In 1957 an artificial hinged knee was developed. Over the years there have been numerous changes made to improve the function and durability of the materials used. Science has also focused on trying to re-create artificial knee joints to mimic the exact way the knee joint functions. If you have a knee joint replacement, you can expect to have it last for 10 to 15 years before it needs to be replaced.
Indications for a Total Knee Joint Replacement
Types of arthritis, pain lasting for one to five years, and patients who do not respond well to rehabilitation or medication may require total knee replacement surgery. If you have nerve disease, a chronic infection or if the knee is solid and grown together, you will not be able to have knee replacement surgery. Sometimes, if both knees need replacing, the surgeon and the patient may consider performing the surgeries at the same time.
Cemented or Uncemented Knee Joint Replacement
There are two ways of performing a total knee joint replacement. "Cemented" means that cement is used to hold the joint in place for older or more debilitated patients. Special surgical glues are placed around the artificial knee. The bone shaft is drilled and the artificial knee is pounded into place. This creates the knee joint surface. "Uncemented" knee joint replacements have holes in them, and the bone grows into the holes and provides an anchor.
Complications of Knee Joint Replacement
Complications exist for obese patients, those involved with chronic steroid use and diabetic patients. There are also complications of developing blood clots and infection. It is also important to try to reduce swelling following surgery, as this can lead to scar tissue forming if the knee joint is not bent regularly. From surgery to full recovery takes about one year. A patient should have good mobility and strength within 3 to 4 months.
When Knee Replacement Surgery Fails
An infection following surgery can occur. If it is deep and severe, it may require that the artificial joint be removed. The infection is then treated until the patient is safe to have a second replacement. Sometimes the artificial surface materials wear, or in rare occasions, the material rubs off and is rejected by your immune system. Aggressive activity can also loosen the replacement, causing increased pain. Knee fractures also can occur.
Objectives of Rehabilitation for a Total Knee Replacement
The main objectives of rehabilitation surgery are to reduce pain and swelling. The next is to improve bending of the knee and to allow gradual weight to be placed on the knee. The patient is next instructed in exercises and how to walk properly. Progress is made to improve use of stairs, going to the bathroom and a gradual return to activities. Stiffness is expected due to swelling and should improve over the year after surgery.
References
- "Sequence Exercise"; Hans Gunnari; 1984
- "Physical Rehabilitation: Assessment and Treatment"; Susan O'Sullivan; 1988
