Orthopaedic Surgery. About Knee Replacement Surgery and new knees for osteoarthritis and a damaged knee.

The skeleton consists of over 200 different bones, which gives the body strength and allows the muscles to move arms and legs. In the joint, two or more bones move relative to each other. Moreover, there are immobile joints, so in total we have over 100 different joints in the body. However, the knee joint a very complicated part, it's not a ball joint as the shoulder or hip, it's not a hinge stage at the elbow or finger joints. A knee joint can be compared with a hinge, but there is a considerable degree of rotation of the joint. There are three joint chambers, an inner side, an outer side and the joint between the patella and femur. A knee joint contains, besides the important ligament anterior cruciate ligament and posterior cruciate ligaments also meniscus, which further makes the knee to the body's most complicated joints. The knee joint is weight bearing, and are daily exposed to many types of loads. All these factors are the reason that there is often damage or wear changes in the knee and the knee joint is the part usually requires examination and treatment. - About knee injuries and knee anatomy >>

Damaged knee

An artificial knee is inserted when the knee is so damaged that it causes great pain, reduced walking distance and impaired movement. In the beginning you should try treatment with painkillers and physiotherapy, but when the pain becomes so debilitating that they affect the daily functions as described or failure to sleep, it's a good idea to consider replacing the knee with an artificial knee. There may be several reasons why a knee joint is destroyed, but the most common are osteoarthritis and rheumatoid arthritis. In osteoarthritis can be made insertion of the artificial parts, either a semi-artificial knee joint, or a whole. These are big operations that require hospitalization, but also acts knee well and almost all are still functioning after 15 years.

Osteoarthritis

The word 'arthritis' should not be taken literally. The changes look indeed as if the knee is worn to a greater or lesser degree, but rarely can find a clear cause of degenerative arthritis. Degenerative arthritis (osteoarthritis) is nowadays a widespread disease. It is the most common disease of the joints, which affects virtually all of age. 8 out of 10 have osteoarthritis, once they have crossed the 50 years. It starts with the smooth cartilage lining the joint surfaces starts to become thin and uneven due to wear. Eventually it disappears altogether. At the same time thickened joint capsule and forming more joint fluid, whereby the joint becomes thicker. In the earliest stages of osteoarthritis, there is often only slight discomfort with pain, but as the change is to increase the pain. For many patients this means a life dominated by pain. People with osteoarthritis of the knee are experiencing many problems in everyday life. Maybe you can not do his job, you can not get his daily exercise, you have to give up hobbies and refrain from traveling.

Symptoms of osteoarthritis

The symptoms of osteoarthritis of the knee are mainly pain, localized on the inner or outer side of the knee or diffuse across the knee region. There are often harshness from the knee, sometimes small interlock cases and pain aggravated by climbing stairs, especially if the patella is involved. There is frequently a swelling of the knee, in the early period of view and to the exertion, subsequently a constant swelling, and partly caused by increased fluid in the joint, and partly due to thickening of the joint capsule, which is the strong connective tissue sheath which extend as a sleeve entire the way round the knee joint. The constantly increasing volume of synovial fluid, often causing swelling of the back of the knee, forming a so-called Baker cyst. This is to be understood as a hernia of the knee joint, the fluid bags out through the back of the joint capsule, and presents itself as a swelling in the popliteal space. Error position of the knee is quite frequent: Usually the patient is wheeled leg just caused by osteoarthritis of the inner joint chamber. When osteoarthritis is localized in the outer joint chamber, developed knock-knees. Later in the process there will be problems with bending or stretching the knee maximally. In the case of osteoarthritis in 2 or 3 of the knee joint chambers, and these are severe symptoms, the person will probably be proposed insertion of an artificial knee joint.

Artificial knee joint

A knee prosthesis consists of 3 parts: one part which is put on the femur and one part which is put on the tibia and one part which is put on the kneecap. Prosthesis replaces parts articulation surface of the femur, tibia and back of the kneecap. The femoral member is composed of stainless steel. At surgery tapped it on the femur and attached with bone cement. Prosthetic part of the tibia is also made of stainless steel and consists of a metal plate with a keel, which goes into the medullary cavity of the tibia. This prosthesis are also fixed with bone cement. On top of the metal plate which is plastic (polyethylene) which forms a joint with a prosthetic part of the femur. Prosthetic portion of the patella are plastic and secured equally with proven bone cement manufactured by recognized manufacturers.

Expectations for an artificial knee?

Almost all of which will experience a reduction in the pain of knee compared to before the operation, and the majority of the patients who receives a knee, can expect complete or almost complete pain relief. A knee prosthesis do not last forever for all patients. This is because the prosthesis parts can be worn to such an extent that the artificial knee wear away from the bone. For more than 95% of patients with a knee prosthesis for at least 10 years - and over 90% in at least 15 years. There is a correlation between how much you load the prosthesis and the risk that the loose. This does not mean you should "spare" or "save" your knees. The purpose of the operation is exactly that you need to get rid of the pain and improve walking function. If the artificial knee at a time wears away, you get pain or looseness in the knee and should consult your own doctor. An artificial knee can be replaced by a new operation. You can not expect to be able to squat after having put a knee in. To this movement is not good enough, but it is definitely a goal to achieve as good a movement that you can ride a regular bike.

The knee operation

Normally constructed rygbedøvelsen and only very rarely used anesthesia. By an epidural, you can usually even keep up with what's happening. An experience most, however, want to be apart, so, in connection with the operation itself is often given a sleeping pill, which quickly is out of the body, so you again are fully conscious when the operation is completed. Emphasis is a drop in the back of the hand, through which the given liquids and medicine. During surgery, one lies on his back. The operation performed by a specialist in orthopedic surgery. At surgery puts an incision of 20-30 cm in front of the knee joint. The doctor removes the worn cartilage in the knee and a little of the worn bone and meniscus and anterior cruciate ligament. The adjoining portions of the femur, tibia and the patella bone is prepared for insertion of the knee prosthesis, which is then placed. If there is a wrong position of the knee, loosening one of sideledbåndene, so the knee can be corrected. The wound is closed, and emphasis is often a drain for drainage of blood. The skin is closed with metal clips. It will put a bandage on the knee and a ismanchet to discourage swelling and pain in the knee. The cuff changed the first day, so it is cool most of the time and is also used for training. The operation lasts about an hour.

After the Knee Replacement

One should expect that there is no pain after surgery, and pain are covered several times daily with painkillers. For a lot of pain results in too little training and it is very important that you get trained much. For both the knee as the hip patients is that rehabilitation starts the day after the physiotherapy and continues until discharge, which usually takes place after 3-6 days when you are able to get out of bed, a bath and even dressing and climbing stairs with crutches. The training consists of exercises that stimulate blood circulation, increase joint mobility, increase muscle strength and improves time. The goal of the training during hospitalization is that prior to discharge should be clear: getting in and out of bed, put and get up from a chair, personal care and toileting, climbing stairs and could go with 2 sticks. In consultation with the physiotherapist developed a training program, which you should continue after discharge.

Sick leave with "reward"

Usually, one is on half up to 3 months after the operation. This is particularly true if you have heavy physical work or much standing and walking activities. More sedentary work can be resumed before, if you feel ready for it. The reward is a pain-free knee and an almost normal again. Although you are unlikely to be recommended to perform real sport like tennis and badminton, one can not, as usually resume normal daily activities such as golf, swimming and cycling can be performed without increased risk of complications with the new knee.

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