 Knee joint replacementTotal knee replacement (TKR) Total knee replacement involves an incision in the front of the knee, removal of all the damaged bone and cartilage surfaces from the thigh bone (femur) and leg bone (tibia). A metal artificial knee joint (usually made of a cobalt-chrome alloy) is cemented into position to replace the bone surfaces. A piece of polymer plastic is inserted between the two metal surfaces to provide for a smooth articulated joint. Patients usually can start to walk the day after surgery, with the aid of a walking frame, and they stay in hospital for 4-6 days. Most can walk with a walking stick by about 1-2 months after surgery. Success rates of TKR are between 90-95%. The artificial joint implants can last for many years. 10 years after surgery only about 5% of patients need to have a repeat knee surgery. 20 years after surgery, more than 80% of patients are still walking on their original total knee replacement. Risks include anaesthetic risks, and surgical risks such as wound problems, infection, bleeding, blot clots, injuries to other structures, etc. In general, these risks are quite low. Every patient is different. A detailed discussion of the risks, benefits and alternatives to surgery should be carried out with your surgeon.  Unicompartmental knee replacement (UKA) Sometimes, only half of the knee is affected by arthritis. In these cases, only the diseased compartment needs to be replaced. The operation has the advantage of a smaller scar, and faster recovery times. "Uni" implants unfortunately do have a slightly higher chance of wearing out faster. In older patients with lower physical demands, UKAs have an 85-90% chance of lasting 10 years. As such, a detailed discussion with your surgeon of the pros and cons of UKA versus a TKR is recommended. UKAs are also increasingly used in younger patients who would otherwise be undergoing osteotomy. Recent studies on patients after either osteotomy or UKA show that the need for a second operation (usually a TKR) within the first 5 years is less when a UKA is carried out.  Computer navigation Cutting the bones and inserting the TKR as parallel as possible to the mechanical axis of the lower limb is critical to the longevity of the knee replacement. Traditionally, mechanical frames and guides are used to make the necessary cuts in the bone. Recently, computers are used at the time of surgery to accurately guide the surgeon to make cuts exactly in line with the mechanical axis of the lower limb. Recent research confirms that computer navigation results in a more accurate and narrower band of variation in the bone cuts compared to traditional techniques. Whether this accuracy would truely translate to increased longevity of knee replacement implants has yet to be conclusively proven. Disadvantages of computer navigation are increased surgical times, and added costs. Back to main patient information. |
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