Total Knee Arthroplasty

Patients with severe pain and stiffness that does not respond to conservative treatments or more moderate surgery may require total knee arthroplasty, commonly known as knee replacement, to relieve pain and restore function. Whereas in a healthy knee smooth cartilage cushions the connecting bone ends, when osteoarthritis develops, the resulting pain and stiffness that may require surgical intervention.

In a total knee arthroplasty, the damaged ends of the bones are removed and replaced with a prosthesis made of metal and plastic. These artificial parts allow the joint to move smoothly so the patient experiences pain relief and a better quality of life.

Total Knee Arthroplasty Procedure

The total knee replacement procedure is performed in a hospital under general anesthesia. During the procedure, an incision is made in the knee to access the joint so the damaged bone and cartilage can be removed. Once the damaged tissue is removed, the prosthetic device is inserted and may be either cemented or pressed into place. Cemented knee replacements are most commonly used, and are fixed into the joint for immediate support. Press-fit knee replacements are designed to have the surrounding bone grow into the implant for long-term joint stability.

Recent advances in surgical technology make it possible to perform minimally invasive joint replacements. Various minimally invasive techniques allow the joint to be replaced with less cutting and manipulation of muscles, tendons and ligaments around the joint. There are other potential advantages to minimally invasive surgery, including smaller incisions, less bleeding, less scarring, less pain and a speedier recovery.

Recovery from Total Knee Arthroplasty

A short hospital stay is likely, varying a bit depending on the type of procedure performed and the overall health of the patient. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort that can be managed with prescribed pain medication.

Physical therapy starts in the hospital, as soon as possible after surgery, usually the next day, to ensure rapid healing and restoration of full function. Most patients either proceed to inpatient rehabilitative treatment for approximately a week, or return home and begin outpatient rehabilitation sessions a few times a week.

Patients in physical therapy progress from taking steps with a walker or crutches to walking without assistive devices on stairs and slopes. Continuous passive motion (CPM) machines are commonly used to reduce recovery time and prevent muscle contracture without straining the joint. Patients are also given exercises to perform at home to reinforce the rehabilitative process.

Risks of Total Knee Arthroplasty

Although considered a safe procedure for most patients, there are certain risks associated with all surgery. These risks include: infection, excessive bleeding, blood clots, buildup of excessive scar tissue, limited range of motion, nerve damage, and implant rejection. For the great majority of patients, total knee arthroplasty is successful and uneventful, providing effective pain relief and greatly improved quality of life.

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The Musculoskeletal Center

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Mass General - North Shore

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