Total knee prosthesis is the creation of an artificial joint by covering the worn joint surfaces with special parts made of metal and polyethylene and designed for painless joint movement. Knee prosthesis, which was first applied in 1968, has been improved thanks to advances in surgical techniques, materials used and design, and has become a much more successful treatment method today.
WHO IS TOTAL KNEE PROSTHESIS SUITABLE FOR?
Rest Total knee prosthesis is suitable for patients whose knee pain cannot be controlled despite treatment methods such as medications, physical therapy methods, cane use and intra-articular injections, whose daily life activities such as walking and climbing stairs are severely restricted and who have severe damage to the joint cartilage. It is preferred that the patient be between the ages of 60 and 80, but in some special cases such as rheumatoid arthritis and osteonecrosis, a prosthesis can be performed at an earlier age.
HOW IS TOTAL KNEE PROSTHESIS DONE?
Parts of a total knee prosthesis After appropriate anesthesia, the knee joint is accessed through an incision made in front of the knee. The eroded cartilage tissue on the contacting surfaces of the three bones that form the joint (femur, tibia and patella) is cut and removed together with a thin bone layer, then the prosthetic pieces selected in appropriate sizes are used to prepare the bone by using a filling material called bone cement (polymethyl methacrylate). attached to surfaces. Thus, the joint surfaces are re-covered with parts made of metal and plastic. The surgery takes between 1-2 hours. Pain pumps that deliver medication epidurally (placed at the waist) or intravenously are often used for postoperative pain control. The next day, knee movements are started and the patient can stand up with assistance. You can be discharged from the hospital when you can walk comfortably in the room and corridor. This period varies greatly from patient to patient and may vary between 3 and 7 days. Schematic view of the knee after total knee prosthesis placement
WHAT SHOULD I EXPECT AFTER TOTAL KNEE PROSTHESIS SURGERY?
More than 90% of patients who underwent total knee prosthesis experienced a significant reduction in knee pain and increased ability to walk/go up stairs. A significant improvement is achieved in performing daily living activities such as walking . When you are discharged from the hospital, you will have the opportunity to walk around the house using a support. It takes between 4 and 8 weeks for your pain to improve significantly and for you to go out independently, although it varies for each patient. It is not appropriate to do sports that require running, jumping, and heavy work after total knee prosthesis; these types of activities will shorten the life of the prosthesis. Non-strenuous sports such as walking, golf, swimming can be done. There is no harm in driving. Curvatures and deformities in your leg before surgery are also corrected during the surgery, which will prolong the life of the knee prosthesis. In weak patients, the expected knee movement after total knee replacement is as seen in the video below. However, especially in overweight patients, this range of motion is less. The average range of motion is around 115 degrees, so it is often not possible to fully squat or pray after knee replacement. Although techniques and designs that increase knee range of motion have been implemented in recent years, it may be detrimental for patients to sit with their feet under them in terms of long-term survival of knee prosthesis.
CAN MAGNETIC RESONANCE IMAGING (MRI) BE PERFORMED AFTER OTAL KNEE PROSTHESIS?
Most modern total knee prostheses are made of chrome cobalt alloy, an MRI-compatible metal. Although the tissues in close proximity to the knee cannot be imaged, there is no problem in taking an MRI of another region. If you have a knee prosthesis placed before 1990, it would be appropriate to consult your doctor about its brand or metal alloy in terms of MRI compatibility.
DOES THE TOTAL KNEE PROSTHESIS HAVE A LIFETIME?
What constitutes the total knee prosthesis? Metal and plastic parts wear out over time due to the friction that occurs during movement. As a result of the body's response to metal and plastic fragments that appear due to wear and are too small to be seen with the naked eye, parts of the knee prosthesis may separate from the bone to which they are attached and become loose. The lifespan of knee prostheses made using appropriate surgical techniques and modern prosthesis designs has now been extended to 15-20 years. Loose knee prostheses can be removed with a second surgery in most patients and a new prosthesis can be placed, but the life of the second prosthesis is as long as the first. n is not. In order to early diagnose problems such as wear and loosening, it is appropriate to check your knee prosthesis with regular examinations and x-rays, even if you have no complaints. Your doctor will tell you when to come for a check-up.
Pre- and post-operative X-ray images of a patient who underwent knee prosthesis
WHAT COMPLICATIONS MAY OCCUR AFTER KNEE PROSTHESIS SURGERY?
Serious complications after total knee replacement surgery occur at a very low rate. The most common problem is the formation of clots in your veins (deep vein thrombosis) due to slow blood flow in your leg. To prevent this, preventive treatment is applied with blood thinning medications after surgery. This treatment can be extended for up to 20 days if necessary. Starting knee movements and walks early after surgery and avoiding being immobile will reduce this risk. After total knee arthroplasty, infection, that is, inflammation of the prosthesis, is seen between 0.1% and 2%. Having an infection elsewhere in the body (e.g. in the urinary tract, teeth), having diabetes and other chronic diseases may increase this risk. It is necessary to treat any infections that may occur elsewhere in the body before surgery. Preventive antibiotic treatment is administered during surgery and the risk of infection is reduced by taking special precautions during surgery. If infection develops in a total knee prosthesis, procedures such as repeated surgeries, removal of the prosthesis, antibiotic treatment and reinsertion after a certain period of time may be required. Apart from those listed above, complications such as wound healing problems, vascular or nerve injuries, dislocation of some parts of the prosthesis, fractures around the prosthesis, and fractures in the prosthesis itself may occur, but these are very rare.
WHAT SHOULD BE DONE TO PREVENT INFECTION AFTER TOTAL KNEE PROSTHESIS? ?
Even if it is low, there is a risk that bacteria mixed with the blood will reach your knee prosthesis, settle there and cause an infection. If you are going to have a dental or urinary tract surgical procedure within the first two years after prosthesis surgery, you must use antibiotics beforehand. Especially for work such as tooth extraction, stone cleaning and root canal treatment. It is important to prevent infection with an appropriate antibiotic one hour before the procedure. It would be appropriate to consult your orthopedic doctor for the dosage and duration of the antibiotic. You should also pay attention to foot care and inform your orthopedic doctor if signs of foot and nail infection occur.
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