Knee Osteoarthritis
Cartilage wear is a common cause of knee joint disease.
Clinical examination of the patient is the 1st step to diagnosis. Cartilage wear can be detected at a very early stage with the help of arthroscopy (knee endoscopy). If the disease is already far advanced, the changes are also visible in the X-ray image. Magnetic resonance imaging is also suitable as an imaging technique.
Osteoarthritis can be seen on plain radiographs as narrowing of the joint space between the femur and tibia, and possible buildup of osteopytes. (new small pieces of bone). The joint surfaces are often destroyed and bring considerable pain for the patient.
KNEE JOINT PROSTHESIS
If a joint-preserving therapy is out of the question for a variety of reasons, because the previous conservative and surgical measures (acupuncture, kinesiotaping, physiotherapy, pain medication, joint lavage, arthroscopic surgery, etc.) have been exhausted, the insertion of a so-called total knee prosthesis (knee TP) is performed.
The primary goal of the surgery is to achieve freedom from pain and mobility.
UNILATERAL ENDOPROSTHESES
The isolated replacement of a joint section requires that the knee ligament structures are intact.
Implants of artificial partial knee prostheses are among the most common accident surgery/orthopedic procedures and have given many people around the world back their freedom of movement and thus an active life. These routine procedures are hardly stressful for the body, firstly because an experienced trauma surgeon/orthopedic surgeon does not need long operation times for them and secondly they are performed by minimally invasive procedures. This procedure allows for faster rehabilitation through the smallest possible incisions.
Frequently asked questions
Which person can receive a partial denture?
Younger and more active patients are increasingly being fitted with a partial knee endoprosthesis. The anchorage in the bone and the implanted material (polyethylene) are thus exposed to greater stresses ( because athletic) and are therefore subject to a higher risk of failure. The less bone substance has to be removed during implantation, the greater the subsequent possibilities for retraction when changing to a full denture.
Advantages of a partial denture:
- small skin access
- minimally invasive procedure
- low risk of infection
- Immediate resilience postoperatively
- better mobility, because less muscle is severed
- average shelf life 10-15 years
- Delay of the total joint replacement
When can full weight-bearing be resumed after the operation?
- Full loading can already be started on the day of surgery
- Cycling is possible again after 4 weeks
- Running sports after 6 months
Inpatient stay?
4-5 days – then outpatient or inpatient rehabilitation.
BILATERAL ENDOPROSTHESIS
WHAT IS A TOTAL KNEE ARTHROPLASTY?
It is an inserted replacement joint. The articular surface is replaced by a metal/plastic inlay. This therapy becomes necessary when there are already severe, advanced signs of wear and tear in the knee joint, leading to pain or other complaints such as restriction of joint mobility or malposition of the knee joint.
Of essential importance is the connection of the upper and lower leg components. Uncoupled total endoprostheses are recommended.
We almost exclusively use so-called surface replacement prostheses, in which the joint surfaces on the upper and lower leg are replaced, whereby the components are not mechanically connected to each other. The mechanical connection of the two components has not proved successful in practice, as this often resulted in fractures due to material fatigue.
The stability of this type of prosthesis is therefore crucially dependent on the function of the still intact capsular ligament apparatus. If surgery is waited too long, the ligament instability is usually so severe that an uncoupled surface replacement is no longer possible.
It is essential that the lateral ligaments and the posterior cruciate ligament are preserved to allow a natural and stable range of motion.
In cases of extreme lateral ligament blockage, for example as a result of a severe knock-kneed or bow-legged position, the installation of a mechanically coupled type of prosthesis anchored with longer stems in the femur and tibia is required.
Frequently asked questions
What happens during the operation?
The knee joint is opened centrally (along the patellar tendon) with only one skin incision. Then the diseased joint cartilage is removed and remnants of the diseased bone are removed. In order to remove as little bone as possible, the new metal surface is fitted to the bone in a gender- and size-specific manner. This procedure preserves the important ligaments of the knee joint. Thus, even after the operation, the knee is still stable and one has an almost natural mobility.
Specific risks?
The most common general risks include infection of the wound, thrombosis, post-operative bleeding, and scarring that can lead to limited movement. If there is an infection in the prosthetic area, it must be treated immediately with antibiotics.
Advantages of a knee prosthesis?
- FREEDOM FROM PAIN
- only the joint surfaces are replaced
- essential bands remain intact
- Rotation improved in standing position
- Comes close to the natural mobility
- shorter rehabilitation time
- Golden Standard
Aftercare?
1st day post OP: motor splint
2nd day: intensive physiotherapy with motor splint
Discharge: after 8-10 days (climbing stairs must already be relearned)
Further: 3-4 weeks of outpatient or inpatient rehabilitation
Sport and knee prosthesis?
MOVEMENT IS LIFE!!!
………aber caution is advised, do not engage in high fall,high contact and high injury sports. We recommend Nordic walking, swimming, rowing, golfing, cross-country skiing, yoga , cycling and hiking. Light equipment training also seems useful to us. Everything with measure and aim!
It is important to practice the sport correctly, consciously and purposefully. Caution is generally advised with ball sports! Remember to possibly wear knee bandages, kinesiotape and always warm up and stretch properly beforehand!