Total knee arthroplasty

Knee arthroplasty is a widespread procedure used to replace worn and damaged knee surfaces.

By replacing these surfaces with an implant, the patient is relieved from the feeling of pain.It increases the range of motion of his joint and thus returns to his daily activities.

The traditional and most widely used approach is based on a large vertical skin incision in the centre of the knee.The procedure is performed through a small incision (7-10 cm) on the anterior surface of the knee.

Through this incision, muscle disruption and transection of the quadriceps tendon is avoided. The patient's mobilisation is immediate and the return to daily activities very fast (driving, stairs, sports). In contrast, minimally invasive total knee arthroplasty uses a smaller incision in the skin and a less invasive technique. The aim is to reduce post-operative pain and patient recovery time. However, unlike the traditional method, the minimally invasive technique is not indicated for all patients. The treating physician must adequately explain and explain all possible surgical options

The most common cause of chronic pain and disability of the knees is arthritis. Osteoarthritis, rheumatoid arthritis and post-traumatic arthritis are the most common forms.

Osteoarthritis usually occurs in people 50 years of age and older and often in people with a family history of arthritis. The cartilage that covers the bones of the knee softens and is destroyed. The bones rub against each other, causing pain and stiffness.

Rheumatoid arthritis is a disease in which the synovial membrane thickens and becomes inflamed, producing too much synovial fluid that expands (swells) the joint. This chronic inflammation can damage the cartilage and eventually cause its loss, resulting in pain, and stiffness.

Post-traumatic arthritis can follow a serious knee injury. A knee fracture or severe ligamentous injury to the knee changes the biomechanics causing increased loads that over time cause damage to the articular cartilage, leading to pain and limitation of joint function.

Total knee arthroplasty is the only definitive treatment for end-stage osteoarthritis. In recent years, and compared to patients we were asked to operate on in the past, patients undergoing knee arthroplasty are now younger, or if they are older, are quite active.
Preparation for knee arthroplasty includes an examination by an orthopaedic surgeon and possible imaging tests (e.g. X-rays). Information about the surgery, medication, dietary instructions and possible physiotherapy before the operation.

Total knee replacement involves replacing the injured or damaged part of the knee with implants.

In a standard total knee arthroplasty, a 25-30 cm incision is made. After the bones of the joint (femur, tibia, patella) are properly shaped and any axial deformities are corrected, the metal parts of the artificial joint are fixed. A friction surface of high density polyethylene is inserted between them

In minimally invasive total knee arthroplasty, although the surgical procedure is based on the same principles as in classical total knee arthroplasty, the incision and soft tissue detachments are smaller.

However, the surgical instruments used to prepare the femur and tibia are specially designed to position the prostheses correctly. During knee arthroplasty patients usually undergo epidural anesthesia, and in some cases total anesthesia, depending on the age of the patient.

During the procedure, bone preparation is initially performed, meaning the damaged cartilage surfaces are removed along with a small amount of underlying bone. The cartilage is then removed and the bone is replaced with titanium metal prostheses that reconstruct the surface of the joint.

Most patients get up and walk on the day of surgery or the day after. Rehabilitation requires physical therapy and specific exercises designed to improve the functionality of the knee.

Postoperatively, a special physiotherapy programme is followed for 3-4 weeks until the patient can climb stairs unaided. Full return to all activities is achieved after 2 - 3 months.