Knee replacement surgery is a medical procedure performed by replacing the damaged knee joint with an artificial (prosthetic) knee joint. The purpose is for relieve pain and restore knee joint function, so that the patient can continue to use his knee as usual.
The knee joint can be damaged by injury or inflammation (arthcritical), which can prevent the patient from performing daily activities. A damaged knee joint will cause pain in the knee when doing activities, 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 giving drugs or giving a support device to help the patient move using his knee. If non-surgical treatment methods are no longer effective in relieving pain and relieving complaints, the patient can undergo knee replacement surgery. The doctor will inform the patient when he can undergo this procedure.
The patient's damaged knee joint will be replaced with a metal prosthetic joint. Through knee replacement surgery, the doctor will replace the ends of the thighbone, shinbone, calfbone, and kneecap bone with the prosthetic. Patients who undergo this procedure are usually elderly patients or patients with severe arthritis.
Indications for Knee Replacement Surgery
A common cause of a person having to undergo knee replacement surgery is arthritis. However, there are many types of arthritis, 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 becomes chronically inflamed due to an autoimmune disease that makes it difficult for the knee to function.
- Osteoartcritical.Osteoarthritis occurs when a person's knee joint becomes inflamed due to aging (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 result from a serious injury to the knee joint.
People with knee arthritis will find it difficult to do activities that rely on their knees, such as walking, climbing stairs, or getting up from a sitting position, squatting, and sleeping. If arthritis What happens is severe enough, knee pain will still be felt even though the patient is not using his knee, for example when resting.
Before being recommended by a doctor to undergo knee replacement surgery, the patient will be recommended to undergo non-surgical treatment. For example, through the administration of drugs, among others:
- Non-steroidal anti-inflammatory drugs.
- Corticosteroids.
- Joint supplements, such as glucosamine or chondroitin sulfate.
In addition to the use of drugs, patients can also undergo other treatment procedures to relieve knee arthritis, such as:
- Physiotherapy.
- Use of assistive devices for walking and activities, such as canes or supportsbraces).
- Diet for weight loss, especially in patients arthcritical who are also obese.
- Limiting physical activity, especially those that rely on the knees or feet.
If these treatments are no longer effective in relieving knee pain due to arthritis, the doctor will then recommend the patient to undergo knee replacement surgery.
Knee Replacement Surgery Warning
Not all patients with knee arthritis can undergo knee replacement surgery. Several conditions cause a patient arthcritical unable to undergo this procedure, among others:
- Suffer septic arthritis.
- Suffering from severe vascular disease.
- Having an infection, even if the site of infection is not on the knee or near the knee.
- Suffering from functional abnormalities of the leg muscles.
There are also conditions that cause knee arthritis patients to undergo surgery with special treatment or supervision, including:
- Patients suffering from obesity.
- Have a history of osteomyelitis around the knee.
- Have a skin condition or disease that can interfere with the outcome of surgery, for example psoriasis.
Preparation for Knee Replacement Surgery
The patient will first undergo an examination to confirm the need for knee replacement surgery. Examinations that can be carried out by patients include:
- General medical history examination
- General physical examination
- X-ray photo
- blood test
- MRI
- CT scan
If based on this 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 medications, especially blood thinners. The doctor will also inform you of the type of anesthesia (anaesthesia) that will be used during the operation. If the patient has an allergic reaction to the anesthetic, the patient must inform the doctor before the operation.
About 8 hours before surgery, the patient will be asked to fast by the doctor, usually fasting begins at midnight. If the patient is pregnant or planning a pregnancy, it is advisable to discuss with the doctor regarding the pregnancy. Patients will also be asked by doctors to be accompanied by family members before and after surgery, especially for transportation from home to hospital. Patients can also discuss with their families the post-operative recovery period, especially regarding the home environment, so that patients can move easily. Patients can also start exercising using a walker during the preparation period so that when they enter the recovery period, the patient is familiar with the assistive device. The patient will be given antibiotics before, during, and after surgery to prevent infection, as well as sedation to help the patient stay relaxed and calm during the operation.
