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Knee Replacement

What is Knee Replacement Surgery?

A total knee replacement replaces your diseased knee joint and eliminates the damaged bearing surfaces that are causing you pain. The design of the implant offers you renewed stability and minimizes the wear process. Overall there are three benefits from your knee replacement:

1. Elimination of pain
2. Improved motion
3. Minimum wear and tear

Total knee replacement offers the greatest quality of life improvement of all operations. It has one of the highest success rates and one of the best outcomes.

Knee Replacement Components

The lower part of the replacement knee joint is comprised of a flat metal plate and stem that your surgeon will implant in the tibial bone. This tibial tray can be either cobalt chrome alloy or titanium alloy. It can be fixed by either cement or bone “ingrowth”. Next, a polyethylene insert is clipped into the tibial tray to serve as the new knee bearing surface. The upper part of the replacement knee joint consists of a contoured metal shield that fits around the lower end of the thigh bone (femur). The inner surface can be fixed to the cut bone surfaces by the surgeon’s choice of bone ingrowth or bone cement. The outer surface of the contoured metal shield is shaped to allow the knee cap (patella) to slide up and down in its groove. The surgeon may choose to retain the natural knee cap or re-surface it. In this case a polyethylene button will be cemented in place.

Knee Replacement Design Choices

Unicompartmental – A partial knee replacement — also called a unicompartmental knee replacement — involves putting an implant on just one side of the knee, rather than over the entire surface of the knee joint. Think of the knee as having three compartments: an inside, outside, and a front compartment for the kneecap. Most frequently, it is the inside compartment that becomes arthritic. A unicompartmental knee replacement is done if part of the knee joint is damaged by arthritis and the other compartments have healthy, normal cartilage.

Fixed Bearing – The polyethylene cushion may be part of the platform (fixed) or free to move on a metal base (mobile). Most people get a fixed-bearing prosthesis that reduces knee pain dramatically and may last for many years. If you are younger, more active and/or overweight, sometimes a doctor may recommend a mobile-bearing or a rotating platform knee replacement designed for potentially longer performance with less wear. Doctors also consider gender, occupation, disability level, pain intensity, interference with lifestyle and other medical conditions in selecting the appropriate prosthesis.

Medial Pivot – The Medial-Pivot knee replicates the rotating, twisting, bending, flexion, and stability of your natural knee, so it feels more like your natural knee. A normal knee actually pivots on its medial (inner side) condyle. When the knee flexes, the lateral (outer side) side rolls back while the medial side rotates in one place. This design “stays put” or is more stable during normal knee motion as opposed to sliding forward slightly.

Rotating Platform and Mobile-Bearing – Knee implants imitate the motion of your natural knee. In the Rotating Mobile Knee prosthesis, the polyethylene insert can rotate slightly around a conical post. It also slides back and forth on the tibial tray. This allows the knee to twist and turn (called rotation), as well as move back and forth, flexing and extending (called articulation). The insert absorbs forces across a larger contact surface, helping reduce the amount of wear to the bearing and loosening in places where the implant attaches to bone. However, compared with Fixed-Bearing designs, Mobile-Bearing knee implants are less forgiving of imbalance in soft tissues. They may increase the chance of dislocation and may cost more than Fixed-Bearing implants.

Posterior Cruciate Ligament (PCL)-Retaining or Substituting – The Posterior Cruciate Ligament is one of the major ligaments in the knee. It provides support and stable movement of the knee. In total knee replacement surgery, the PCL can be kept or removed and this choice depends on the condition of the PCL, the type of knee implant or the type of surgery the surgeon likes to do. Each of these designs has advantages and disadvantages. Surgeon preference depends on his or her training and the clinical situation.

PCL-Retaining – In PCL-Retaining designs, rearward movement of the tibia is resisted by an intact PCL, which creates stability.

PCL-Substituting – PCL-Substituting knees (also called posterior stabilized knees) have a raised sloping surface or a polyethylene post that compensates for the missing PCL to give your knee more stability.

Alternative Bearing – Oxinium™ oxidized zirconium is a metallic alloy developed by Smith and Nephew with a ceramic surface that provides wear resistance without brittleness. Oxinium material combines the best of both metal and ceramics. It is a metal, with excellent fracture toughness like cobalt chrome, but it has a ceramic surface that offers outstanding wear resistance. The ceramic is an enhanced surface that is part of the metal itself rather than an external coating, making it very durable with unusually high damage tolerance.

Cemented or Cementless Fixation – Knee replacements may be “cemented” or “cementless” depending on the type of fixation used to hold the implant in place. The majority of knee replacements are generally cemented into place. Cemented knee replacements have been used successfully in all patient groups for whom total knee replacement is appropriate, including young and active patients with advanced degenerative joint disease. 15 years of clinical reports support this conclusion. Implant designs were introduced in the 1980’s that were intended to attach directly to the bone without the use of cement. Cementless designs rely on bone growth into the surface of the implant for fixation. Most implant surfaces are textured or coated so that the new bone actually grows into the surface of the implant. Screws or pegs may also be used to stabilize the implant until bone ingrowth occurs. Because they depend on new bone growth for stability, cementless implants may require a longer healing time than cemented replacements. Each case is individual and your surgeon will evaluate your situation carefully before making any decisions. Do not hesitate to ask what type of fixation will be used in your situation, and why that choice is appropriate for you.

Types of Polyethylene – Polyethylene used in knee joints runs the gamut from non-cross linked (sterilized by ethylene oxide gas or gas plasma methods) to moderately-cross linked (gamma radiation sterilization). Generally speaking, increased cross linking results in wear reduction, but there are design variables of the implant to consider.

Navigational Assistance – Knee replacement surgery with the aid of a Navigation System helps improve the results of your procedure. The System empowers surgeons to accurately fit new implant components specifically to the anatomy of the body, potentially giving you:

• More exact implant placement
• Extended life of the implant
• Optimal joint positioning which restores mobility
• Decreased possibility of a revision surgery
• Faster recovery
• Improvement in your quality of life

Complete our Patient Questionnaire and get a free MedToGo quote for this surgery now.