Name of the Procedure:

Arthroplasty, knee, tibial plateau
Common name(s): Knee replacement, Tibial plateau arthroplasty

Summary

Arthroplasty of the knee, specifically involving the tibial plateau, is a surgical procedure to replace or rebuild the damaged surface of the knee joint. This involves the lower portion of the femur (thigh bone), the top of the tibia (shin bone), and occasionally the patella (kneecap).

Purpose

Arthroplasty addresses severe knee joint damage typically caused by osteoarthritis, rheumatoid arthritis, or injury. The goal is to relieve pain, restore function, and improve mobility by resurfacing the damaged tibial plateau and other knee joint surfaces.

Indications

• Severe knee pain or stiffness that limits everyday activities
• Chronic inflammation and swelling unresponsive to rest or medications
• Knee deformity, such as bowing in or out of the knee
• Failure of non-surgical treatments like physical therapy and medications
• Significant loss of knee function affecting quality of life

Preparation

• Preoperative fasting typically required (usually after midnight on the day of surgery)
• Discontinuation of certain medications, such as blood thinners, as advised by the surgeon
• Pre-surgical tests, including blood work, EKG, and chest X-ray
• Preoperative evaluation by the anesthesiologist and possible physical therapy consultations

Procedure Description

1. Anesthesia is administered (general or spinal).
2. An incision is made over the knee to access the joint.
3. Damaged cartilage and bone are removed from the tibial plateau and other affected areas.
4. The bone surfaces are prepared to fit the prosthetic components.
5. The prosthetic tibial component is placed and secured, often cemented in place.
6. The femoral component is fitted and secured to the lower end of the thigh bone.
7. Other components, like the patellar implant, are added if necessary.
8. The incision is closed with sutures or staples, and a sterile bandage is applied.

Duration

Typically, the procedure takes around 1 to 2 hours.

Setting

Performed in a hospital or specialized surgical center.

Personnel

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

Risks and Complications

• Infection
• Blood clots
• Implant loosening or wear
• Knee stiffness or limited range of motion
• Nerve or blood vessel damage
• Anesthesia-related complications

Benefits

• Pain relief
• Improved knee function and mobility
• Enhanced quality of life
• Restoration of normal knee alignment

Recovery

• Hospital stay of 1-3 days post-surgery
• Physical therapy begins within 24 hours after surgery
• Use of crutches or a walker initially
• Pain management with prescribed medications
• Full recovery typically within 3-6 months
• Follow-up appointments to monitor progress

Alternatives

• Non-surgical treatments like physical therapy, medications, and injections
• Partial knee replacement
• Osteotomy (bone cutting to realign the knee)
• Pros: Less invasive options may have shorter recovery. Cons: May not provide long-term relief or full function restoration.

Patient Experience

During the procedure, the patient is under anesthesia and will not feel pain. Postoperatively, they may experience pain managed with medications, potential swelling, and initial difficulty in moving the knee. Physical therapy and walking aids will be required for the first few weeks or months.