Types of Knee Surgery, Process, and Precautions
Types of Knee Surgery
Traditional Total Knee Replacement
One of the most common types of knee surgery and types of knee replacement is the traditional total knee replacement. Traditional total knee replacement involves a 7 to 10-inch incision, a hospital stay of 3 to 5 days, and a recovery period typically lasting from 1 to 3 months. There are several types of knee surgery and implants available – made of cobalt chrome, titanium, and polyethylene (plastic). They can be fixed to the bone with acrylic cement or press-fit, which allows bone to grow into the implant. The selection and fixation method is based on the degree of arthritic bone loss, and quality of the ligaments supporting the knee.
- The damaged cartilage areas at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- The cartilage and bone that has been removed is replaced with metal components that recreate the surface of the joint.
- The underside of the patella is cut and resurfaced with a plastic button. Some orthopedic surgeons do not resurface the patella, depending on the circumstances.
- A plastic spacer is inserted between the metal components to create a smooth gliding surface.
Studies have shown that two-thirds of the patients who undergo types of knee surgery like total knee replacement surgery have degenerative disease in both knees, and 20% of them will undergo surgery of the second knee within two years of the first. Patients with bilateral disease can either undergo a one-stage surgical procedure for both knees performed at the same time, or performed in two separate surgical procedures, either during the same hospital stay or two hospital stays between 1 to 12 months apart. Research has indicated that bilateral total knee replacement in a one-stage surgical procedure is a reliable alternative to a two-stage procedure for select patients, but not for all.
Minimally Invasive Knee Replacement
Minimally invasive knee replacement requires a 3 to 6-inch incision and avoids trauma to the quadriceps tendon and muscles in the front of the thigh. A smaller, less invasive approach results in reduced tissue damage. Due to the smaller incision, specially designed surgical instruments are required to prepare the femur and tibia and insert the implants properly. This approach may lead to less pain, decreased recovery time, and better motion due to less scar tissue formation, but not all patients are candidates for minimally invasive knee replacement.
Research has indicated that obese patients who undergo total knee replacement and similar types of knee replacement have higher complication rates than normal-weight patients, and risk goes up with body mass index. So if you are overweight or obese, your orthopedic surgeon may recommend losing some weight prior to surgery to minimize the stress on your new knee, and possibly decrease the risks associated with surgery.
Due to the risk of blood clots, patients undergoing these types of knee replacement surgery are often started on anticoagulants such as warfarin, heparin, low molecular heparin, or aspirin the night before surgery. This dose is adjusted after surgery depending on the patient’s hematologic values. Upon discharge, most patients will remain on anticoagulation therapy for about a month. Special precautions must be followed when you are on anticoagulants due to the increased risk of bleeding.