Knee replacement surgery is a medical procedure performed by replacing a damaged knee joint with an artificial knee (prosthetic) joint. The goal is to relieve pain and restore the function of the knee joint, so that patients can still use their knees as usual.
The knee joint can suffer damage due to injury or inflammation (arthritis), which can prevent patients from carrying out daily activities. A broken knee joint will cause knee pain when on the move, such as walking, climbing stairs, sitting or lying down.
Before undergoing knee replacement surgery, the patient will first undergo non-surgical treatment. The treatment can be in the form of medication or providing a buffer to help patients move using their knees. If the non-surgical treatment method is no longer effective in relieving pain and alleviating complaints, the patient can undergo knee replacement surgery. The doctor will inform patients when they can undergo this procedure.
The patient's knee joint that has been damaged will be replaced using a prosthetic joint made of metal. Through knee replacement surgery, the doctor will replace the tip of the thigh bone, shin, calf bone, and knee bone with the prosthetic. Patients who undergo this procedure are usually elderly patients or patients suffering from severe arthritis.
Indications of Knee Replacement Surgery
A common cause for a person to have knee replacement surgery is arthritis. However, arthritis itself has many types, and the types of arthritis that often cause a person to have knee replacement surgery are:
- Rheumatoid arthritis. Rheumatoid arthritis occurs when a person's knee joint experiences chronic inflammation due to autoimmune disease which causes the knee to become difficult to function.
- Osteoarthritis. Osteoarthritis occurs when a person's knee joint becomes inflamed due to increased age (degeneration). This condition is mostly experienced by the elderly. But in some cases, it also occurs at a young age.
- Post-traumatic arthritis (post-traumatic arthritis). This type of arthritis can occur due to serious injury to the knee joint.
Patients with arthritis of the knee will find it difficult to do activities that rely on the knee, such as walking, climbing stairs, or getting up from a sitting, crouching, and sleeping position. If arthritis is severe enough, knee pain will still be felt even if the patient is not using his knee, for example when resting.
Before being recommended by doctors to undergo knee replacement surgery, patients will be recommended to undergo treatment without surgery. For example, through the provision of medicines, including:
- Non-steroidal anti-inflammatory drugs.
- Corticosteroids.
- Joint supplements, such as glucosamine or chondroitin sulfate.
In addition to the use of medication, patients can also undergo other treatment procedures to relieve knee arthritis, such as:
Physiotherapy.
- Use of assistive devices for walking and doing activities, such as walking sticks or braces.
- Diet for weight loss, especially in arthritis sufferers who also suffer from obesity.
- Limit physical activity, especially those that rely on knees or legs.
If these treatments have not been effective in relieving knee pain due to arthritis, the new doctor will then recommend the patient to undergo knee replacement surgery.
Warn Knee Replacement Operations
Not all patients with knee arthritis can undergo knee replacement surgery. Some conditions that cause an arthritis patient cannot undergo this procedure, including:
- Suffered from septic arthritis.
- Suffers from severe vascular disease.
- Are suffering from an infection, even though the location of the infection is not in the knee or near the knee.
- Suffered from functional abnormalities of leg muscles.
There are also conditions that cause knee arthritis patients to have surgery with special treatment or supervision, including:
- Patients suffering from obesity.
- Have a history of osteomyelitis around the knee.
- Having a condition or skin disease that can interfere with the results of surgery, for example psoriasis.
Preparation of Knee Replacement Surgery
The patient will first undergo an examination to confirm the need for knee replacement surgery. Examinations that can be undertaken by patients, include:
- General medical history check
- General physical examination
- X-ray photos
- Blood test
- MRI
- CT scan
If based on the examination the patient is required to undergo knee replacement surgery, the doctor will inform the patient regarding the surgical procedure. The doctor will also ask the patient to stop taking certain medicines, especially blood-thinning drugs. The doctor will also inform the type of anesthesia (anesthetic) that will be used during the operation. If the patient has an allergic reaction to the anesthetic, the patient must notify the doctor before the operation is carried out.
About 8 hours before surgery, patients will be asked to fast by the doctor, usually fasting starts at midnight. If the patient is pregnant or planning a pregnancy, you should discuss with your doctor about the pregnancy. Patients will also be asked by a doctor to be accompanied by family members before and after surgery, especially for the shuttle from the house to the hospital. Patients can also discuss with family related to the postoperative recovery period, especially regarding the home environment, so that patients can move easily. Patients can also start training using walking aids during the preparation period so that when they are recovered, the patient is familiar with these aids. Patients will be given antibiotics before, during and after surgery to prevent infection, and also sedatives to help patients remain relaxed and calm during the operation.
