27438 Arthroplasty, patella; with prosthesis

Name of the Procedure:

Arthroplasty, patella; with prosthesis.
Common name: Patellar Arthroplasty, Knee Cap Replacement

Summary

Arthroplasty, patella; with prosthesis is a surgical procedure in which the knee cap (patella) is replaced with an artificial implant. This is generally done to relieve pain and restore function to the knee joint.

Purpose

This procedure addresses conditions such as severe arthritis, patellar fractures that do not heal properly, or other degenerative joint diseases. The goals are to reduce pain, improve knee function, and enhance the patient's quality of life.

Indications

• Severe pain and stiffness in the knee joint
• Failure of non-surgical treatments like medications and physical therapy
• Significant loss of knee function affecting daily activities
• Chronic patellar instability
• Patellar fractures that have not healed correctly

Preparation

Pre-procedure instructions may include:

• Fasting for at least 8 hours prior to the surgery
• Adjustments or cessation of certain medications, particularly blood thinners
• Pre-operative diagnostic tests such as X-rays, MRI, or CT scans
• Medical clearance from a primary care physician or cardiologist

Procedure Description

1. The patient is given either general anesthesia (fully asleep) or spinal anesthesia (numb from the waist down).
2. A surgical incision is made in the front of the knee to expose the patella.
3. The surgeon removes the damaged surface of the patella.
4. The new prosthetic patella is fitted onto the remaining bone.
5. The prosthetic component is secured, typically using surgical cement.
6. The incision is closed with stitches or surgical staples, and the knee is bandaged.

Tools and equipment:

• Surgical scalpel
• Retractors
• Bone saw
• Prosthetic implants
• Surgical cement for fixing the prosthesis

Duration

The procedure typically takes between 1 to 2 hours, not including recovery time post-anesthesia.

Setting

The procedure is usually performed in a hospital or specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Implant loosening or wear
• Nerve damage
• Persistent pain or stiffness

Benefits

• Pain relief in the knee
• Improved mobility and function
• Enhanced ability to perform daily activities These benefits are often realized within a few weeks to months post-surgery, depending on rehabilitation progress.

Recovery

• Initial hospital stay of 1-3 days
• Use of crutches or a walker for a few weeks
• Physical therapy beginning shortly after surgery
• Pain management with prescribed medications
• Full recovery and return to normal activities typically within 3 to 6 months

Alternatives

• Physical therapy
• Medications (NSAIDs, corticosteroids)
• Less invasive surgical options such as arthroscopy
• Knee fusion (arthrodesis)
• Pros: Less invasive options may have a quicker recovery time.
• Cons: They may not provide as durable or complete relief from symptoms as patellar arthroplasty.

Patient Experience

During the procedure, the patient will feel little to no sensation due to anesthesia. Post-procedure, they might experience pain and discomfort managed by painkillers. Swelling and stiffness are common, and physical therapy will be crucial for recovery.