Knee injuries and arthritis can leave your articulations severely damaged. Even apparently simple activities in your day-to-day may seem challenging. Climbing the stairs can be a pain, and walking becomes quite difficult. Your knee feels stiff when you’re trying to use it, and you feel pain lying down and sitting. Do you need a prosthesis knee?
Before thinking about knee replacement surgery, you need to go through other options. And if your doctor is considering this surgery, you probably want to know why. This article will help you find the answers you need to take the next step.
We will go through knee replacement surgery and its alternatives. Why would you get it replaced? We will give you the medical criteria and the signs and symptoms you should look after before making up your mind.
What is knee replacement about?
Knee replacement surgery is also known as knee arthroplasty. Another name is knee resurfacing, which is very accurate because the bones are not replaced as a whole. Only the surface is remodeled through metal implant placement.
The procedure of this surgery includes four steps. They are:
- Bone preparation: In this step, doctors locate the damaged cartilage and remove them. They will also remove a minimal portion of bone.
- Metal implant positioning: Right after, the metal components are placed on the surface of the tibia and femur.
- Patella resurfacing: Next, the kneecap or patella can be resurfaced. In some cases, this step is necessary. In others, it is not.
- Creation of a gliding surface: Doctors would now insert a plastic spacer. It is placed between the metal surfaces, creating a smooth surface.
Knee replacement surgery is a treatment you should decide on with your doctor. Your family should also be able to help because you will need to go through a difficult recovery period.
Before surgery, you will need to go through an evaluation that includes:
- Cardiopulmonary evaluation: It is how doctors predict what will happen during anesthesia. If your heart and lung function are fine, you will withstand anesthesia without a problem.
- Lab studies: They are critical, too. Doctors will assess your blood clotting capacity and your kidney function. A complete blood count is also helpful in ruling out anemia.
- Imaging studies: You will have to go through different knee radiographs. Imaging studies of your lungs are also essential to rule out any infection or potential respiratory problem.
These exams will help your doctor decide if you are a suitable candidate for total knee replacement or not.
⇒ Now, let’s discuss knee replacement alternatives you can try first.
Other alternatives you can try first
Even before thinking about knee replacement surgery, your doctor will probably try other options first. Many patients with osteoarthritis and other degenerative diseases may ultimately need knee replacement surgery. Still, it is sometimes more recommended to stay with conservative treatment.
In most cases, you will go through one or several of these treatments before considering knee replacement surgery:
- Oral medications: These are usually over-the-counter medications such as naproxen, ibuprofen, or acetaminophen. They are designed to fight inflammation. In some cases, your doctor may prescribe more potent anti-inflammatories.
- Ointments and creams: You can rub them onto your skin above the articulation. These creams and ointments have anti-inflammatory components and often lead to temporary relief of the symptoms.
- Intra-articular injections: These injections are administered directly into the affected articulation. They are corticosteroids and other components made to relieve inflammation. Each cortisone shot usually relieves the symptoms for a few months. They are generally given along with hyaluronic acid to improve the lubrication of the injection.
- Physical therapy and exercise: Strengthening your leg muscles is fundamental to recover. This can be achieved through exercise or physical therapy. However, if your condition is more severe, you might need clearance from your doctor before trying some types of strenuous physical activities.
- Weight loss: Sometimes, losing weight can be a part of the therapy if you’re obese or overweight. Your knees will be enduring three extra pounds for every extra pound of weight. Even before knee replacement surgery, most patients are recommended to lose weight.
Why would you go through knee replacement surgery?
Most patients who undergo knee replacement surgery have tried all or most of the treatments listed above and still have very severe symptoms. In some cases, osteoarthritis symptoms improve temporarily with the treatments mentioned above. But osteoarthritis patients usually need knee replacement surgery at some point.
There are also severe mobility issues as a result of knee injuries. You might also want to go through this surgery if your mobility is severely compromised.
Are you a candidate?
There are medical indications for knee replacement surgery. They include:
● Disabling pain: It is one of the most important indications of knee replacement surgery. It usually happens in people with severe arthritis and osteoarthritis pain. Their pain is very severe and becomes a cause of disability. They typically feel night pain, and their symptoms severely reduce their quality of life.
● Deformity of the articulation: Patients with rheumatoid arthritis often undergo deformation of the articulations after a while. Even osteoarthritis patients may experience the same in a later stage of the disease. This is an important indication for knee replacement surgery but not the most common because patients now rarely reach this stage of the disease.
● Joint space reduction: Before planning your knee replacement surgery, you need to undergo a few imaging tests, as mentioned above. One of the reasons is to measure joint space levels. This measure is essential for doctors because it provides an objective look at how severe the disease really is. As joint space reduces, both ends of the bones in the articulation are closer, and there’s a higher chance they meet and create erosion. As the surfaces erode, the articulation pain becomes worse.
