27445 Arthroplasty, knee, hinge prosthesis (eg, Walldius type)

Name of the Procedure:

Arthroplasty, knee, hinge prosthesis (eg, Walldius type)

Summary

Arthroplasty, often referred to as knee replacement surgery, involves the replacement of a damaged knee joint with a hinge prosthesis, such as the Walldius type. This type of procedure is typically utilized when standard knee implants are insufficient due to severe joint instability or significant bone loss.

Purpose

The procedure aims to alleviate severe knee pain and restore function in patients with advanced joint damage. This is particularly beneficial for patients who have not found relief from conservative treatments such as medications, physical therapy, or less invasive surgical procedures.

Indications

• Severe osteoarthritis or rheumatoid arthritis
• Major knee deformities
• Significant joint instability
• Substantial bone loss around the knee joint
• Patients with previous unsuccessful knee replacements

Preparation

• Fasting for at least 8 hours before surgery.
• Medication adjustments as directed by the physician.
• Preoperative evaluations like blood tests, EKG, and imaging studies (X-ray, MRI).
• Discussion of medical history and any potential allergies.

Procedure Description

1. The patient is placed under general anesthesia or spinal anesthesia.
2. The surgical area is sterilized, and an incision is made over the knee.
3. The damaged bone and cartilage are removed.
4. The hinge prosthesis, resembling a hinge mechanism, is fitted into the joint space.
5. The prosthesis is secured using bone cement or other fixation methods.
6. The incision is closed with sutures or staples, and a sterile dressing is applied.

Tools & Equipment:

• Surgical knives
• Bone saws and reamers
• Hinged prosthesis (e.g., Walldius type)
• Bone cement

Duration

The procedure typically takes about 2-3 hours.

Setting

Performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

• Infection
• Blood clots (deep vein thrombosis)
• Prosthesis loosening or failure
• Nerve or blood vessel injury
• Persistent pain or stiffness
• Allergic reactions to anesthesia

Benefits

• Significant pain relief
• Enhanced mobility and knee function
• Improved quality of life
• Long-term durability of the hinge prosthesis

Benefits may start to be realized within weeks, with continued improvement over several months.

Recovery

• Hospital stay of 3-5 days post-surgery.
• Pain management through medications.
• Physical therapy starting within 24 hours after surgery.
• Use of walkers or crutches initially.
• Recovery time ranges from 6 weeks to 3 months.
• Follow-up appointments for monitoring progress.

Alternatives

• Conservative treatments: medications, physical therapy, knee braces.
• Arthroscopic surgery for less severe conditions.
• Partial knee replacement.
• Non-surgical management with lifestyle modifications and pain relief strategies.

Patient Experience

Patients can expect some pain and swelling immediately post-surgery, managed with pain medication. Initial use of assistive devices for walking and adherence to a physical therapy regimen are crucial. Gradual improvement in pain relief and mobility typically occurs over several weeks to months. Regular follow-up with the healthcare provider ensures proper recovery and prosthesis function.