Total
Knee Replacement
Total knee
replacement
restores the
smooth
surfaces on
the end of
knee bones.
Conceptually,
the painful
arthritic
surfaces are
replaced
with highly
polished
metal and
plastic.
Smooth caps
are
permanently
secured to
the end of
femur,
tibia, and
kneecap with
cement. The
remaining
normal bone,
ligaments,
and muscle
are
preserved.
The
operation
lasts less
than an
hour. In the
end, a
virtually
pain-free
gliding
surface is
restored.
Only
recently is
was quite
common to
overhear
that TKR was
too painful,
required too
long a
recovery,
and was
dreadful
compared to
hip
replacement.
While knee
replacement
remains a
major
operation,
recent
developments
have
improved the
recovery
process. In
TKR, long
term
durability
is still the
overall
goal, but a
new emphasis
has been
placed on
achieving
better
function,
accelerating
rehabilitation,
and
minimizing
pain.
Progress in
postoperative
recuperation
is credited
to several
technical
changes in
the surgery.
Most obvious
to patients
is a major
reduction in
the skin
incision.
Depending on
the size of
a patient
and a
patient's
knee,
surgeons can
shrink the
length of
the incision
by up to a
third or a
half of the
classic
incision's
length.
Below the
skin,
well-established
dissection
techniques
and
miniaturized
instrumentation
have been
modified to
reduce
intraoperative
muscle and
tendon
trauma.
Rather than
divide the
quadriceps
muscle and
tendon in
half,
surgeons now
preserve the
majority,
and at times
the
entirety, of
the muscle
sleeve.
Preserving
the
quadriceps
attachment
to the
patella
keeps the
muscular
forces
intact.
Reducing
muscle
trauma in
TKR has a
direct
clinical
benefit.
Clinical
studies
demonstrate
not only a
faster
return of
muscle
function,
but also a
lasting
improvement
in range of
motion.
Currently,
most healthy
patients
will leave
the hospital
in 2 to 3
days with
only a cane.
The vast
majority
will be
independent
enough to go
directly
home.
One major
advance in
biomaterials
may now
allow these
patients to
pursue work
or
recreation
over a
longer term.
The bearing
surface is
now
manufactured
from
enhanced
materials,
with either
compression
molded or
highly
crosslinked
polyethylene.
The stable,
fixed-bearing
designs
continue to
outperform
rotating or
mobile knee
replacements
in several
major
studies.
Furthermore,
for select
patients who
require even
greater knee
flexion for
social,
cultural or
religious
reasons,
modern "High
Flexion"
implants
will allow
the knee to
safely bend
up to 155
degrees.
Finally,
surgery
these days
is less
painful and
less
frightening.
Routine
patients no
longer
require
general
anesthesia
or
ventilator
assistance.
Strict
attention to
postoperative
pain
management
protocols
have been a
major
success.
With oral
premedication,
pain fibers
are blocked
before they
can be
activated.
Regional
nerve blocks
provide safe
and thorough
analgesia
both
intraoperatively
and
postoperatively.
Preoperative
education
classes not
only prepare
the patient
and family
for surgery
and
recovery,
but also
demystify
the
complexities
of knee
replacement.
To view a
total knee
replacement
animated
surgery,
please go
to…
www.dorrarthritisinstitute.org/surgeries/minknee
For more
information
on TKR, go
to...TKR.
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