Knee Replacement

Half a century ago, even as recently as the 1960s, patients with arthritis were crippled, as good options did not exist for the treatment of their pain. As arthritis progresses and gets more severe, the conservative treatments, such as a change in lifestyle, medications, and injections, may no longer suffice for pain relief. This is when you may be a candidate for knee replacement.

The first modern total knee replacements were performed in the 1960s. Although plagued with problems, these early operations helped thousands of people conquer the pain from arthritis when their options had run out. Numerous advances have occurred the last 20 years. These recent advances include improved wear and loosening rates and better medical care after surgery. Great strides have also been made in pain management, physical therapy, and recovery of function. Today, hundreds of thousands of knee replacements are performed in the United States annually.

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Knee replacement, technically speaking, is as close as we come to a “cure” for arthritis of the knee. It removes the arthritis and replaces the joint with prosthetic surfaces that have smooth motion. A common misconception is that the entire knee is removed. This is not the case. Only the arthritic ends are removed and the femur and tibia are simply shaped so that new prosthetic “caps” can be placed over the ends of the bone.

Procedure

The patients arrive at the hospital on the morning of surgery. Routine knee replacement patients should expect to stay 2-3 days. Unicompartmental (partial) knee replacement patients will stay 0-1 days, typically.

The procedure involves an incision along the front of the knee, measuring anywhere from 4-9 inches. The size of the incision very often depends upon the patient’s body shape and size.

Mini-incision or minimally-invasive knee replacement, which is a recent development, can and will be performed on you by Dr. Mathews, if your body shape and size allow it.

PrepOp Front View

PrepOp Side View

PostOp Front View

PostOp Side View

The bones are shaped and the prosthesis is cemented onto the ends of the femur, tibia, and patella. Then a highly-specialized plastic is placed in-between the bone ends to act as the new bearing surface. Ask Dr. Mathews to see a model, so that you can see an example in the office.

TKA Model Perform Your Own Knee ReplacementOpen New Browser Window
Virtual Knee Surgery – Take on the role of the Surgeon
throughout a total knee replacement surgery.

Much research effort and money has been spent in order to find the “perfect” hinge bearing surface. Ideally, this surface would be one with no wear. Highly specialized plastics have shown excellent results, as have newer metals and designs in knee replacements. Dr. Mathews attends numerous scientific meetings per year and can discuss the latest trends and scientific findings in bearing options with you.

Dr. Mathews will use one of these low-wear surfaces or designs in your knee replacement, so that it has a chance of lasting as long as possible.

Knee Replacement and Age

A common misconception is that a patient feels that they are too young or too old for a knee replacement. Knee replacements are performed in people of a wide range of ages – from their 40s well into their 90s. A young age is becoming less of an issue, as the ability to implant longer-lasting joint replacements increases. Old age is also not a contraindication, as medical management and surgical techniques are far better now than they were years ago. Most people lean toward replacement when they would rather not live their lives out in pain, and would rather enjoy life while they are healthy.

Timing of Knee Replacement

This is an individual decision, based upon general health, the amount of pain and limitation, as well as expectations.

The question of tolerability is very important. What is tolerable to one person may not be tolerable to another. For some people, driving around in an electric wheelchair is far preferable to having a knee replacement. Others simply are frustrated that they can no longer get through their 18 holes of golf and would rather have the painful joint replaced.

Once again, however, this is an individual decision. Dr. Mathews can inform you and help guide you, but the final decision is truly yours.

  • Factors which play a role
    • Pain level
    • Inability to do things you used to do
    • Affected activities of daily living
    • Patient health and the ability to withstand an operation. This decision factor will ultimately involve the input of your medical doctor, and possibly other specialists, in order to assess your medical risk

Knee Replacement Benefits

Scientific studies have time and again demonstrated the exciting benefits derived from knee replacement. These include pain relief and return to previous function, as well as patient satisfaction. Total knee replacements usually last for the rest of a person’s life. Results better than 90-95% are the norm.

Knee Replacement Risks

All surgeries (even the most minor ones) have risks, although rare, and knee replacement is no different. Your doctor can review these risks of the surgery with you at any time.

The Cost of a Knee Replacement

This will usually depend upon the insurance coverage of a patient. Our office can help you with this, as can the hospital personnel.
Anesthesia for Knee Replacement

  • Anesthesia is generally done one of two ways:
    • General anesthesia
    • Epidural / spinal
    • Both methods are low-risk and effective. This is a decision that will be made with your anesthesiologist.

Medical Clearance

The ultimate clearance for surgery will come from your medical physician or, if you do not have one, one that you will be referred to. Prior to surgery, he/she will look you over from head-to-toe and decided if any further tests (other than the routine ones) or consultations by other specialists need to be done. Once the clearance is completed and any medical issues are attended to or stabilized, then surgery can be performed more safely.