M.D., serving the communities of San Diego, La Jolla, East County, CA.