• Total Knee ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Partial Knee ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Total Hip ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Revision Hip ReplacementNicholas B Frisch MD Nicholas B Frisch MD

  • Revision Knee ReplacementNicholas B Frisch MD Nicholas B Frisch MD

Knee Replacement

Total Knee Replacement

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.

Indications

Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It often affects older people.

In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. These factors can cause pain and restricted range of motion in the joint.

Your doctor may advise total knee replacement if you have:

  • Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).
  • Moderate to severe pain that occurs during rest or awakens you at night.
  • Chronic knee inflammation and swelling that is not relieved with rest or medications
  • Failure to obtain pain relief from medications, injections, physical therapy, or other conservative treatments.
  • A bow- legged knee deformity

Causes

The exact cause of osteoarthritis is not known, however there are several factors that are commonly associated with the onset of arthritis and may include:

  • Injury or trauma to the joint
  • Fractures at the knee joint
  • Increased body weight
  • Repetitive overuse
  • Joint infection
  • Inflammation of the joint
  • Connective tissue disorders

Diagnosis

Your doctor will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.

X-rays typically show a narrowing of the joint space in the arthritic knee.

Nonsurgical Treatment

  • Weight loss
  • Activity modification: avoid high impact activities and those that exacerbate your symptoms
  • Physical therapy
  • Anti-inflammatory medications
  • Injections
    • Corticosteroids
    • Viscosupplementation
  • No narcotic (opioid) pain medication. If you are currently being treated with opioid pain medication for your chronic joint pain you should discuss this with your surgeon. We do not advise chronic use of opioid pain medication for the treatment of arthritis and recommend you discuss alternative treatment options before prolonged use.

Procedure

The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.

The surgery is performed under general or regional anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are cut at appropriate angles using specialized jigs. The femoral component is attached to the end of the femur with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws. Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, like the original meniscus cartilage. The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed; and a sterile dressing is placed over the incision.

Post-operative care

Rehabilitation begins immediately following the surgery. You will get up and start walking the day of surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. You will be able to walk with crutches or a walker. Your physical therapist will provide you with a home exercise program to strengthen thigh and calf muscles.

Risks and complications

As with any major surgery, possible risks and complications associated with total knee replacement surgery include:

  • Knee stiffness
  • Infection
  • Blood clots (deep vein thrombosis)
  • Nerve and blood vessel damage
  • Ligament injuries
  • Patella (kneecap) dislocation
  • Plastic liner wears out
  • Loosening of the implant

If you find difficulty in performing simple activities such as walking or climbing stairs because of your severe arthritic knee pain, then total knee replacement may be an option for you. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume your normal activities of daily living

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Additional Resources

Outpatient Total Knee Replacement

Partial and total knee replacement is the surgical treatment for knee arthritis, where the damaged knee is removed and replaced with an artificial knee implant. Traditionally performed as an inpatient procedure, partial and total knee replacement surgery are now being conducted on an outpatient basis, allowing patients to go home the same day of the surgery. This is made possible with recent advances such as improved perioperative anesthesia, minimally invasive techniques and initiation of rehabilitation protocols soon after surgery.

Whether or not the surgery is performed in the hospital or in an outpatient setting, the implants and surgical techniques are the same. You will typically be in the recovery area for a few hours and start walking on your new joint immediately with physical therapy and nursing staff. Once your pain is well controlled and you are able to walk safely, most patients will be discharged home that day.

Not every patient is a candidate for outpatient joint replacement. The decision to undergo outpatient joint replacement should be made with your surgeon and family. For those patients who are candidates for outpatient surgery it can provide a streamlined experience and allows you to recover in the comfort of your own home.

Post-operative care

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Partial Knee Replacement

Unicompartmental (Partial) knee replacement is a minimally invasive surgery in which only the damaged compartment of the knee is replaced with an implant. It is also called a partial knee replacement. The knee can be divided into three compartments: patellofemoral, the compartment in front of the knee between the knee cap and thigh bone, medial compartment, on the inside portion of the knee, and lateral compartment which is the area on the outside portion of the knee joint.

Traditionally, total knee replacement was commonly indicated for severe osteoarthritis of the knee. In total knee replacement, all worn out or damaged surfaces of the knee joint are removed and replaced with new artificial parts. Partial knee replacement is a surgical option if your arthritis is confined to a single compartment of your knee.

Disease Overview

Arthritis is inflammation of a joint causing pain, swelling (inflammation), and stiffness.

Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It most often affects older people. In a normal joint, articular cartilage allows for smooth movement within the joint, where as in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. These factors can cause pain and restricted range of motion in the joint.

Causes

The exact cause is unknown, however there are several factors that are commonly associated with the onset of arthritis and may include:

  • Injury or trauma to the joint
  • Fractures of the knee joint
  • Increased body weight
  • Repetitive overuse
  • Joint infection
  • Inflammation of the joint
  • Connective tissue disorders

Symptoms

Arthritis of the knees can cause knee pain, which may increase after activities such as walking, stair climbing, or kneeling.

The joint may become stiff and swollen, limiting the range of motion. Knee deformities such as knock-knees and bow-legs may also occur.

Diagnosis

Your doctor will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.

X-rays typically show a narrowing of joint space in the arthritic knee.

