Osteoarthritis is a degenerative disease caused by the deterioration of articular cartilage. The joints are formed by the union of two bones by the joint capsule. The bone ends which are joined to form the joint are covered with articular cartilage. When this cartilage is injured, pain, stiffness and inability to move occur. The joints that most suffers are usually the knees.

Osteoarthritis can occur in the whole knee or partially in any of its components. It initially manifests with pain after a long walk or standing still. Problems of knee stability, mobility, clicking, locking sensation and even occasional inflammation usually also appear.

Do I need a knee replacement?

Knee osteoarthritis is diagnosed by performing an adequate clinical history. The orthopedic surgeon, in an interview with the patient, performs an examination of the joints, the request for x-rays and sometimes other tests. Radiography, made with the patient standing, to diagnose the degree of knee osteoarthritis, following his or her age, describing the patients discomfort and how it affects his or her quality of life. This information will help making the decision of placing prosthesis or to wait.

From the moment the patient had his or her first consultation about the initial symptoms of osteoarthritis, until it is decided to have a knee replacement usually a large period of time goes by. The main reason is that we always try to delay putting prosthesis, because the prosthesis has a half-life, and it will need replacing. Depending on the patient’s age, it is possible to carry out other type of surgeries to relieve pain and gain some time before placing knee prosthesis.

Knee replacement surgery

The knee replacement surgery takes about 2 hours. It is performed under general or local anesthesia, so you will not feel any pain. The surgeon will make an incision on the knee to open it. It will separate the patella and cut the ends of the femur and tibia to accommodate the prosthetic knee. He will cut the bottom of the kneecap to prepare it for the parts that will be placed. He will fix the prosthesis to the end of the femur and the end of the tibia and special bone cement will be used to attach the prosthesis to the patella. Finally the muscles and tendons around the new joint will be repaired and the surgical incision will be closed. After the operation, the patient remains hospitalized for a few days. Complete recovery will take 4 months to a year.

A total knee replacement should be the last option. Instead, it is better to first have a partial prosthesis, as these operations have a shorter recovery period than full replacements. These prostheses are especially suitable if there is little bone destruction and most of the structure of the knee ligament is intact. The most common are Unicondylar knee replacement and or patellofemoral prosthesis, for those patients with only isolated osteoarthritis in the knee cap, very typical in people with a history of fractures.

Usually prosthetic knees have both metal and plastic parts. The great advances in the last decade are innovation in materials, increasingly resistant to allow the prosthesis durability. It is also a significant improvement in postoperative pain control, allowing speedy recovery, tolerating movements and exercises in an early stage.

Knee replacement

Prostheses are made out of surgical material and none of them lasts a lifetime. Eventually loosen and wear down. The knee prosthesis usually last about 15 years after implantation. When it begins to fail, it must be replaced, which involves a much more complex surgery than placing a first prosthesis. Delaying the replacement of the prosthesis is time saving the joint itself, but this should not be done at the expense of the poor quality of life of the patient.

Prosthesis can fail for many reasons: because of an infection, wear down of the prosthesis, fractures of the bones near it. But a critical factor in the length of the prosthesis is the experience of the surgeon who performed the surgery. It is shown that operations performed by surgeons who placed only a few prostheses per year, have higher rates of complications.

Total knee replacement

Total knee replacement, including femoral head, tibial plate, patellar plate, and meniscus replacement plate.

Rehabilitation after knee replacement

90% of patients undergoing total knee replacement feel great pain relief and a great improvement in their mobility, therefore a great improvement in the quality of life. Recovery time is usually variable and depends on each patient, but typically it takes about six days to go home and about 6 months to be back to normal life.

During the first month you should rest and focus on rehabilitation. After the first month you can gradually get back to normal life.

Within three months the improvement is remarkable and you can perform many of the routine activities and after six months, patients are starting to forget about their operation.

After surgery knee prosthesis it is not advisable to perform high-impact activities, such as jumping or running, beyond the specific races to catch the bus or to prevent a grandson crossing the street, but you can perform activities such as walking, hiking, cycling, swimming, golf or even make soft trekking, so there is rarely any major limitations for the elderly.