Knee Replacement

People with severely damaged knees (either from injury or arthritis) might find it difficult to walk, run, or climb up stairs without significant pain. Sometimes, even the simplest of everyday activities, such as sitting up or laying down, are too painful. People with these problems might be candidates for knee joint replacement surgery.

When medications, walking supports, and other nonsurgical treatments have been tried and are not effective, Dr. Meier might recommend a partial or total knee replacement for patients who continue to suffer with chronic knee pain and lack of function. Joint replacement surgery is a very effective surgical procedure for the proper candidates, which can relieve knee pain, correct a leg deformity, and help you once again perform normal activities pain-free.

Since knee replacement surgery was initially performed in 1968, there have been major advancements. Through improvements in surgical technology and techniques, total knee replacements have become one of the most successful procedures in all of medicine. In fact, more than 600,000 knee replacements are performed each year in the United States, and that number grows with each passing year.

If you have chronic knee pain or a leg deformity caused by arthritis, contact Dr. Meier, a Beverly Hills orthopedic surgeon. Whether you are just beginning to explore your options or have already decided upon knee replacement surgery, Dr. Meier and his team can provide excellent guidance and surgical expertise. Call Meier Orthopedic Sports Medicine today at (310) 777-7845.

Anatomy of the Knee Joint

knee-replacement-surgery-los-angelesThe knee is the body’s largest joint. Without a healthy, functioning knee joint, you will not be able to perform a lot of the everyday activities that most people take for granted.

The knee joint is composed of three bones: the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). Several large knee ligaments (ACL, MCL, PCL, and LCL) hold the long bones together, providing stability to the knee joint.

A smooth tissue substance known as articular cartilage is located between and around the area where the bones touch to protect them and enable them to move easily. Meniscal cartilage is attached to the flat plateau of the tibia (shinbone) and acts as a shock absorber to help cushion the entire joint. The remaining surface of the knee joint is covered by the articular cartilage at the end of the femur, and the entire joint is all enclosed by the synovial membrane, which is a thin lining that releases a fluid that lubricates the cartilage of the joint.

Thanks to this delicate balance, friction (and therefore pain) should be reduced to zero in a healthy knee. However, disease, injury, or inflammation can all disrupt this biological harmony and can result in pain, muscle weakness, or reduced function.

Causes of Chronic Knee Pain

Though there are many causes of chronic knee pain and disability, the most common cause is arthritis. Of the many types of arthritis, most chronic knee pain can be traced to three types of arthritis:

Osteoarthritis is caused by age-related wear and tear of the knee cartilage. After the cartilage is worn down enough, bones are able to rub against each other, causing knee pain, stiffness, and inflammation. Osteoarthritis usually occurs only in people over the age of 50, though it may sometimes occur in people much younger too.

Rheumatoid arthritis is a disease of the immune system that leads to chronic inflammation and abnormal thickening of the synovial membrane that surrounds the knee joint. It can cause cartilage damage and eventually cartilage loss, as well as pain and stiffness in the knee.

Post-traumatic arthritis occurs after a serious knee injury. Bone fractures to the tibia, femur, or patella, as well as the trauma that results in ligament tears of the knee can damage the articular cartilage. Once the articular cartilage is damaged, it is more prone to wearing away and further damage. This can lead many times to chronic knee pain and limited knee function.

If you are deemed a candidate for a knee replacement, either partial or total, please take the time to determine if this procedure is right for you. The decision should be a cooperative one between you, your family, your family doctor, and your orthopedic surgeon, and should not be entered into quickly.

Knee Arthroplasty

knee-replacement-los-angeles-meierKnee joint replacement surgery, or knee arthroplasty, is basically a knee “resurfacing”. The interacting surfaces of the bones within the joint are actually being replaced with synthetic materials during the operation. There may be four parts to a knee replacement procedure:

  1. Preparing the bones. Dr. Meier removes the damaged cartilage surfaces at the ends of the thighbone and shinbone as well as a small portion of underlying bone.
  2. Metal implants are positioned. Metal components take the position of the removed cartilage to recreate the joint surface.
  3. Kneecap is resurfaced. If the patella is involved and needs resurfacing, orthopedic surgeons cut the undersurface of the kneecap (patella), and install a new plastic surface to interact with the front of the femur. Depending on the circumstances, some surgeons will not resurface the kneecap.
  4. Insert a spacer. In between the metal components, a medical-grade plastic  is inserted. This will create a smooth gliding surface.

Patients are usually put under general anesthesia (asleep) during knee arthroplasty. The procedure typically takes about two hours. For total knee replacements, patients will recover in a hospital for a few days so that they can be properly monitored with regards to pain management, and blood clot prevention, among other things. Patients will also begin physical therapy while in the hospital.

Partial Knee Replacement

A partial knee replacement, also called a unicompartmental arthroplasty, is an option that Dr. Meier may recommend for some patients with chronic pain who are considering a knee replacement. Most patients with severe arthritis have significant wear in two of the three knee compartments, but a minority of patients have wear confined primarily to one knee compartment and might be candidates for a partial knee replacement. This procedure can take place in a hospital setting, but Dr. Meier recently performed unicompartmental arthroplasty on a patient in an outpatient, ambulatory surgery setting, allowing the patient to go home the next morning without an official hospital stay.

Partial knee replacements have the following advantages over total knee replacements:

  • Quicker rehabilitation
  • Better range of motion in the knee
  • Shorter hospital stays
  • Less blood loss
  • Lower risk of infection, stiffness, and blood clots

Talk to your orthopedic surgeon to find out if you may be a candidate for a partial knee replacement.

Recovery, Rehabilitation, and Prognosis

In the immediate weeks after partial or total knee replacement surgery, a fall could be devastating and precipitate the need for another knee operation. You will want to avoid that by using any or all of the following: cane, crutches, a walker, hand rails, or someone to help you ambulate until you regain your balance, flexibility, and strength.

A vigorous physical therapy rehabilitation program will be set up by either your orthopedic surgeon or a physical therapist. Recovery time will depend on a number of variables, but usual time to full recovery can be as little as three months. Some people might take longer to recover, and they could take up to six months to regain full muscle strength and mobility, and feel really comfortable with their knee again.

About 90 percent of modern knee replacements will still function well 15 years after surgery. The important thing to remember is to follow your orthopedic surgeon’s instructions after surgery. If you take care of and protect your knee replacement and maintain your general health, you will greatly contribute to the success of your surgery.

Contact a Knee Replacement Surgeon in Beverly Hills

Dr. Meier is one of the world’s foremost experts in knee surgery. He has the experience and knowledge to perform your knee replacement surgery successfully. Find out more by contacting a Beverly Hills orthopedic surgeon at (310) 777-7845. You may also fill out our contact form and a representative from Meier Orthopedic Sports Medicine will be in touch with you shortly.

Next, find out how Dr. Meier treats a Baker’s cyst.

 

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