Knee Replacement Surgery Procedure
At the beginning of the knee replacement surgery procedure, the patient will be asked to change his clothes with special surgical clothes. The patient will then be asked to lie on the operating table and will be given general anesthesia, so that he will not be conscious during the operation. To collect urine that comes out during surgery, the patient will be fitted with a catheter in his urinary opening. If there is a lot of hair at the operating site, the hair will be shaved so the surgical area is clean.
The knee skin area will then be smeared with antiseptic fluid to avoid infection during and after surgery. After that, the doctor will then make a skin incision (incision) in the knee area, which is about 6-10 cm, to open the knee. The orthopedic doctor will then cut and remove the damaged knee joint, and replace it with a prosthetic. The knee joint replacement methods that are generally performed for patients include:
- Total knee replacement. Total knee replacement is done by replacing all parts of the knee joint, including the kneecap bones, some femur, shin, and calf bone. In addition to replacing bones, joints and knee joint pads are also replaced with metal or plastic.
- Partial knee replacement. Partial knee replacement is done by cutting the bones and joints only on the part that is inflamed. If inflammation occurs in the knee joint in the femur, the doctor will only cut the bone and replace the joint pads in this part. Partial knee replacement allows the patient to undergo a faster recovery period than total knee replacement. However, it is possible that the patient will have to undergo repeat surgery if inflammation of the knee joint spreads to other parts.
- Bilateral knee replacement. Bilateral knee replacement is knee replacement surgery performed on both knees at the same time. Patients who undergo bilateral knee replacement are only patients who have been diagnosed with arthritis in both knees. Bilateral knee replacement allows the patient to undergo both joint surgeries at one time. However, patients will undergo a longer recovery period.
After fitting the prosthetic knee joint, the doctor will then test whether the prosthetic knee is functioning properly or not. The trick is to bend and rotate the knee while the patient is still unconscious. If the prosthetic knee testing has been completed, the doctor will close the slices that have been made with sewing thread, then cover with a sterile bandage to prevent infection in the knee joint. Knee replacement surgery usually lasts about 2 hours. After the operation is complete, the patient will be taken to an inpatient ward to undergo postoperative recovery.
After Knee Replacement Surgery
The patient will experience pain around his knee after undergoing surgery. This is a normal symptom that is felt by the patient during the recovery process. To relieve pain, the doctor will give pain relievers. In order to avoid the occurrence of deep vein thrombosis, doctors can give blood-thinning drugs. In addition, patients are also encouraged to move the legs and heels during the recovery period, so that blood flow in the limbs is maintained.
During the hospital stay, doctors and medical staff will help the patient to do breathing exercises, and begin physical activities using the knee. Both methods are part of the recovery period, and can be done both at the hospital and at the patient's home during the outpatient period. This exercise must be done routinely so that the patient can get used to the prosthetic knee that has been mounted. In addition, the doctor will provide a list of foods that should be avoided and consumed by patients during the recovery period.
The recovery period after knee replacement surgery generally lasts around 3-6 weeks. After recovery is complete, the patient is able to do light physical activity around the house. Patients may only drive the vehicle if they are accustomed to prosthetic knees, and if they are not taking pain medication. As for physical activity that is classified as heavy, it should be avoided. For example, doing sports that are prone to knee collisions, such as soccer.
At present, the success rate of knee replacement surgery is quite good, which is around 90 percent. Most patients who have had knee replacement surgery no longer feel pain in their knees. By adjusting physical activity, the results of knee replacement surgery can last up to a dozen years.
Risk of Knee Replacement Surgery
Knee replacement surgery is currently very safe to undergo, and rarely causes side effects or complications. These rare risks include:
- Stroke.
- Infection.
- Nerve damage in the operating area.
- Deep vein thrombosis
- Heart attack
Specifically for infections, patients must be careful of their symptoms during the recovery period. If symptoms of infection appear during the recovery period, the patient needs to immediately notify the relevant doctor. Symptoms to look out for include:
- Fever.
- Fluid discharge from the operating site.
- Swelling, redness and pain in the operating area.
- Experiencing cold sweat.
Another complication that must also be aware of is the wear or erosion of the prosthetic knee joint that has been installed. Wearing of the knee joint can occur more quickly if the patient frequently performs heavy physical activity or often lifts heavy loads.
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