TOTAL KNEE JOINT REPLACEMENT
Total Knee Joint Replacement Surgery
Knee Arthritis - A Leading Factor in Total Knee Joint Replacement
Knee arthritis involves progressive damage to the joint cartilage and underlying bone, resulting in symptoms like chronic pain, swelling, stiffness and impaired mobility. As the smooth cartilage layer wears away, bone rubs against bone causing inflammation and the formation of bony spurs. Daily activities like walking, standing and climbing stairs become increasingly difficult.
When conservative treatments like medication, injections, therapy and walking aids no longer provide adequate relief, knee replacement surgery may be recommended. Joint replacement aims to remove damaged surfaces and restore more normal joint function.
Candidacy for Total Knee Replacement (TKR) Surgery
Since knee replacement is major surgery, Dr. Siegel carefully selects candidates to ensure optimal outcomes. Ideal patients for knee replacement are:
- Those with severe, debilitating knee arthritis pain limiting activities of daily living
- Individuals over 50 years old (or skeletally mature adolescents)
- People with a BMI under 40
- Non-smokers or those willing to quit smoking
- Compliant individuals committed to the intensive therapy regimen after surgery
Younger, more active patients may require special planning and implant considerations to accommodate their higher activity demands following joint replacement.
Components of Total Knee Replacement Surgery
Knee replacement surgery involves resurfacing the damaged knee joint with metal and plastic implant components to restore smooth gliding function. The main steps include:
- Removing diseased cartilage and bone
- Reshaping and preparing the bone surfaces
- Positioning the implant components
- Securing the implants using cementing techniques and/or bone ingrowth surfaces
- Inserting a plastic liner between the metal components to enable smooth motion
- Closing up the incisions
Various Implant Fixation Options
As an experienced orthopedic surgeon, Dr. Siegel has different options for securing the knee replacement components to the bone for long-term stability. Common techniques he may use include:
Cemented implants use bone cement, typically polymethylmethacrylate (PMMA), as an adhesive to anchor the parts to the bone. After preparing the joint surfaces, the surgeon mixes a liquid and powder to form a quick-drying cement. The cement is applied to the implant, which is then pressed firmly into position for rigid fixation as the cement hardens.
Cemented components provide immediate post-operative stability so patients can bear weight and start moving the knee soon after surgery. This technique works well even for elderly patients with osteoporotic bone. However, over time cement particles can loosen, causing pain and requiring revision surgery.
Uncemented knee replacements rely on the bone growing into tiny pores coating the implant surface for long-term biological fixation, without cement. A precise press-fit implantation provides initial stability until bone ingrowth securely integrates the components.
Without cement risks, uncemented parts may potentially last longer. Bone integration creates a strong, durable bond. This option also better restores natural knee motion mechanics. However, bone quality must be adequate for ingrowth and the recovery period is lengthier than for cemented devices.
Hybrid knee replacement uses both cemented and uncemented components to harness advantages of each technique. Typically, the femoral part is cemented for initial stability while the tibial side is uncemented for biological ingrowth.
The hybrid approach provides early mobility from the cemented upper component along with the potential for durable tibial fixation over the long run. It allows some cement use in osteoporotic bone while optimizing uncemented ingrowth where possible. However, hybrid knees have less long-term clinical data than conventional methods.
Selecting the Best Implant Approach
The optimal implant fixation technique depends on several patient factors. Based on each individual's age, activity demands, bone density and other medical issues, Dr. Siegel selects the ideal method to maximize function and longevity.
For older, more sedentary patients, cemented replacements provide excellent pain relief and stability. Their polyethylene plastic liners also work well with slower leisurely activities. For younger or more active patients, Dr. Siegel may recommend uncemented or hybrid approaches to promote ingrowth potential and joint mechanics that can better accommodate higher activity levels.
In patients with poor bone quality that may not permit adequate uncemented ingrowth, hybrid or fully cemented knee replacements are preferable. Dr. Siegel considers all patient circumstances and needs to tailor the best solution for each case.
