Total Knee Replacement

Total knee replacement is a surgical procedure to replace the damaged parts of the knee joint with metal and plastic parts. It is one of the most common surgeries performed by orthopedic surgeons. Common causes for knee pain include arthritis caused by primary osteoarthritis, rheumatoid arthritis, psoriatic arthritis, and secondary arthritis.  The surgery is performed when all conservative forms of management are exhausted.

Owing to the success of the surgery, a number of patients are today undergoing total knee replacement. By 2030, knee replacement surgery is projected to grow by 189 percent. Knee pain due to arthritis can be quite debilitating for patients of all age groups. Knee arthroplasty offers excellent pain relief with increased mobility.

Total knee replacement X-ray

Total knee replacement X-ray

Anatomy

The knee joint is a large synovial hinge joint. The joint is formed by the lower end of the thigh bone (femur) and the upper part of the shinbone (tibia). The kneecap (patella) forms a joint with the lower part of the thigh bone.

Patella acts as a lever for straightening the leg. It also allows smooth gliding of the bones when straightening or bending the leg.

Articulating cartilage is a glistening white smooth tissue covering the end of the bones forming the joint. The cartilage also covers the undersurface of the patella. The cartilage is toughened and flexible to allow smooth gliding of the joint surfaces.

The ligaments surrounding the knee provide stability to the joint. The ligaments providing stability at the front and the back are anterior cruciate ligament and the posterior cruciate ligament. Medial and lateral collateral ligaments provide stability on the sides of the knee joint. Tear or laxity of the ligaments lead to instability and damage the joint.

Meniscus are small pads, one on the inner side and one on the outer side of the knee joint. Both the meniscus cushions the impact on the ends of the bones. They also provide additional stability to the joint. Both the meniscus and the ligaments have limited blood supply.

Synovium is a tissue lining the inner surface of the joint. The synovium secretes a watery thin, clear and sticky fluid known as synovial fluid. Just like machine oil, it acts as a lubricant allowing smooth gliding of the joint. Bursae are small fluid-filled sacs helping in smooth gliding of the structures around the knee joint.

Proper alignment between the femur and tibia is necessary for the distribution of joint forces equally. Muscles crossing the knee joint allow for bending and straightening the knee.

Causes

Arthritis due to variety of reasons remains the most common indication for total knee replacement. Various types of arthritis are primary osteoarthritis, secondary osteoarthritis, rheumatoid arthritis, or psoriatic arthritis.

With growing age, the structures which form the knee joint, including the bones, articular cartilage, tendons, ligaments, meniscus, and muscles degenerate. The changes culminate into tears of the meniscus and cartilage, leading to loss of smooth gliding of the joint. The joint may become inflamed and swollen.

Rheumatoid arthritis is a systemic disease often affecting multiple joints, especially the smaller joints. The knee joint may be affected as well and usually, both the knees may be involved. There is extensive destruction of the cartilage and subchondral bone with inflammation of the synovium. The destruction is carried out by the body’s immune cells recognizing the normal cells as foreign.

Other forms of arthritis such as psoriatic arthritis and gouty arthritis also lead to the destruction of the joint. Arthritis secondary to knee injury is known as secondary osteoarthritis. Injuries such as fractures or tears of the meniscus and ligament may cause incongruity of the joint surface. Young patients with a history of trauma to the injury may present with secondary arthritis.

Congenital or residual deformities while growing such bow legs or knock knees cause malalignment of the joint. The unequal distribution of forces leads to the development of early arthritis.

Symptoms & Management

Patients with advanced arthritis usually present with knee pain. The knee pain is especially aggravated on activities such as walking, squatting, bending, twisting or turning. They experience difficulty navigating stairs and report stiffness after periods of inactivity. Joint crepitus may be experienced which is described as a grinding/popping sensation on moving the knee.

A wide range of conservative management options is tried before knee replacement surgery. These include heat pads, physical therapist visits, weight loss, or glucosamine and chondroitin sulfate tablets. The patient may receive cortisone injections or visco-supplement injections in the knee.

Unfortunately, arthritis is a progressively worsening condition. The conservative management options may thin out and the pain may become more persistent. The patients who have exhausted all conservative treatment options are candidates for knee replacement.

