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Knee Replacement

Diz Protezi Ameliyatı

Knee replacement is one of the most effective surgeries performed to improve quality of life in today's medical world. Thanks to this modern treatment method, many patients suffering from knee pain or restricted mobility step into an active, healthy and painless life again. As Dr. Utku Erdem Özer, with my years of experience and expertise in the field, I have prepared a comprehensive guide detailing knee replacement surgery and its positive effects on your life.


In this article, you can find out what a knee replacement is, who it is recommended for, pre- and post-operative processes, expected results and answers to frequently asked questions. Knee replacement surgery can be a turning point, especially for patients with chronic conditions such as osteoarthritis. Our aim is to help patients make informed decisions by understanding the details of this treatment method.


Table of Content:


What is Knee Replacement Surgery?

A knee replacement is surgery to replace all or part of your knee joint. In knee replacement surgery, the damaged surfaces of the articular cartilage are removed and replaced with an artificial joint made of metal and plastic. This new joint is called a prosthesis.


Knee replacement surgery is an operation performed in the treatment of patients with severe arthritis in the knee joint. After knee replacement surgery, pain is eliminated in almost all patients and patients resume a mobile and painless life. Knee replacement surgery is performed in patients who have undergone all treatments other than prosthesis without any results.


Today, the modern treatment of end-stage knee joint arthritis is knee replacement. However, the timing of the knee replacement, i.e. when the operation should be performed, should be decided by the patient and the doctor. These treatments include painkillers, intra-articular injections and physical therapy.



How Many Types of Knee Replacement Are There?

There are two types of knee replacement.

  • Total knee replacement: This topic will be covered in detail on this page.

  • Partial knee replacement

 

Both types of prosthesis surgeries are very successful surgeries in appropriate patient selection. Knee replacement is one of the most common orthopedic surgeries in the world.

Who is Knee Replacement Performed?

 The common characteristics of patients with the following conditions are that they are end-stage cartilage patients. In other words, they are a group of patients whose knee pain cannot be eliminated except by knee replacement.

  • Patients with end-stage cartilage problems (knee arthritis, gonarthrosis, osteoarthritis)

  • Patients with a previous intra-articular fracture of the knee and resulting cartilage damage.

  • Patients with systemic rheumatic diseases such as rheumatoid arthritis, gout, lupus, ankylosing spondylitis.

  • Patients with a previous infection of the knee (septic arthritis) that resulted in the destruction of articular cartilage.


How to Decide on Knee Replacement Surgery?

If your pain does not go away with non-operative methods, you will discuss your condition with an orthopedic specialist and your x-rays will be evaluated. If you are suitable for knee replacement surgery, prosthesis surgery is recommended. 


The patient is the main decision maker for knee replacement surgery. If the calcification in your knee affects your quality of life and your daily life movements, if you are unable to perform daily life activities such as short distance walks, going up and down stairs, you are suitable for knee replacement surgery.


How is Knee Replacement Surgery Performed?

Knee replacement surgery is performed with an open surgical technique. An incision of about 15 centimeters is made in front of the knee. The knee joint is entered next to the kneecap. First, the damaged cartilage structures are removed, then, using special molds, the surfaces of the bones forming the upper and lower parts of the knee are cut according to the new joint, that is, the prosthesis.


Before placing the knee prosthesis, which will remain in the patient for a lifetime, a trial is first placed and the joint is tested, and if appropriate, the prosthesis pieces, which are identical to the trial, are sterilized, opened from their boxes and placed in their places with bone cement. Finally, a plastic liner is placed between the two surfaces. The bone cement is thoroughly frozen and checked for bleeding. The incision is sutured closed.

You can watch the bilateral knee replacement surgery performed by Op. Dr. Utku Erdem Özer by clicking this link:




How Many Hours Does Knee Replacement Surgery Take?

The average duration of knee replacement surgery on a single knee is 1 hour. Bilateral knee replacement surgery where both knees are performed is around 1 hour and 30 minutes.


X-rays of my knee replacement patient


Diz Protezi Ameliyatı Öncesi ve Sonrası
Before and After Knee Replacement Surgery


Review of My Knee Replacement Surgery Patient:

By clicking this link, you can watch the video in which my patient, whom I operated on one knee, describes the knee replacement surgery and postoperative process: https://www.instagram.com/reel/CyTlINLLXH6/?igsh=MXhmMGR1N24yanptOA%3D%3D


What Should Be Done After Knee Replacement Surgery?

When Can I Go to the Toilet After Knee Replacement Surgery?

A urinary catheter is inserted into the patient before the knee replacement surgery. The catheter is removed after the patient is walked and bladder gymnastics are performed. Long-term use of a urinary catheter is not suitable for infection.


After the patients are walked, they can also sit on the alafranga toilet. They can use the alafranga toilet to urinate or defecate.


How Should Nutrition Be After Knee Replacement Surgery?

It is important to get enough protein to recover quickly after knee replacement surgery.

As Op. Dr. Utku Erdem Özer, in line with the latest scientific studies, I make my own knee replacement patients use protein powder (whey protein) 5 days before and 5 days after surgery. I also advise my patients to eat a protein-rich diet.


Is Knee Replacement Surgery and Postoperative Recovery Period Very Painful?

Pain management after total knee replacement surgery, or more precisely, the pain suffered by the patient, has been significantly reduced in recent years with the advancement of spinal-epidural anesthesia applications, regional nerve blocks and pain pumps used. A completely painless postoperative period can be created by numbing the patient's lumbar region (Spinal anesthesia) and administering medication through a catheter for 3 days after the operation (Epidural catheter method).


The most important advantage of this is to achieve joint range of motion that will allow the patient to start moving early after surgery and return to daily life activities such as sitting and standing on a chair, going up and down stairs, without wasting time with joint stiffness.


