Total knee replacement surgery is performed by removing the damaged or diseased knee joint and replacing all three knee compartments with an artificial implant.

Who is a Candidate?

     
People who:

• Have a total knee replacement recommendation from a primary care doctor or orthopedic surgeon.
• Have arthritis in all three knee compartments.
• Have a stable knee structure and don't suffer from severe bone loss around the knee.
• Have significant deformity in their knees (bowlegs).
• Are age 55 or older.

What is a Total Knee Replacement?

     
A total knee replacement is a surgical procedure that replaces the damaged or diseased knee with artificial parts. All three compartments of the knee are replaced. The procedure separates the muscles and ligaments around the knee to expose the tissue surrounding the knee joint. The patella (knee cap) is moved out of the way, and the ends of the femur (thigh bone) and tibia (shin bone) are cut to fit the prosthesis.

The two parts of the prosthesis are implanted onto the ends of the thigh bone, shin bone, and the undersurface of the knee cap. The ACL and PCL are removed in this procedure. The procedure is performed by making an incision 8 to 12 inches in length. Before closing the incision, the surgeon bends and rotates the knee, testing and balancing it to ensure that it functions properly. The total knee replacement can last 15 to 20 years.

Since the normal knee kinematics is changed by having a total knee replacement, it may feel different to perform daily activities. The shape and motion of the knee will be different than with the natural knee, so the muscles and ligaments will need to adapt. At first, this may lead to discomfort and fatigue for the patient. The patient's knee may have a clicking sound after the surgery because of the new implant, which is completely normal.

Minimally Invasive Knee Replacement

The minimally invasive knee replacement is performed by making a small incision in the knee to replace lost cartilage and diseased bone. This is a new technique used to perform a total knee replacement.

What is a Minimally Invasive Knee Replacement?
The surgeon makes a 4 to 5 inch incision in the patient's knee. The damaged surfaces of the knee are removed and the ends of the bones are reshaped. The implant is secured to the bones. Once the surgeon has completed this procedure, the incision is then closed. The surgery usually takes between one and three hours to perform. The procedure has the same long-term outcome as the traditional total knee replacement.

Benefits of the Minimally Invasive Technique

• Smaller, less noticeable incision - 4 to 5 inches vs. 8 to 12 inches with a total knee replacement
• Shorter rehabilitation
• Less blood loss
• Shorter hospital stay
• Faster return of basic knee functions

Quad-Sparing Total Knee Replacement

The minimally invasive quadriceps-sparing knee replacement is performed by replacing lost cartilage and diseased bone without making an incision in the quadriceps muscle and tendon. It is performed with computer assistance, so that a guide rod doesn't have to be inserted into the femur bone - allowing for exact positioning of the component.

What is a Quadriceps-Sparing Total Knee Replacement?

The quadriceps-sparing, minimally invasive knee surgery reduces post operative pain by sparing the quadriceps muscle and tendon that have been cut through during a traditional total knee replacement surgery. Surgeons make the small incision that will move the soft tissue rather than cutting through it. A computer assisted technique is used so the surgeon can perform the procedure without inserting a guide rod into the femur bone. The computer gives the surgeon immediate feedback during the procedure so that the patient has the best possible knee alignment.

To perform the surgery, the surgeon makes a 4 to 5 inch incision in the patient's knee. The damaged surfaces of the knee are removed and the ends of the bones are reshaped to allow immediate weight bearing. Once the surgeon has completed this procedure, the incision is then closed and a bandage is applied. The surgery usually takes between one and two hours.

Benefits of a Quadriceps-Sparing Total Knee Replacement

• Less trauma to muscles and tendons. The quadriceps tendon and muscle are avoided rather than cut through.
• Smaller, less noticeable incision- 4 to 5 inches vs. 8 to 12 inches with a total knee replacement.
• Performed without inserting a guide rod into the femur bone.
• Less damage to tissue.
• Shorter rehabilitation.
• Less blood loss.
• Shorter hospital stay.
• Faster return of basic knee functions.
• Good mobility within 24 hours after operation. 

Quad-Splitting Total Knee Replacement

The minimally invasive quadriceps-splitting knee replacement is performed by replacing lost cartilage and diseased bone by making a small split incision in the quadriceps muscle.

What is a Quad-Splitting Total Knee Replacement?

This surgery is performed through a smaller skin incision, yet allows excellent visualization of the knee structures. This exposure allows the knee replacement surgery to be performed more accurately and more efficiently than traditional surgery. This exposure lowers the risk of infection and other complications.

Benefits of a Quad-Splitting Total Knee Replacement

• Less trauma to muscles and tendons. The quadriceps tendon is not cut. The muscle is gently separated.
• Smaller, less noticeable incision- 5 inches vs. 8 to 12 inches with a total knee replacement.
• Performed without a computer, thereby decreasing operative time and complications.
• Less damage to tissue.
• Shorter rehabilitation.
• Less blood loss.
• Shorter hospital stay.
• Faster return of basic knee functions.
• Good mobility after surgery.

The Allergic Alternative

           
If a patient is allergic to a type of metal that the implant is made of, then the surgeon will change the type of metal to make it possible for the patient to still have the procedure.

Post Surgery Treatments

• Incision Care - The incision will be covered with a large bandage. A tube may be placed in the incision during surgery to drain extra fluid from the wound. The tubes will be removed by a physician when indicated. The bandage will be changed on the second, third, or fourth day after surgery. The bandage will be changed as needed after that. The incision may be closed by staples or stitches. These will be removed at the direction of the orthopedic surgeon. 
• Ice Therapy - The physician may decide the patient will benefit from ice therapy. Ice often helps decrease swelling and discomfort after surgery or exercise. The patient should generally use ice for one hour after exercise and for the first few days after surgery. The physician may instruct the patient to use ice more frequently. 
• Continuous Passive Motion - Some physicians use a CPM machine after surgery to help the patient regain the flexion and extension of their knee. The CPM is often started on the first or second day after surgery and used until discharge from the hospital. There are several different CPM machines available. If ordered by a physician, one will be selected and fitted to the patient's leg. Nursing staff will instruct the patient on how to use the machine properly.

It is not usually necessary to use the CPM machine after discharge from the hospital. If it should become necessary, arrangements will be made for a home CPM machine before the patient is discharged. Some surgeons do not use a CPM machine at all. The patient's physician will determine if a CPM machine is appropriate and for how long it should be used.