Knee Replacement

KNEE PROSTHESIS

Knee Prosthesis is a disease characterised by complaints of severe pain and difficulty in walking due to calcification, shape and alignment deterioration with advanced loss of properties of the knee joint cartilage.

What is Knee Prosthesis?

Knee prosthesis is the removal of a part of the knee joint cartilage that is worn out for any reason and replacing it with an artificial joint that will provide the same function. The main purpose of knee prosthesis is to place the worn or damaged knee joint back on its normal axis. This is done by removing both the worn cartilage and some of the bone under the cartilage. Thus, the knee prosthesis application that can mimic the normal knee joint is realised. Reinforced plastic parts and specially designed metal parts are used in knee prosthesis.

The knee joint is the largest and most complex joint of the body. It forms this function with 3 important bones (thigh, shin, kneecap) 4 important ligaments (inner side, outer side, posterior cross, anterior cross), many muscles (quadriceps, hamstring, popliteus, gastrocnemius, etc.), tendons and menisci (internal and external). The complex structure of the knee joint can also be complicated by injuries and therefore the majority can be treated surgically. Knee prosthesis is one of these.

Knee prostheses; are prostheses used in the treatment of the knee joint that is severely damaged, causing pain, loss of function and inflammation. In knee replacement surgeries where the knee joint is replaced with an artificial joint called a prosthesis, damaged bone and cartilage tissues are removed and special structures containing metal alloys are used instead. In general, knee prostheses are frequently used in knee arthritis where the knee joint is severely damaged.

What is the Function of the Knee Joint?

The largest joint of the human body that carries our body weight with hips and ankles is called the knee joint. The knee joint is a very complex joint. The knee joint consists of 3 different bones;

  • Petalla (knee cap)
  • Tibia (tibia)
  • Thigh bone (femur)

There is a shiny and white coloured cartilage on the surface of the 3 different bones forming the knee joint. Especially the flexible cartilage structure called meniscus; It has a critical importance in the protection of both the thigh bone and the shin bone.

For any reason, damage to the cartilage tissue or bones that make up the knee joint causes severe pain. Different techniques and methods come into play at the point of relieving the severe pain in question. When physical therapy, drug therapy or some injections into the knee joint do not give results, this damaged area is treated with knee replacement surgery.

What are the Causes of Deterioration of the Knee Joint?

The knee joint can wear out for many different reasons. Although genetic factors have a high effect on the deterioration of the knee joint, we can state that external factors also accelerate this process. At this stage, we can list the reasons that cause deterioration in the knee joint as follows;

  • Overweight and obesity problem
  • Various rheumatic diseases
  • Knee problems due to genetic causes
  • Physical impact due to any external factors
  • Wear and tear in the knee due to advancing age

Among the causes of knee joint deterioration, repeated minor traumas with heavy sports training are also effective. In such cases, arthroscopy comes into play.

What is Arthroscopy?

Arthroscopy is the most commonly used method in the diagnosis and treatment of problems occurring in the knee. Thanks to the arthroscopy method, it is possible to detect the diseases and damage in the knee with the help of a camera inserted from the outside without opening the joint in any way. With arthroscopy method

  • Meniscus tears
  • Rheumatic diseases
  • Damage to cartilage
  • Synovia (joint membrane) diseases
  • Anterior and posterior cruciate ligament injuries

can be treated. This method is frequently preferred because it has an ideal effect in terms of patient comfort.

KNEE PROSTHESIS (KNEE ARTHROPLASTY):

In order to eliminate the complaints of severe pain and difficulty in walking due to advanced calcification, shape and alignment deterioration in the knee joint, the deteriorated surfaces of the joint are cut in accordance with the technique, and artificial materials called prostheses are placed in their place.

Conditions that can be treated with knee prosthesis:

  • Gonarthrosis
  • Arthrosis after rheumatic diseases

Knee Prosthesis Revision (Knee Arthroplasty)

Knee prosthesis revision is the operation of removing and renewing the existing prosthesis due to reasons such as loosening, infection, fracture of the prosthesis in patients who have previously undergone knee prosthesis surgery.

What are the Types of Knee Prosthesis?

  • Total Prosthesis
  • Partial (Unicondylar) Prosthesis

Total Prosthesis Total: knee prosthesis is the creation of an artificial joint by covering the worn joint faces with special parts made of metal and polyethylene, designed for painless joint movement.

Partial (Unicondylar) Prosthesis: Partial (Unicondylar) knee prosthesis is an operation in which only the worn area of the knee is replaced; unaffected cartilage, meniscus and ligaments are preserved.

Knee Prosthesis Construction Processes

Knee prosthesis treatment is performed under general anaesthesia in the operating theatre by making an incision in the front of the knee and opening the knee joint. Some of the worn bones are cut out and the knee prosthesis, which has been provided in advance in accordance with the person, is mounted on the patient’s knee. The knee joint is closed again and the operation is terminated.

Who is Knee Prosthesis Preferred for?

  • Persistence of pain even at rest
  • Distortion of the knee shape
  • Deformity of the legs
  • Advanced calcification
  • Limitation of movement
  • The medicines used do not help and cause various side effects
  • Physiotherapy and similar treatment methods are not beneficial

It is applied in such cases. Knee prosthesis application is generally applied in patients over 60 years of age. The reason for this is that the prosthesis has a certain life span and the expired prosthesis should be replaced with a new one. Knee replacement surgery can also be performed at an earlier age in cases of osteonecrosis and similar conditions.

