Total Knee Replacement

What is a Total Knee Replacement?

Total knee replacement is the creation of an artificial joint by covering the worn joint surfaces with specially designed components made of metal and polyethylene, aiming to achieve painless joint movement.

Who is a candidate for Total Knee Replacement?

Total knee replacement is suitable for patients who have advanced joint cartilage damage, despite receiving treatments such as rest, medication, physical therapy, cane use, and intra-articular injections, and whose knee pain cannot be controlled, and daily activities such as walking and climbing stairs are severely limited. It is preferable for the patient to be between 60-80 years old, but in certain special cases such as rheumatoid arthritis and osteonecrosis, the procedure can be performed at earlier ages.

How is Total Knee Replacement performed?

After administering appropriate anesthesia, the knee joint is accessed through an incision made in the front of the knee. The worn cartilage tissue on the contacting surfaces of the three bones that make up the joint (femur, tibia, and patella) is removed along with a thin layer of bone, and then selected prosthesis components of appropriate sizes are attached to the prepared bone surfaces using a bone cement called polymethyl methacrylate.

In this way, the joint surfaces are re-covered with parts made of metal and plastic. The surgery takes between 1-2 hours. Appropriate antibiotics are used at the beginning of the surgery for prophylaxis. Epidural (administered through the spine) or intravenous pain pumps are often used for pain control after total knee replacement surgery. Knee movements and standing up with assistance are initiated the day after the removal of the hemovac drain left in the knee. You can be discharged from the hospital when you become comfortable walking in the room and corridor. This duration varies from patient to patient but can range from 3 to 7 days.

Can Both Knees be Replaced with Prosthetics at the Same Time?

Yes, it is possible, but the anesthesia time will be longer, there will be a slight increase in the risk of infection, and the need for blood transfusion will increase. Therefore, appropriate patient selection is important for this procedure.

What should I expect after Total Knee Replacement Surgery?

More than 90% of patients who undergo total knee replacement experience a significant reduction in knee pain and a noticeable improvement in daily activities such as walking and climbing stairs. When you are discharged from the hospital, you will be able to walk inside your home with the support of an assistive device. The significant improvement in pain and independent walking varies for each patient but usually occurs between 4 to 8 weeks, even though it can be different for each patient. Running, jumping sports, and heavy physical work are not suitable after total knee replacement surgery as these activities can shorten the lifespan of the prosthesis. Low-impact activities such as walking, golfing, and swimming can be performed. There is no restriction on driving a car.

Any existing deformities or malformations in your leg will be corrected during the surgery, which will prolong the lifespan of the knee prosthesis. It is often not possible to fully kneel down or perform prayer after knee replacement. Although techniques and designs that increase the range of motion of the knee are being applied in recent years, it may be risky for patients to tuck their feet under their buttocks while sitting for the long-term survival of the knee prosthesis.

Can Magnetic Resonance Imaging (MRI) be performed after Total Knee Replacement?

Most modern total knee prostheses are made of a metal called chrome-cobalt alloy, which is MRI compatible. Although the tissues in close proximity to the knee may not be visualized, there is no problem with obtaining an MRI from another region. If you have

a knee prosthesis implanted before 1990, it would be appropriate to consult your doctor about its brand or metal alloy for MRI compatibility.

Does Total Knee Replacement have a lifespan?

With appropriate surgical techniques and modern prosthesis designs, the lifespan of knee prostheses has now extended up to 15-20 years. Loose knee prostheses can be removed and replaced with a second prosthesis in most patients, but the lifespan of the second prosthesis is not as long as the first one. Regular examinations and X-ray evaluations of your knee prosthesis, even if you have no complaints, are appropriate to diagnose problems such as wear and loosening early.

What complications can occur after Knee Replacement Surgery?

Serious complications after total knee replacement surgery occur at a very low rate. The most common problem is the formation of blood clots (deep vein thrombosis) in your leg veins due to slowed blood flow. To prevent this, preventive treatment with medications to thin the blood is administered after surgery. This treatment can be extended up to 30 days if necessary. Starting knee movements and walking in the early period after surgery and avoiding immobility can reduce this risk.

After total knee replacement, infection, known as prosthesis infection, occurs between 0.1% and 2% of cases. Having an infection in another part of the body (e.g., urinary tract, teeth), diabetes, and the presence of other chronic diseases can increase this risk. Treatment of any possible infections in another part of the body before surgery is necessary. Protective antibiotic treatment is administered during surgery, and special precautions are taken to reduce the risk of infection. If an infection develops in the total knee prosthesis, repeated surgeries, removal of the prosthesis with antibiotic treatment, and re-implantation after a certain period may be necessary.

In addition to these, complications such as wound healing problems, vascular or nerve injuries, dislocation of certain prosthesis components, fractures around the prosthesis, and fractures in the prosthesis itself can occur but they are very rare.

How to Prevent Infection after Total Knee Replacement?

Although the risk is low, there is a risk of bacteria entering your knee prosthesis through the bloodstream and causing an infection. If you are going to undergo a surgical procedure related to your teeth or urinary tract within the first two years after the prosthesis surgery, you must take antibiotics before the procedure. It is particularly important to protect against infection by using an appropriate antibiotic one hour before procedures such as tooth extraction, tartar cleaning, and root canal treatment. It would be appropriate to consult your orthopedic doctor for the dosage and duration of the antibiotic.

Additionally, you should pay attention to foot care, and if any signs of foot or nail infection occur, inform your orthopedic doctor.