Procedure

Before the procedure, the patients are examined thoroughly for any deformity in the knees. Their medical conditions are assessed for them to be medically fit to undergo the procedure. Routine blood tests and cardiograms are done as a part of presurgical testing. The surgery is usually performed either in general anesthesia or spinal anesthesia.

Cross-matching of the patients’ blood is done for blood transfusion if needed. Any kind of blood thinner is stopped a few days before the procedure. Imaging studies usually an X-ray and sometimes a CT scan may be done to assess the degree of bone loss. Preoperative planning is done to assess the correct biomechanical axis of the knees.

The joint is opened from the front and the damaged bone along with cartilage is removed. Bone cuts are made with specially designed jigs to prepare the joint surface. Both the anterior and posterior cruciate ligaments are usually sacrificed in posterior stabilized implants. The medial and lateral collateral ligaments are retained and surgically released to balance the alignment.

Knee replaceemnt parts

Prosthetic parts of total knee replacement

The metal parts are then introduced and are glued with acrylic bone cement. A special high-grade plastic (Polyethylene) is inserted between the metal parts acting as a stabilizer and cushion. The metal parts are made of a cobalt-chromium alloy and are designed to allow smooth gliding. The undersurface of the patella is resurfaced and a special plastic is cemented to the undersurface. The joint is thoroughly irrigated, cleaned and closed. Intraoperative medications may be injected to reduce post-op pain. The patient is shifted to the recovery room where their vitals are closely monitored.

Total knee replacement components (front view)

Total knee replacement components (front view)

Total knee replacement components (front view)

Total knee replacement components (back view)

The above images show the prosthetic knee replacement components from the front and the back. The femoral component (posterior stabilized) has a cam mechanism which allows posterior translation of the femur on the tibial post of the bearing surface. The femoral rollback aids in achieving deeper flexion which in a normal knee is done by the knee ligaments. The polyethylene insert is made of highly cross linked polyethylene, which is resistant to wear and tear.  The keel of the tibial component is fixed in the upper part of the shin bone using bone cement.

Revision knee modular components

Revision knee modular components

Revision knee modular components

The modular components shown in the images above are used in revision knee surgery or complex knee replacement. Depending upon the knee anatomy and bone loss, the surgeon is able to achieve greater stability of the prosthetic implant using modular components.

Tibial cone augment

Metal cone resembling trabecular bone may be used to fill in bone gaps encountered in the metaphyseal region intraoperatively. The trabecular surface pattern of the tibial cone ensures biological union of the component.

After the Procedure

The recovery time is expedited and patients are able to walk the same day of the procedure with support. The post-operative pain is managed with medications and usually, a blood thinner is prescribed to prevent blood clots. Physical therapy is initiated to regain strength and increase flexibility.

Most patients are able to go home the day after surgery. The patients are able to walk without support usually in 8-12 weeks. They are able to resume their daily activities. X-rays are taken of the artificial knee/replaced knee to check for proper alignment and fixation.

They are able to walk, climb stairs, bend, ride a bicycle, drive a car and climb stairs without any limitation. The patients are advised not to undergo any high impact activities such as running or jumping.

Possible complications

As true with any major surgery, they may be potential complications with a joint replacement surgery. There may be medical complications such as heart attack, stroke, or pneumonia. There may be intraoperative complications such as fractures, shortening, instability, nerve or blood vessel damage.

During the few weeks after the surgery, there is an increased risk of blood clots in the leg, infection or dislocation. In the following months, the patient may complain of persistent pain, a clunk while moving the knee, dislocation or stiffness. In the long run, there may be loosening of the implant or the plastic component may wear off.

Success

On average, a total knee replacement lasts for more than 15- 20 years, for some patients, it may last their lifetime. Owing to the success, total knee replacement surgeries are being performed regularly. The patients express satisfaction in being able to get back to their daily activities. They are pain-free and report greater range of motion.

References:

  • https://aaos-annualmeeting-presskit.org/2018/research-news/sloan_tjr/

 

 

Call Us Now!

4.9
Based on 93 reviews
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
js_loader

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.