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Knee Replacement: Tale of the Patella

 knee replacement

What Is Knee Replacement?

The orthopedic surgery which removes the damaged bones and cartilages in the knee joint and replaces it with an artificial prosthesis made up of metal, heavy plastic or plymers, commonly called as a knee cap is known as a knee replacement procedure. Knee is a synovial type of hinge joint which bears the weight of the entire body and also helps in walking. The bony parts may wear with time leading to the need for replacement in order for the normal functions to be carried out smoothly.

Causes of Knee Disorders:

  • Osteoarthritis is the major cause, leading to damage to the cartilage and bony surfaces
  • Arthritis leading to wearing out of the bones, lower end of thigh bone (femur) and upper end of tibia-fibula
  • Trauma, injury and accidents can be a secondary cause

Signs and Symptoms Of Knee disorders:

  • Pain in and around the knee
  • Swelling, edema and redness around knees
  • Hot flashes, tenderness around knee region
  • Limited range of motions
  • Difficulty while walking, climbing stairs
  • In extreme cases, a throbbing type of pain can also occur during rest conditions

Diagnosis of Knee Disorders:

  • Physical Examination: The orthopedic surgeon closely examines the knee joint for tenderness, swelling and the range of motions. This can be achieved both by visual examination as well as palpitation in and around the joint.
  • Lab Tests: In case gout in suspected, a blood test may be advised to check for the levels of uric acid in the body. A urine test can also be advised for the same.
  • Synovial Fluid Test: Synovial fluid can be extracted from the joint space with the help of fine needle aspiration cytology in order to study the presence of atypical and inflammatory cells in the joint.
  • Imaging techniques: X-rays are routinely advised to study the bony articulations of the joint. A computed tomography can also be advised to study the minute details of the bony surfaces. In addition, magnetic resonance imaging and ultrasound imaging may be used to study the joint spaces, synovial membranes and the cartilages around the joint.

Types of Knee Disorders:

  • Fractures: Patella or the knee cap is the most commonly bone in the knee that can be fractured easily. However, severe trauma and accidents can also fracture the thigh bone and the calf bones. An underlying case of osteoporosis predisposes for fractures even with a little twisting or fall.
  • Dislocations: a dislocation occurs as a result of the bones in the knee joint moving out of their position and alignment. This most commonly occurs during fights, trauma, accidents and falls.  
  • Bursitis: Fluid filled tiny sacs known as bursae give a cushioning effect to the joint and allow easy sliding of the tendons and ligaments. Bursae are small fluid-filled sacs that cushion the knee joints and allow the tendons and ligament inflammation of the bursae due to excessive use and wearing out results in bursitis and a tremendous pain.
  • Ligament tears: the ligament injuries are graded from one to three. A grade one is a milder form of a sprain while a grade three is the most severe tear of the ligament. Ligament tears are mostly attributed to sports injuries.
  • Tendonitis: Inflammation of the tendons is known as tendonitis. A tendon is a bone to muscle connective tissue. It is often referred to as jumper’s knee, also a tendonitis of the patella is common in athletes who jump very frequently.
  • Meniscal tears: A tear in the cartilage is known as a meniscal tear. Menisci are the wedges of cartilages between the thigh and the calf bones. They may bend, twist or tear in sports and while performing vigorous physical activities. They may also wear away with age. With a sudden meniscus tear, a pop may be heard or felt in the knee. After the initial injury, pain, swelling, and tightness may increase over the next few days.

Treatment Procedure for Knee Replacement:

  • Total knee replacement: In a total type of knee replacement surgery, as the name suggests, joint surface from the lower end of the thigh bone to the upper end of the calf bone is replaced. Many a times, the patella is also removed and replaced with a plastic dome. The prosthesis used is cemented in place. If cementation is not the option, then that part of the prosthesis which will be facing the bone is textured to enable bone to grow over it in order for both the surfaces to establish a natural bond.
  • Partial knee replacement: A partial type of knee replacement is the choice when only the inner surface of the knee has worn out due to arthritis. The procedure is also known as unicompartmental surgery. It involves less interference with the knee when compared to a total type one. The recovery also is quicker and the function better when compared to a total type of knee surgery. Thus, a smaller incision will have to be made making the entire procedure less invasive or minimally invasive. Additionally a revision type of knee replacement may be required after a few years.
  • Knee cap replacement: When only the under surface of the kneecap and its groove are replaced, it is known as a knee cap replacement. This is also called as a patella-femoral replacement or patella-femoral joint arthroplasty. However, chances of a failure are more as compared to the conventional total type of replacement. The goal of the surgery is to only replace the part of patella affected with arthritis and leaving the healthy portion of the knee intact. Thus, the outcome of kneecap replacement can be good if the arthritis doesn’t progress and it’s a less major operation offering speedier recovery times.
  • Revision knee replacement: It is also known by the name of complex knee replacement. It is most commonly the choice if a second or a third joint replacement is needed, or in cases where arthritis is very severe. Apart from the stated reasons, major bone loss due to arthritis or fracture, weak ligaments may also call for a revision type of surgery.  The prosthesis used in these procedures have a ling stem as a result of which the componenet is fixed securely into the bony cavity. They interlock in the centre forming a hinge joint and tightly securing all the parts.

Complications And Risk Factors Associated With Knee Replacement:

  • Post operative swelling, edema may lead to discomfort
  • Bleeding, blood clots in and around the joint, in legs and feet
  • Infections around sutures
  • Dislocations of the prosthesis can occur due to excess weight, obesity, vigorous movements
  • Uncontrolled diabetes and hypertension can pose a threat at the time of the surgery.

Am I A Good Candidate For Knee Replacement?

If at any stage of your life you feel you have been struck with arthritis of knee, have severe pain, restricted movements and immense difficulty in performing daily activities, we recommend you to opt for a knee replacement as soon as possible. Also if reports after trauma or injury to the knee are suggestive of a replacement, you should waste no time and go for it.

Benefits:

  • A knee replacement will strengthen your knee joint and enable you to walk properly
  • Also the surrounding tissues become stable and help the joint in working smoothly
  • Increases the shelf life of the knee joint and also the longevity of use

Why Choose India?

Indian orthopedic institutes offer a wide range of surgical approaches for the correction of joints in the human body. Knee replacement surgery, being one of them is practiced widely across the country with magnificent results. Team MedcureIndia is closely affiliated with such skilled hospitals and aims at directing its clients towards the same.