Name of the Procedure:

Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty). Commonly known as Total Knee Replacement (TKR) or Total Knee Arthroplasty (TKA).

Summary

Total Knee Arthroplasty (TKA) is a surgical procedure to replace the knee joint with artificial components. This is typically done when the joint is severely damaged by arthritis or injury, causing significant pain and impaired movement.

Purpose

TKA addresses severe knee pain, stiffness, and loss of function usually due to osteoarthritis, rheumatoid arthritis, or traumatic injury. The goal is to relieve pain, improve joint function, and enhance the patient's quality of life by allowing better mobility.

Indications

• Severe knee pain that limits daily activities such as walking or climbing stairs
• Moderate to severe knee pain while resting, day or night
• Chronic knee inflammation and swelling not relieved by rest or medication
• Knee deformity (bowing in or out of the knee)
• Failure to improve with other treatments like medications, physical therapy, or other surgeries

Preparation

• Patients may need to stop taking certain medications, such as blood thinners, several days before surgery.
• Fasting is usually required starting midnight before the day of surgery.
• Preoperative tests might include blood work, a chest X-ray, and an electrocardiogram (EKG).
• Patients may undergo pre-surgical physical therapy to strengthen the muscles around the knee.

Procedure Description

1. The patient is given anesthesia; either general anesthesia or spinal epidural.
2. An incision is made over the knee to expose the joint.
3. The damaged femoral and tibial surfaces are removed and shaped to fit the artificial joint components.
4. Metal and plastic components are fixed to the prepared bone surfaces to recreate the joint surfaces.
5. If the patella requires resurfacing, a plastic component is attached to replace the damaged cartilage.
6. The incision is closed with sutures or staples, and a drain might be placed to remove excess fluid.
7. The knee is bandaged, and a knee immobilizer may be used.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

TKA is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Physician assistants
• Surgical technicians

Risks and Complications

Common risks include:

• Infection
• Blood clots in the leg veins or lungs
• Implant loosening or wear
• Knee stiffness or reduced range of motion

Rare risks include:

• Nerve damage
• Allergic reaction to anesthesia
• Persistent pain or swelling
• Fractures around the prosthesis

Benefits

• Significant pain relief
• Improved knee function and mobility
• Enhanced quality of life and ability to perform daily activities without discomfort
• Benefits typically realized within a few months of surgery

Recovery

• Initial hospital stay of 2-3 days
• Pain management with medications
• Physical therapy starting shortly after surgery to regain movement and strength
• Full recovery and return to most activities typically within 6-12 weeks
• Avoid high-impact activities to ensure the longevity of the implant
• Follow-up appointments with the surgeon to monitor progress

Alternatives

• Non-surgical treatments: medications, physical therapy, and injections
• Partial knee replacement (unicompartmental knee arthroplasty)
• Pros: Less invasive with shorter recovery times
• Cons: May not be suitable for patients with extensive knee damage

Patient Experience

• The patient may feel discomfort after the anesthesia wears off, managed by pain medications.
• Most patients experience significant pain relief within weeks as recovery progresses.
• Physical therapy is crucial for successful rehabilitation.
• Gradual return to daily activities with some temporary restrictions on knee movement to prevent damage to the new joint.

Overall, TKA is a well-established procedure that significantly improves patients' quality of life by alleviating pain and enhancing mobility.