Advantages of Knee Replacement Surgery
When performed by a skilled surgeon like Dr. Siegel using advanced techniques, knee replacement surgery provides profound improvements for approximately 95% of patients. Benefits include:
- Substantial reduction in chronic knee arthritis pain
- Restored ability to walk, climb stairs and perform daily activities
- Enhanced mobility, balance and stability
- Elimination of joint inflammation and swelling
- Correction of knee deformities like bowlegged alignment
- Renewed independence, confidence and quality of life
After recovery, most patients can expect at least 15 years of improved comfort and function from their artificial knee. Some implants last 20-30 years, especially with strict activity modifications. Modern technologies and surgical skills continue to extend the longevity of knee replacement outcomes.
Recovery After Knee Replacement Surgery
While knee replacement provides life-changing improvements, the recovery process requires commitment and perseverance. Hospital stays average 1-3 days, followed by transitioning to outpatient therapy. Early rehabilitation starts with range of motion and muscle strengthening exercises.
Assistive devices like walkers or canes help stabilize weightbearing initially following surgery. Patients progress from wheelchairs to full weight bearing over 6-12 weeks as pain and swelling subside. Moderate activity restrictions remain in place for about 3 months to allow full healing.
Most patients see significant gains in stability and function by 6-12 weeks post-operatively. Continued improvements in mobility, muscle strength and endurance accrue over 3-6 months. Mild residual swelling may persist for up to a year before the knee feels completely normal. Close follow-up care with an experienced surgeon like Dr. Siegel helps ensure optimal recovery.
Risks and Complications
While overwhelmingly safe and effective, knee replacement surgery does pose some risks like any major procedure. Potential complications include:
- Infection - less than 2% risk with preventive antibiotics
- Blood clots - minimized by early mobilization and medications
- Fracture - unusual with proper techniques
- Stiffness - aggressive therapy prevents loss of motion
- Implant loosening - uncommon with latest devices
- Chronic pain - affects less than 20% of patients
- Nerve damage - rare with careful surgical approaches
Dr. Siegel employs meticulous techniques and proven protocols to maximize patient safety. He uses advanced technologies like robot-assisted navigation for precision implant positioning that protects delicate knee structures. His experience managing complex cases ensures excellence in routine knee replacements.
Alternatives to Knee Replacement Surgery
For patients unwilling or medically unfit for knee replacement, other options aim to provide some degree of symptomatic relief, including:
- Medications - oral or injected steroids, hyaluronic acid, etc
- Braces - knee sleeves redistribute forces somewhat
- Physical therapy - strengthens muscles to support the knee
- Weight loss - reduces stress on the damaged joints
- Assistive devices - canes, walkers or wheelchairs for mobility
- Lifestyle changes - avoiding high impact activities
These conservative measures may temporarily alleviate pain and delay the need for surgery. However, joint damage continues to accumulate irreversibly over time. Once conservative therapies fail to provide adequate relief, knee replacement is the only intervention that can truly reverse structural damage and restore lasting function.
Why Choose Dr. Herrick J. Siegel for Knee Replacement
With over 21 years of specializing in joint reconstruction, Dr. Siegel offers expertise across all techniques to provide personalized solutions for each patient's needs:
- Extensive experience with over 15,000 knee replacements performed to date
- Comfort managing complex knee reconstructions
- Specialized revision surgery skills to replace failed implants
- Patience in explaining options and setting appropriate expectations
- Emphasis on rapid recovery protocols to maximize function
- Priority on pain management and patient comfort
- Meticulous surgical skills to minimize complications
- Latest techniques like robot-assisted navigation for precision
- A holistic approach focused on each patient's personalized goals
For those suffering with severe knee arthritis pain, a consultation with Dr. Siegel provides trusted guidance on whether knee replacement surgery is the right option. His mastery of this life-changing procedure helps patients regain activity, independence, and quality of life.
To learn more about the range of orthopaedic options available to you, contact Dr. Herrick J. Siegel at 205-930-8339.