The ability to resurface the knee using knee replacement technology has restored function to millions of people suffering from painful degenerative joint disease of the knee. Knee degeneration is usually secondary to osteoarthritis but may also be caused by rheumatoid arthritis or trauma. When pain and loss of function are no longer alleviated by other conservative treatments, knee replacement offers predictable relief of pain and restoration of function in the vast majority of individuals.
This is accomplished by removing approximately ten millimeters of bone and residual cartilage off the ends of the femur, the top of the tibia and behind the patella. Most components are cemented in place which offers predictable early and long term fixation with high success rates. The components are very similar between most manufacturers and typically involve a metal component on the femur and tibia with a plastic insert between them and a plastic component on the patella. There are five major manufacturers for these implants and dozens of smaller ones. Most implants currently used have very good long term success rates, but there may be subtle differences that may be desirable when considering patient specific needs. The surgeons at Florida Joint Care Institute have an extensive knowledge of the implants and materials available and can help patients to understand which one may be most appropriate.
Knee replacement surgery is performed through an incision in the front of the knee. With careful planning this can be performed as minimally invasive as possible using a smaller incision and protecting the muscles of the knee without having to cut them. All knee replacement surgeries require careful planning. This begins from the moment a patient is seen in consultation. There are many health factors that are taken into consideration before surgery in order to minimize the chance of complications and improve outcomes. There are often medical conditions that require further treatment by an internist or specialist prior to surgery. We believe that a comprehensive approach to patient care is the best way to achieve a healthy and functional recovery.
The surgeons at Florida Joint Care Institute use cutting edge digital X-rays calibrated to each patient as well as specialized computer software to plan the surgery. This ensures appropriate component selection to match each patient’s anatomy and that the leg lengths are calculated to restore normal alignment and length which may have been altered from the degenerative joint disease. During the surgery there is additional instrumentation that measures anatomy directly to ensure sizing is exact. There is no more precise way to measure size and restore anatomy than planning the surgery appropriately and verifying using this direct technology during the operation.
Rehabilitation after surgery reflects the extensive planning given to each patient’s surgery. The majority of patients will start physical therapy to stand or even walk the same day of surgery. This improves early functional recover and lowers the risks of blood clots from forming. All patients recover in a private room and work with the orthopaedic and nursing teams within the joint care program. Most patients are able to walk and transfer independently by the second or third day after surgery and many patients are discharged home with a home visiting nurse and therapist to perform visits for the first few weeks after surgery. If additional needs are required, a patient may elect to go to a rehabilitation facility to work aggressively with physical therapy until enough independence is reached to be discharged home.
Recovery occurs as a stepwise process. Within the first few weeks, independence is reached and patients progress away from a walker and cane. 75% of the recovery occurs within the first six weeks. The last 25% occurs in the subsequent couple of months as strength improves. The vast majority of recovery is therefore completed within four months of surgery, but endurance will continue to improve as activities are resumed.
Although knee replacement technology has been refined over several decades, and outcomes are better than ever, there are unique risks inherent to the operation. With careful planning these risks are minimized but it is important to have this discussion with your surgeon prior to the operation to be appropriately informed. By understanding these risks and expectations of benefits, our patients are able to achieve the best outcomes possible.