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Total Knee Replacement

The knee joint has three parts: the femoral condyles, the tibial plateau and the patella. In a healthy knee, these components are covered with even, smooth cartilage that allows pain-free movement. If a joint is diseased, the cartilage deteriorates and the patient starts to suffer from pain, stiffness and functional limitation, which have a detrimental effect on quality of life. 

There are a number of diseases that can cause the joint to deteriorate, but the most common are osteoarthrosis, rheumatic diseases such as rheumatoid arthritis, ankylosing spondilitis, etc. 

A total knee replacement consists of replacing a seriously damaged knee joint with a prosthesis.  

Benefits of the Operation

A knee replacement allows the knee to move normally again, eliminating the severe pain suffered by these patients when both walking and resting. This means patients recover their quality of life and can walk normally again. 

Total knee placement (or knee arthroplasty) is one of the most successful operations in this history of medicine, because 95% of patients achieve good to excellent results and the survival rate with conventional prostheses is 94% at 10 to 15 years. 

The success of the surgery does, however, depend on the patient's commitment to exercise, take the necessary precautions with the knee and to lead a healthy life.

Medical-technical description

Nowadays there are different models of knee replacements. Each type of prosthesis meets the needs of a specific type of patient, which is why each patient gets individualised treatment, receiving the best prosthesis for his or her requirements. Generally speaking, the different types of prostheses currently available are: 

  • Primary total knee replacement: After drying the diseased areas of the femur, tibia and patella, two or three components are implanted. A central rod is inserted into the tibia and another on the femur that follows the distal part of the femur and which has pivots for better attachment to the bone. If necessary, a further part is inserted in the patella. The latter is spherical to articulate with the femur and has a flat surface with pivots for attachment to the bone. The prosthesis is joined to the bone with bone cement. The most commonly-used type in active patients offers patients great mobility and adequate knee stability. These implants are made of tough materials that guarantee they last a long time.
  • Unicompartmental knee prosthesis:This is used when only one part of the knee is replaced. There are different types:
    • Unicondylar knee replacement: If the disease only affects one internal or external compartment, these prostheses make it possible to perform more economical surgery which preserves more of the bone with quicker recovery times.
    • Palletar prosthesis: when the disease mainly affects the femoropatellar joint, it is possible to replace this area only.
  • Revision prosthesis: when a primary prosthesis needs replacement or there is a lot of deformity.

There are cemented and non-cemented components that are selected according to the morphology of the knee to treat and the quality of the patient's bone mineral  density, age, etc.

About the operation

Total knee replacement takes place in the operating theatre. The procedure usually takes one hour, although the patient is in the theatre and recovery room for between three and five hours. Patients stay in hospital for between three and four days.

Before the operation

  • The patient goes to the doctor's office for a prior consultation, decisions are taken and the doctor explains the surgery in detail and gives the patient an informed consent.
  • You must take a list of all the medications you use (including medicinal plants) to the hospital with you on the day of your surgery.
  • The patient has a complete preoperative study with laboratory tests, ECG and x-rays.
  • You must cut your toenails, because you will not be able to do it for 12 weeks after the operation.
  • You should plan your convalescence at home for after the surgery. Get help from your family, friends and social services to do the shopping, wash you, make your meals, etc.
  • Get hold of a high stool or chair for the kitchen and bathroom, and a booster seat for the lavatory. You must sit on high chairs so that your knees are no higher than your hips.
  • Do not drink alcohol or smoke for 48 hours before the procedure.
  • If you are to have your surgery in the morning, you must not eat or drink anything that morning. If the surgery is to take place in the afternoon, have an early breakfast then do not eat or drink anything after 9 am.
  • You must remove all metal objects during the operation (rings, bracelets, earrings, body piercings, etc.).

Post-operative care

  • An elastic compression bandage will be applied, which you must wear while in bed. The drains are removed on the day after surgery. You will have to wear an elastic compression stocking to the thigh for at least three months after the operation.
  • You will start moving on the first day. You should put no more than 50% of your weight on the hip for six weeks, until osteointegration commences in non-cemented joint replacements, or until complete osteointegration in cemented replacements.
  • You will receive preventative anti-clotting medicines and antibiotics.
  • First you will need a walking frame and then some crutches.
  • After six weeks you will start doing exercises to strengthen the abductor muscles. A complete range of movement is usually achieved in the six to eight weeks following the operation.
  • After you are released, you should contact us if you suffer from chest pain or have breathing difficulties, swelling or reddening in one of your legs, sharp pain in the knee on which you have had the surgery, fever or shivering.
  • Correct rehabilitation is necessary, so on the first few days you must not travel or do any strenuous or violent movements.
  • After you have been released, you must avoid doing several movements and adopting positions for three months to prevent injury and the risk of dislocation of your new knee.
    • Make sure your knees are not higher than your hips when sitting.
    • Do not crouch down to pick things up from the floor.
    • Avoid twisting the leg in question inwards or outwards while sitting or lying down.
    • Do not lift weights.

The importance of immediate rehabilitation

  • Correct rehabilitation is essential after an operation of this type. Rehabilitation should start as soon as possible and on the first few days you must not travel or do any strenuous or violent movements. That is why we recommend that before you go back to your country you should spend at least eight days doing rehabilitation at our Casaverde rehabilitation centre.
  • This will help you to improve muscle tone and for the muscles affected by the surgery to gradually become stronger, which will reduce the risk of falling or complications.
  • This will optimise mobility of the joint affected and reduce any pain and/or discomfort that may appear after the surgery.
  • Improves trophism – nourishes the tissues around the operation site and encourages correct healing and closure of the surgical wound.
  • Restores motor skills, giving patients help, guidance and re-educating them adopt walking patterns that will soon have them on the road to recovery.

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