Knee Replacement Surgery Procedure
At the start of the knee replacement surgery procedure, the patient will be asked to change into a surgical gown. The patient will then be asked to lie down on the operating table and will be given general anesthesia, so that he will not be conscious during the operation. To accommodate the urine that comes out during surgery, the patient will be fitted with a catheter in the urinary hole. If there is a lot of hair at the surgery site, the hair will be shaved to keep the surgical area clean.
The knee area will then be smeared with an antiseptic solution to prevent 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 part of the knee joint, and replace it with a prosthetic. Common knee replacement methods for patients include:
- Total knee replacement. Total knee replacement is done by replacing all parts of the knee joint, including the kneecap bone, part of the femur, shinbone, and calf bone. In addition to replacing the bones, the joints and knee joint pads are also replaced with metal or plastic.
- par knee replacementunlucky. Partial knee replacement is done by cutting the bone and joint only in the area that is experiencing inflammation. If the inflammation occurs in the knee joint in the thigh bone, the doctor will simply cut the bone and replace the joint cushion in this area. Partial knee replacements allow patients to have a faster recovery period than total knee replacements. However, there is a possibility that the patient will have to undergo reoperation if the inflammation in the knee joint spreads to other parts.
- Bilateral knee replacement. Bilateral knee replacement is a knee replacement surgery that is performed on both knees at the same time. Patients who underwent bilateral knee replacement were only patients who had been diagnosed with arthritis in both knees. Bilateral knee replacement allows the patient to have surgery on both joints at one time. However, patients will have a longer recovery period.
After the prosthetic knee joint is installed, 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. After testing the prosthetic knee, the doctor will close the incision again with suture, then cover it with a sterile bandage to prevent infection of the knee joint. Knee replacement surgery usually lasts about 2 hours. After the operation is complete, the patient will be taken to the inpatient room to undergo postoperative recovery.
After Knee Replacement Surgery
The patient will experience pain around his knee after undergoing surgery. This is a normal symptom experienced by patients during the recovery process. To relieve pain, the doctor will give pain medication. In order to avoid happening deep vein thrombosis, the doctor can give you blood thinners. In addition, patients are also advised to move their feet and heels during the recovery period, so that blood flow in the legs is maintained.
During the stay in the hospital, doctors and medical staff will help the patient to do breathing exercises, and start doing physical activities using the knees. Both methods are part of the recovery period, and can be performed either in the hospital or at the patient's home during the outpatient period. This exercise should be done regularly so that the patient can get used to the prosthetic knee that has been installed. In addition, the doctor will provide a list of foods that the patient should avoid and eat during the recovery period.
The recovery period after knee replacement surgery generally lasts about 3-6 weeks. After the recovery is complete, the patient can do light physical activity around the house. Patients can only drive a vehicle if they are accustomed to prosthetic knees, and if they are not taking pain medication. As for physical activity that is classified as strenuous, it should be avoided. For example, doing sports that are prone to knee impacts, such as soccer.
Currently, the success rate of knee replacement surgery is quite good, which is around 90 percent. Most patients who have undergone 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.
Risks of Knee Replacement Surgery
Knee replacement surgery is currently very safe to undergo, and rarely causes side effects or complications. These rare risks include:
- strokes.
- Infection.
- Nerve damage in the surgical area.
- Deep vein thrombosis
- Heart attack
Especially for infections, patients should be aware of the symptoms during the recovery period. If symptoms of infection appear during the recovery period, the patient should immediately notify the doctor concerned. Symptoms to look out for include:
- Fever.
- Discharge of fluid from the surgery site.
- The occurrence of swelling, redness and pain in the area of operation.
- Experiencing a cold sweat.
Another complication to watch out for is wear or erosion of the prosthetic knee joint that has been installed. The wear and tear of the knee joint can occur more quickly if the patient does frequent strenuous physical activities or lifts heavy weights frequently.