● Older adults with reduced mobility: One of the most common candidates are older adults who do not engage in strenuous physical activity. It is because knee replacement has a limited operating life. They may need to be replaced when the activity level is very high. Thus, this surgery is more commonly recommended in older adults. In this population, it is essential to consider cardiopulmonary health very closely to make sure they are candidates for surgery without added risks.
● Young patients after post-traumatic arthritis: Younger patients can also be candidates for knee replacement surgery. However, they should learn about the longevity and limitations of joint replacement. In most cases, these young patients endured trauma in the past, ending up with inflammation and chronic destruction of the articulation.
● Varus or valgus laxity: In some cases, there is a significant deformity of the articulation of the knee. In some cases, the deformity causes damage to the articulation. One of such cases is varus or values laxity, which may prompt knee prosthesis as one of the treatments. These cases require a particular type of prosthesis. Otherwise, the long-term survival of the surgery will be uncertain.
Are there any contraindications?
In some cases, patients may need a knee prosthesis, but surgery is not recommended or contraindicated. In such cases, other alternatives should be considered besides knee replacement surgery.
Some absolute contraindications of total replacement of the knee include:
- Knee sepsis: The infection should be solved first when the articulation is severely damaged and infected with a microorganism. Knee sepsis may compromise the healing of the tissues after surgery and increase the likelihood of complications.
- Remote infections: Some remote infections may become absolute contraindications, especially those of the respiratory system. Such infections make it more likely to undergo respiratory distress during surgery.
- Severe vascular problems: Circulatory issues should also be solved before surgery. Otherwise, oxygen saturation and circulation in the tissues may become compromised.
There are also relative contraindications. In these cases, doctors may still decide to go through surgery depending on the case. These contraindications include:
- Skin conditions: When the skin at the site of the surgery is compromised by psoriasis and other diseases, doctors may first decide to try different methods. It is not an absolute contraindication, however.
- A history of osteomyelitis in the knee: Osteomyelitis is a severe bone infection, and it may have sequelae in the knee articulation. In some cases, people with a history of this disease may not be candidates for knee replacement surgery.
- Obesity: Patients with overweight and obesity should try to lose weight before surgery, especially in cases of morbid obesity.
Signs and symptoms you should look after
You probably don’t have the medical experience to know precisely if you are a candidate for knee replacement surgery. But you don’t need to go through extensive medical training to suspect you need surgery. Just consider these signs and symptoms and talk about them with your doctor:
- Severe knee pain: We all have different pain thresholds. It means that two people experiencing the same pain may feel a higher or lower intensity depending on their central nervous system and other variables. However, you are more likely to need this surgery if your knee pain is so intense that it limits your daily activities. This type of pain is not relieved with conservative measures.
- Knee pain is moderate or severe when you are resting: In many cases, patients who need knee replacement surgery refer to moderate or severe pain at night or when they are resting. The articulation becomes even more stiff and hurts even if they don’t move around.
- Swelling and inflammation that does not improve: Your knee increases its size or looks reddened and swollen. This inflammation does not get better with oral medication, rest, ice, and other measures. Your doctor has probably tried many conservative measures, and your condition is still not improving.
- Your leg is bowing in or out: This is a sign of deformation in the articulation. The leg doesn’t look straight anymore. It is bowing in or out instead, making a curve. You might even lose balance sometimes as this curve becomes more pronounced.
- Treatment failure: We have repeatedly mentioned this throughout the article because it is perhaps one of the most important things you need to consider. If you still feel moderate or severe symptoms of pain and stiffness after treating your knee with several options.
If you have a doubt or suspect that you need knee replacement surgery, be sure to talk to your doctor about it. We all have different pain thresholds, and it is possible to misinterpret these signs and symptoms. A skilled doctor will go through additional tests to know objectively if you are a candidate or not.
Conclusion
Knee replacement surgery is also known as knee resurfacing because it involves taking out the surface of both articulations and replacing them with metal components and a plastic gliding surface. This procedure is complex and requires a previous examination by a professional to make sure that you’re a candidate. However, there are still ways to suspect that you need this type of surgery.
There are many treatments to try before considering this surgery. They include oral medications, intra-articular injections, creams, ointments, exercise, physical therapy, and weight loss. These options are usually tried before surgery, which is left as the last resource.
You’re likely a candidate for this surgery if you have long-term knee pain that does not resolve with the aforementioned treatment options. This type of pain is usually worse at night or when trying to rest. In some cases, patients may also experience knee deformity. The leg starts bowing in or out, and they are severely inflamed without significant improvements.
If you are a candidate, you will go through a series of exams to ensure that surgery is a safe option. Once you are cleared, and after considering your laboratory tests, imaging tests, and physical exam, your doctor will make his recommendations, and knee replacement therapy can be one of them.
Some patients are likely to need knee replacement therapy at some point during their lifetime. However, it is also essential to know that there’s a limited lifetime of the surgery, and it is often recommended for older adults with limited physical activity.