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About Knee Replacement Surgery

Knee replacement surgery can be performed as a partial or a total knee replacement.In general, the surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.

The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility

History

The pioneer of knee replacement surgery was Leslie Gordon Percival Shiers (FRCS); his original papers were published in the Journal of Bone and Joint Surgery in 1954. Shiers refused to patent his invention, and demonstrated the operation throughout the world, inviting other surgeons to improve upon his original idea. Following John Charnley's success with hip replacement in the 1960s attempts were made to design knee replacements. Frank H. Gunston

Pre-operative preparation

Knee arthroplasty is major surgery. The xray indication for a knee replacement would be weightbearing xrays of both knees- AP, Lateral, and 30 degrees of flexion. AP and lateral views may not show joint space narrowing, but the 30 degree flexion view is most sensitive for narrowing. If this view, however, does not show narrowing of the knee, then a knee replacement is not indicated. Pre-operative preparation begins immediately following surgical consultation and lasts approximately one month.[citation needed] The patient is to perform range of motion exercises and hip, knee and ankle strengthening as directed daily. Before the surgery is performed, pre-operative tests are done: usually a complete blood count, electrolytes, APTT and PT to measure blood clotting, chest X-rays, ECG, and blood cross-matching for possible transfusion. About a month before the surgery, the patient may be prescribed supplemental iron to boost the hemoglobin in their blood system.

Variations

Different implant manufacturers require slightly different instrumentation and technique. No consensus has emerged over which one is the best. Clinical studies are very difficult to perform requiring large numbers of cases followed over many years. The most significant variations are between cemented and uncemented components and between resurfacing the patella or not.

Post-operative rehabilitation

Post-operative hospitalization varies from one day to seven days on average, depending on the health status of the patient and the amount of support available outside the hospital setting. Protected weight bearing on crutches or a walker is required, until the quadriceps muscle has healed and recovered its strength. Continuous Passive Motion is commonly used, but a Cochrane review concluded that the evidence was weak and the magnitude of its effect was small.[13] Patients typically undergo several weeks of physical therapy and occupational therapy to restore motion, strength, and function. Often range of motion (to the limits of the prosthesis) is recovered over the first two weeks (the earlier the better). At six weeks, patients have usually progressed to full weight bearing with a cane. Complete recovery from the operation involving return to full normal function may take three months, and some patients notice a gradual improvement lasting many months longer than that.

Risks

Risks and complications in knee replacement are similar to those associated with all joint replacements. The most serious complication is infection of the joint, which occurs in <1% of patients. Deep vein thrombosis occurs in up to 15% of patients, and is symptomatic in 2–3%. Nerve injuries occur in 1–2% of patients. Persistent pain or stiffness occurs in 8–23% of patients. Prosthesis failure occurs in approximately 2% of patients at 5 years.

There is increased risk in complications for obese people going through total knee replacement. The morbidly obese should be advised to lose weight before surgery and, if medically eligible, would probably benefit from bariatric surgery.

Epidemiology

With 718,000 hospitalizations, knee arthroplasty accounted for 4.6% of all United States operating room procedures in 2011—making it one of the most common procedures performed during hospital stays. The number of knee arthroplasty procedures performed in U.S. hospitals increased 93% between 2001 and 2011.

By 2030, the demand for primary total knee arthroplasty is projected to increase to 3.4 million surgeries performed annually in the U.S

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