Simple movements such as walking, bending and twisting require the use of the hip and knee joints. When the knee is diseased or injured in any way, the resulting pain can seriously limit movement and function.
The knee is the largest and most complex joint of the body and is essential for almost all routine activities. It needs to be stable but at the same time allow a good range of movement, it is the hinge between the thigh and the lower leg and supports the greatest amount of the body’s weight when standing.
The knee joint is where the ends of 3 bones come together:
-The lower end of the thigh bone or femur.
-The upper end of the main, lower leg bone, or tibia.
-The kneecap or patella.
•To provide stability, bands of thick, tough tissue known as ligaments connect the bones and stabilise the joint.
•To allow good movement, a smooth lining called cartilage covers the ends of the bones to prevent them rubbing against each other, allowing flexible movement and almost no friction. The cartilage also serves as a shock absorber, cushioning the bones from the impact between them.
•Finally a soft tissue called synovial membrane lines the joint and produces a lubricating fluid which reduces friction and wear and tear.
Dr. Boerger, why is the knee such a vulnerable joint?
It is important to remember that on a day-to-day basis the knee is the hardest working joint in the human body. Therefore with the passage of time, the wear and tear it suffers can result in arthritis, a degenerative condition which causes discomfort, pain and even deformity of the knee, severely affecting a person’s quality of life.
Living with pain on a daily basis does affect quality of life, how can this be managed?
It is possible to use conservative treatment such as injections or analgesia and anti-inflammatory medication to treat the pain, but there comes a time when the pain is unbearable and daily activities such as walking, bending down, climbing stairs or even sleeping cause problems. At this time a knee replacement can be the best option to restore quality of life.
When is a knee replacement required?
Knee replacement surgery is quite a common operation, it is calculated that in Spain around 55,000 of these operations are performed every year. The main reasons being severe fracture of the joint in road traffic accidents, degenerative disease causing deterioration of the bone and cartilage in the joint and the development of joint tumours.
Partial or total prosthesis?
The difference between a partial compared to a total knee replacement is that with a partial knee replacement only the affected part of the knee is replaced. A total knee replacement involves the replacement of the three sections of the knee. The anterior and posterior cruciate ligaments are conserved in a partial knee replacement but are removed in a total knee replacement. In the past, partial knee replacement was only considered in patients over the age of 60 with a sedentary lifestyle, but currently, with new implants and new, improved, surgical techniques, at HC Marbella we are using them in active patients more frequently.
What are the advantages of a partial knee prosthesis?
A partial prosthesis preserves the range of movement and function of the knee much better in comparison to a total knee prosthesis. For these reasons, patients tend to be more satisfied with a partial knee replacement especially as, if required, they can always undergo a total replacement in the future. There is also less blood loss during surgery and knee movement is restored more swiftly. If degeneration is severe, there is no other alternative but to resort to a total knee replacement.
You have mentioned new implants and techniques, what type of prosthesis is used at HC Marbella for a partial knee replacement?
At HC Marbella we use the Biomet Corporation, Oxford® partial prosthesis as it has already provided some excellent results with 95% lasting 15 years or longer. For this reason, in many cases, total knee replacement is NOT required following the Oxford® prosthesis. The Oxford procedure is so successful that since 2013 its manufacturer, Biomet, has provided a lifetime guarantee with the implant.
Who can benefit from a partial knee replacement?
Patients with osteoarthritis of the knee where only one part of the knee is affected, either the medial (generally most affected) or the lateral (affected less frequently) part.
At HC Marbella we perform a thorough investigation in each case, asking the patient to identify the area of pain in the knee and examining the range of movement and stability. Although we will determine if the knee is eligible for a partial knee prosthesis with an X-ray, we will never know with 100% certainty if the patient is a good candidate until surgery has commenced.
And patients who have patellar or patellofemoral arthritis?
This type of arthritis often occurs in active, young adults and causes anterior knee pain. When this type of pain is recalcitrant, and does not respond to conservative measures such as weight loss, physiotherapy or oral/injected medication, surgery should be considered.
In patients with severe patellofemoral arthritis, total knee replacement has shown to be effective with great potential for rehabilitation. However, a partial prosthesis appears to be a better option, as it can be implanted at a younger age without the risk of loosening which can occur with a total prosthesis.
For whom is a total replacement appropriate?
We reserve total knee replacement for patients whose knees are severely damaged by arthritis or some other type of lesion, when the joint is severely fractured in road traffic accidents, or where a joint tumour has developed.
Dr. Boerger, what does the operation entail?
In knee arthroplasty surgery, we take damaged tissue and bone from the knee joint, replacing them with a synthetic implant, called a prosthesis.
It is essential that patients are well informed of the steps involved:
1.Preparation for surgery: Make sure you know what medication you are taking, you will probably have to stop taking medication which slows down blood clotting such as aspirin, ibuprofen, or naproxen as well as any anticoagulant medication such as warfarin (Sintron) and other similar drugs.
2.Before surgery: one of two types of anaesthetic will be given, general or epidural. An anaesthetist will be present in theatre throughout the operation.
3.During surgery: The surgeon will make an incision of approximately 3 to 5 inches (7.5 to 13 cm) in the knee. The damaged tissue and bone will then be removed and the prosthesis will be implanted; once in the correct place it is fixed with bone cement. Finally the wound is closed with sutures or staples.
And lastly, what happens during recovery?
At HC Marbella we take special care to make sure recovery is as speedy as possible to enable knee function to be restored in the shortest possible time. In our experience the majority of people recover quickly and have much less pain than they had prior to surgery. It is possible to move the knee the day after the operation. Our team of physiotherapists work with patients to mobilise the knee whilst in hospital, this continues for 2-4 weeks following discharge, discharge usually being 1 to 2 days after surgery.
As with all surgery, whilst the patient is in hospital we give medication to prevent the formation of blood clots, it may be necessary to continue this for a while. If all goes well, patients can return to a normal, fully active lifestyle after about 1 month.
Are there any other important recommendations?
Yes, especially related to sport. High impact exercise or jogging/running must be avoided for a period of time, as the prosthesis includes a support surface which could be damaged.
Traumatology and Orthopaedics Specialist.
September 22, 2017
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