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What is knee replacement surgery?

Is total knee replacement surgery for you?

If you are considering knee replacement surgery, you have plenty of company. The Agency for Healthcare Research and Quality reports that more than 600,000 knee replacements are performed each year in the United States.1

Even better news is that the US Department of Health and Human services considers total knee replacement to be one of the most successful and cost effective interventions in medicine. In fact, the success rate for knee replacements 10 years after surgery is 90-95%.1

This surgery is intended for people with severe knee damage, due to injury or to arthritis-related deterioration of the joint. Knee replacement can relieve pain and allow you to be more active. Your doctor may recommend it if you have persistent knee pain, and medicine and other treatments are not helping you anymore.

The decision to have knee replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your primary care doctor to an orthopaedic surgeon for an initial evaluation.

How is knee replacement surgery performed?

During knee replacement surgery, the surgeon surgically removes the damaged bone and cartilage of the joint and replaces it with smooth, artificial implants - thereby eliminating painful bone-on-bone contact.

Almost all knee replacement implants consist of a four-part system:

  • The tibial (shin) side has two elements and replaces the top of the shin bone. This portion of the implant is made up of a metal tray attached directly to the bone and a plastic spacer that provides the lower half of the new joint's bearing surface
  • The femoral (thigh bone) side is a single element that replaces the bottom of the thigh bone and provides the top half of the new joint's bearing surface. This component also replaces the groove where the patella, or kneecap, sits
  • Finally, the patellar component replaces the surface of the kneecap, which rubs against the femur. The patella protects the joint, and the newly resurfaced patellar button will slide smoothly on the front of the joint

References

  1. American Academy of Orthopaedic Surgeons website, accessed March 7, 2017: https://orthoinfo.aaos.org/topic.cfm?topic=A00389

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References

  1. Hall, et al. Unicompartmental knee arthroplasty (alias uni-knee): an overview with nursing implications. Orthopaedic Nursing. 2004;23(3):163-171. Accessed April 25, 2019.
    • Based on pre-surgical pain levels in UKA patients.
  2. Mayman DJ, Patel AR, Carroll KM. Hospital related clinical and economic outcomes of a bicruciate knee system in total knee arthroplasty patients. Poster presented at: ISPOR Symposium; May 19-23, 2018; Baltimore, Maryland, USA.
  3. Nodzo SR, Carroll KM, Mayman DJ. The Bicruciate Substituting Knee Design and Initial Experience. Techniques in Orthopaedics. 2018;33(1):37-41
    • Compared to non-JOURNEY II knees; Based on BCS evidence
  4. 1Short-term Range of Motion is Increased after TKA with an asymmetric bicruciatestabilized implant.AcceptedPoster Presentation, AAOS 2018 New Orleans. Kaitlin M. Carroll, Peter K. Sculco, Brian CMichaels,RichardL. Murphy, Seth A, Jerabek, David J. Mayman
  5. 2J Orthop. 2017 Jan 7;14(1):201- 206. doi: 10.1016/j.jor.2016.12.005. eCollection 2017. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range
  6.  In Vivo Kinematic Comparison of a Bicruciate Stabilized Total Knee Arthroplasty and the Normal Knee Using Fluoroscopy Trevor F. Grieco, MS a, *, Adrija Sharma, PhD a, Garett M. Dessinger, BS a, Harold E. Cates, MD b, Richard D. Komistek, PhD. The Journal of Arthroplasty, September 2017
  7. Testing concluded at 45 million cycles, ISO 14242-1 and 14243-3 define test completion at 5 million cycles. The results of laboratory wear simulation testing have not been proven to predict actual joint durability and performance in people. A reduction in wear alone may not result in improved joint durability and performance because other factors, such as bone structure, can affect joint durability and performance and cause medical conditions that may result in the need for additional surgery. These other factors were not studied as part of the testing.
  8. Iriuchishima T, Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019. doi:10.4103/ortho.IJOrtho_392_18.
  9. Smith JR, Picard F, Lonner J, et al. The accuracy of a robotically-controlled freehand sculpting tool for unicondylar knee arthroplasty. Congress of the International Society of Biomechanics. August 4-9, 2013. Natal, Brazil.
  10. Zardiackas, Lyle D., Kraay, Matthew J., Freese, Howard L, editors. Titanium, Niobium, Zirconium, and Tantalum for Medical and Surgical Applications ASTM special technical publication; 1471. Ann Arbor, MI: ASTM, Dec. 2005