How is Knee Replacement Surgery Performed?

During knee surgery, the damaged parts of the knee bones are removed and metal and plastic implants are attached to the knee surface in the appropriate direction. . We can list the procedures performed during the knee surgery operation as follows:

  • A small cannula is placed in your hand or arm. This cannula is used to give you antibiotics and other medicines during the operation.
  • After the painkillers start to take effect, your knee is sterilised with a special solution.
  • The process of covering the surfaces of the knee joint usually takes 1 hour.
  • The implants are attached to the bones.
  • The ligaments surrounding the knee need to be adjusted to ensure optimal knee function.
  • Temporary prostheses are applied first. If deemed appropriate, the actual prostheses are fitted.
  • If the surgeon is satisfied with the fit and function of the implants, the incision is closed.
  • A special tube (drain) is inserted into the wound to remove natural fluids from the body.
  • A sterile dressing is applied. An elastic bandage is wrapped from the foot to the groin.
  • The anaesthesia begins to wear off while you are in your recovery room and you regain consciousness.
  • Your knee will be tender for a few days.

Things to Consider After Knee Replacement Surgery

There are some important points that patients who undergo knee prosthesis surgery should pay attention to. These can be listed as follows;

  • If you are exposed to any infection, you should definitely consult a doctor.
  • Dental checkups and treatments should not be interrupted.
  • Living spaces need to be cleared of factors that may pose a risk of falling. Items such as coffee tables and carpets should be positioned in a way that does not pose a risk of falling.
  • Heavy sports should be avoided.
  • Long walks, climbs and jumps that will strain the knee joints should be avoided.
  • Knee joints need to be protected from trauma such as falls, impacts and accidents.
  • Bone and muscle health must be protected. The diet should be designed to strengthen bone health.
  • Exercise programs recommended by the doctor should not be interrupted.

Cold application, ankle exercises, and appropriate positioning are recommended for postoperative edema. Movements that will protect the knee muscle and increase the angle of the joint are started. The patient is tried to stand up and walk with appropriate position and support. When discharged, the patient is shown what movements to pay attention to at home, what exercises to do, and is taught how to take steps and how to walk. Education is provided to the patient and family. The patient should continue this program at home and come for control again on the specified date. When the patient comes for a check-up, the orthopedic doctor who performed the surgery first sees the patient and, if the condition of the joint is suitable, directs the patient to the physical therapy and rehabilitation clinic. Here the patient is taken to an outpatient physical therapy program of approximately 2 or 3 weeks. During the outpatient physical therapy and rehabilitation period, the patient is given cold applications, muscle strengthening currents, pain relieving currents, exercises to open joint movement and strengthen the muscle, and walking, balance and climbing up and down stairs should be practiced.

Knee Replacement Treatment Process

Exercise is very important in the early postoperative period. Wake up in the first 24 hours when the patient is generally well and resume as soon as possible. The first walk was short enough for their own needs, but the distance increases day by day. Walkers, known as walkers, provide great convenience to patients in the first 2 weeks of walking.

Start exercises that increase knee range of motion and strengthen the muscles. The patient has a serious responsibility not to compromise on movement. Wound care should be kept clean and away from contact with water for about 2 weeks and sutures should be removed after the skin is fused (usually after 10 days).

It will take approximately 6 weeks to return to daily life. During this period, when the patient is weaned from the walker and how quickly he/she can return to normal life depends on his/her own efforts. Medicines prescribed by the doctor should be used according to the instructions.

Robotic Knee Replacement Surgery

Robot technologies are being used more and more widely in the world day by day. In parallel with the developments in technology, the use of robots is widespread in the field of healthcare. In parallel with these developments, robotic technology has begun to take its place in the field of orthopedics. The number of orthopedic surgeries performed with robotic technology is increasing day by day. Robot technology is used in hip and knee joint prosthesis surgery in the field of orthopedics. It is expected to be used in shoulder, spine and tumor surgery in the near future.

Robotic surgery are assistive systems used in knee or hip replacement surgeries. Planning the surgery, evaluating the patient’s data and performing the surgery are done with the help of robotic systems under the control of the surgeon. Since even an experienced orthopedic surgeon has some margin of error when adjusting implant positions manually, new searches have been initiated. The most important feature of Robotic Surgery; The bone incisions to be made during the surgery are designed in the computer environment before the surgery, the component positions are ideally adjusted and the bone incisions are made without any errors with the help of the robotic arm. By placing the prosthesis in the ideal position, wear and loosening of the prosthesis occurs later and the prosthesis lasts longer. The entire procedure is performed by your doctor. Special training and certification is required to perform robotic surgery.

  • Using computerized tomography images of the patients’ joints, a 3D analysis of the patient’s joint structure is performed and surgery planning is made individually. In this way, unnecessary bone cuts and tissue damage can be prevented.
  • Since prosthesis placement can be planned specifically for the patient, soft tissue balance and stability and joint balance appropriate to the patient are provided.
  • With the robotic arm support, the patient’s joint shape is revealed by haptic feedback by touching the necessary bone areas during the surgery. In this way, the data is constantly controlled interactively by the physician during the surgery, ensuring that bone incisions are made without errors.
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