Surgical procedure

Your doctor may recommend surgery if non-surgical treatment options such as medications, injections, and physical therapy have failed to relieve the symptoms. Patients who receive a partial knee replacement may be candidates for outpatient surgery and if so, may discuss this option with their surgeon.

During the surgery, a small incision is made over the knee to expose the knee joint. Your surgeon will remove only the damaged part of the meniscus and place the implant into the bone by slightly shaping the shin bone and the thigh bone. The plastic component is placed into the new prepared area and is secured with bone cement. Now the damaged part of the femur or thigh bone is removed to accommodate the new metal component which is fixed in place using bone cement. Once the femoral and tibial components are fixed in proper place the knee is taken through a range of movements. The muscles and tendons are then repaired and the incision is closed.

Post-Operative Care

After surgery you will typically start walking within a few hours. A physical therapist will advise you on an exercise program to follow for a period of time to help maintain range of motion and restore your strength. You may perform exercises such as walking, swimming and biking.

Risks and Complications

Possible risks and complications associated with unicompartmental knee replacement include:

  • Knee stiffness
  • Infection
  • Blood clots (Deep vein thrombosis)
  • Nerve and blood vessel damage
  • Ligament injuries
  • Patella (kneecap) dislocation
  • Plastic liner wears out
  • Loosening of the implant

Advantages

The advantages of Unicompartmental (Partial) Knee Replacement over Total Knee Replacement include:

  • Smaller incision
  • Less blood loss
  • Quick recovery
  • Less post-operative pain
  • Better overall range of motion
  • Feels more like a natural knee

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Additional Resources

Revision Knee Replacement

Revision knee replacement surgery involves replacing part or all your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and require a second revision surgery.

Disease Overview

The knee joints are lined by soft articular cartilage that cushion the joints and aid in smooth movement of the joint bones. Degeneration of the cartilage due to wear and tear leads to arthritis, which is characterized by severe pain.

Total Knee Replacement

During total knee replacement, the damaged cartilage and bone is removed from the knee joint and replaced with artificial components. Artificial knee joints are usually made of metal, ceramic or plastic and consist of the femoral component and the tibial component.

Indications

Revision knee replacement surgery may be advised to patients if they have one or more of the following conditions:

  • Trauma to the knee joint
  • Chronic progressive joint disease
  • Increased pain in the affected knee
  • Worn out prosthesis
  • Knee instability or a feeling of giving way while walking
  • Loosening of the prosthesis
  • Infection in the prosthetic joint
  • Weakening of bone around the knee replacement, a process known as osteolysis (bone loss)
  • Stiffness in the knee
  • Leg length discrepancy
  • Fracture

Surgical procedure

Revision knee replacement surgery may involve the replacement of one or all the components.

The surgery is performed under general or regional anesthesia. Your surgeon makes an incision over the knee to expose the knee joint. The kneecap along with its ligament may be moved aside so that there is enough room to perform the operation. Then the old femoral component of the knee prosthesis is removed. The femur is prepared to receive the new component. In some cases, the damaged bone is removed and bone graft or a metal wedge may be used to make up for the lost bone.

Next the tibial component along with the old plastic liner is removed. The damaged bone is cut and the tibia is prepared to receive the new component. Like the femur, the lost bone is replaced either by a metal wedge, metal cone or sleeve, or bone graft. Then, a new tibial component is secured to the end of the bone using bone cement. A new plastic liner will be placed on the top of the tibial component. If the patella (kneecap) has been damaged, your surgeon will resurface and attach a plastic component. The tibial and femoral components of the prosthesis are then brought together to form the new knee joint, and the knee muscles and tendons are reattached.

Risks and complications

Like all major surgical procedures, there may be certain risks and complications involved with revision knee replacement surgery. The possible complications after revision knee replacement include:

  • Stiffness in the knee
  • Infection
  • Bleeding
  • Formation of blood clots in the leg veins
  • Injury to nerves or blood vessels
  • Prosthesis failure
  • Patella (kneecap) dislocation
  • Ligament injuries

Postoperative care

Following revision knee replacement surgery, a Continuous passive motion (CPM) machine may be used to allow the knee joint to slowly move. The machine is attached to the treated leg which slowly moves the joint through a controlled range of motion, while you relax.

You can walk with crutches or a walker. Weight bearing will typically depend on the extent of the revision procedure performed and will vary from full weight bearing to non-weight bearing. A physical therapist will teach you specific exercises to strengthen your leg and restore range of motion to the knee. Your physical therapist will also provide you with a home exercise program to strengthen thigh and calf muscles.

Knee immobilizers may be used when performing physical therapy, walking and while sleeping to keep the knee stabilized.

Revision knee replacement surgery is performed to replace failed knee prosthesis with a new prosthetic component. The surgery improves mobility and enables you to return to normal activities with a pain-free knee.

In the event of an emergency dial 911.

In the event of a concerning post-operative complication, please contact us immediately for prompt support. Most concerns can be appropriately addressed by our team and we will make every effort to be available to you in a timely fashion. Avoid going to the Emergency Department for surgical issues unless necessary, or unless instructed by our team.

Additional Resources

Credibility Links

  • American Academy of Orthopaedic Surgeons
  • American Medical Association
  • American Association of Hip and Knee Surgeons
  • Mid-America Orthopaedic Association
  • Crittenton Hospital Medical Center
  • DeClaire LaMacchia Orthopaedic Institute
  • Bald Mountain Surgical Center