Total knee replacement is indicated in patients with degenerative arthritis of the knee who have significant pain and functional loss and have failed a non operative approach.
Damaged bone and cartilage are removed from the femur (thigh bone), tibia (shin bone) and usually the patella (knee cap) and replaced with a prosthesis made from metal and polyethylene. Total knee replacement is generally a predictably successful procedure with over 90% of patients very satisfied with the outcome. Patients experience significant reduction in pain and improvement in function.
The type of prosthesis that Dr Glase uses is called a medial pivot design. This means that as the knee flexes and straightens it rotates about an axis that passes through the medial (inside) compartment of the knee. This type of design most closely mimics the biomechanics of the normal (unreplaced) knee. There are published clinical studies showing better results with a medial pivot design.
References:
1. J.W Pritchett - J. Arthroplasty 2011
2. J. W Pritchett - JBJS Br 2004
3. Freeman, Pinskerora - J Biomech 2005
4. Hossain - C.O.RR 2011
Some patients are suitable for unicompartmental or partial knee replacement. This surgery replaces one side of the knee only (usually the medial or inner side of the knee) This surgery is performed via a much smaller incision compared with a total knee replacement. The components are also made of metal and polyethylene.Advantages of a unicompartmental replacement over a total knee replacement are, less pain, faster recovery and a better range of movement.There are however certain strict selection criteria for unicompartmental replacement and these will be discussed at the initial consultation.
The vast majority of patients who undergo knee replacement recover without any complications and achieve a pain free knee with a satisfactory range of functional movement.
Deep infection involving the prosthesis is uncommon with rates reported in the literature of around 1%. Infection can rarely spread from other parts of the body to the prosthesis. It is advisable that any necessary dental procedures be undertaken prior to surgery. Acute infection can be treated by surgical washout. Rarely revision of the prosthesis is necessary.
This is where the bond between the bone and the prosthesis fails. This is rare but can be corrected with further surgery.
Despite all steps to prevent DVT, including early postoperative mobilisation, thromboembolic compression stockings and blood thinning medication following surgery, some patients will still develop a DVT. Pulmonary embolism is where a blood clot travels to the lung. This is a very uncommon complication and requires longer treatment with blood thinning medication.
Areas of numbness over the outer aspect of the knee are not uncommon. This usually diminishes over time. Loss of muscle strength such as a foot drop are very rare
Dr Glase consults and has surgical appointments at The Mater Hospital in North Sydney, Sydney Adventist Hospital in Wahroonga and North Gosford Medical Centre.
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