What are the Movements After Knee Replacement Surgery?

The first goal after knee replacement is to make the patient walk after pain control. The second goal is to provide knee joint angles at appropriate degrees. One of these degrees is 0 degrees, which means that the knee is completely straight.


To ensure this, a pillow is placed on the heel side immediately after surgery. The second angle is the bending angle of the knee. The early target in the bending angle is 90 degrees. At the end of the 1st month, this angle is aimed to be 120 degrees. These angle targets should be achieved by the patient working with special exercises accompanied by a physiotherapist.


Are Contractions Normal After Knee Replacement Surgery?

After most knee replacement surgeries, it is normal to experience tightness in the muscles of the knee area. The contraction is temporary. The cause of the contraction is muscle fatigue and the shape of the leg is improved, the muscles in the normal shaped leg are stretched and the contraction occurs.


How long does the prosthesis used in knee replacement surgery last?

To give a simple answer, the average life span of a knee prosthesis made with modern implants today is 15-25 years. As technology develops, this period will be even longer.


What is the prosthesis used in knee replacement surgery made of?


Diz Protezi Ameliyatı İçin Kullanılan Protez
Prosthesis Used for Knee Replacement Surgery

Total knee replacement consists of 4 parts.

  • Femoral component (thigh bone): upper part

  • Tibial component (tibia): lower part

  • Liner: the plastic piece between two metal structures

  • Patellar (kneecap) component: most knee replacement operations do not require replacement of the kneecap


Femoral Komponent:

This part of the knee prosthesis, which is applied to the end of the thigh bone forming the knee joint, is called the femoral component. The femoral component is made of metals called Cobalt-Chromium.


The durability of the Cobalt-Chromium combination is higher than Titanium in the femoral component of the knee prosthesis in the long term. In other words, Titanium is not suitable for the femoral component. This is because Titanium is a softer material than Cobalt-Chromium.


Tibial Komponent:

The tibial component can be made of both Titanium and Cobalt_Chrome. The difference may vary due to the prosthesis brand. Some brands produce the tibial component in titanium while some brands produce it in cobalt-chrome.


Liner:

The tibial component can be made of both Titanium and Cobalt_Chrome. The difference may vary due to the prosthesis brand. Some brands produce the tibial component in titanium while some brands produce it in cobalt-chrome.


Patellar Komponent:

It is rarely necessary to replace the surface of the kneecap in total knee replacement surgery. When this is unavoidable, the surface of the kneecap is replaced with a dome-shaped patellar component made of polyethylene plastic.


What kind of anesthesia is given during knee replacement surgery?

In total knee replacement surgery, as in total hip replacement surgery, spinal-epidural anesthesia, i.e. lumbar anesthesia, is preferred.


When Can I Walk After Knee Replacement Surgery?

I walk my knee replacement patients with the help of a walker before 24 hours after the surgery. If I performed the surgery early in the morning, I walk the patient in the evening of the surgery or in the morning of the next day, even if the patient has a drain in the knee.


This applies to both unilateral knee replacement and bilateral knee replacement surgery. Walking the patient in the early period protects the patient from many possible complications such as clot formation, as well as increasing the blood flow in the knee area, resulting in a faster recovery. Most of my knee replacement patients can walk without a walker or crutches 3 weeks after surgery. To summarize the process after knee replacement surgery;


  • Day 1 - 3: Short walks under my or the nurse's supervision.

  • Day 3 - 3 weeks: Increasingly longer walks with the help of a walker or crutches.

  • After the 4th week: Walking without the help of a walker or crutches


How long to stay in the hospital after knee replacement surgery?

When knee replacement surgery is performed unilaterally, it is usually sufficient for the patient to stay in the hospital for 3 nights after knee replacement surgery. If knee replacement is performed on both knees of the patient in the same operation, this period may be 5 nights. 


The general condition of the patient before the operation, the age of the patient, and whether the patient has other diseases or not are factors that affect the length of hospitalization after the operation. Another factor affecting the length of hospital stay is the state of rehabilitation after surgery.


When the patient is discharged, he/she should be able to sit up from his/her bed even with assistance, walk in his/her room and in the corridor outside the room with the help of a walker, and sit on an alphabet toilet. In order to be able to do this, it is important that the patient's knee bending angle is 90 degrees at the time of discharge from hospital.


When Are Stitches Removed After Knee Replacement Surgery?

In my surgeries, there is no need to remove stitches, as I suture the patient's skin with absorbable and invisible sutures. The healing time of the wound is between 10-14 days on average. After this time, the wound does not need dressing.


How much of a scar is left after knee replacement surgery?

Knee replacement surgery is performed through an incision of approximately 12-15 cm. Factors affecting the size of the wound are whether the patient is overweight or not and the degree of curvature in the leg due to arthritis. Scientific studies have shown that a small incision has no advantage on pain and healing.


How Long After Knee Replacement Surgery Can I Shower?

After the 24th hour of my own knee replacement surgeries, I usually remove the drains in the knee and close the wound with waterproof dressing materials. After this period or on the 3rd-4th day of the operation, you can take a shower under the supervision of the nurse at the hospital if you want without going home.


When you are discharged and go home, it will not be a problem to take a shower as long as you have waterproof dressing material on your wound.


When Will I Fully Recover After Knee Replacement Surgery?

By the end of the 2nd month, you will be able to perform most activities of daily living without pain. By the end of the 2nd month, you almost never need to take painkillers. 


The average time to reach your full strength and not need painkillers is 6 months after surgery. 


The recovery time after knee replacement is closely related to your knee muscle strength before surgery. The stronger your muscles are before the operation, the more comfortable and faster you will get through the postoperative period.


How Much Physical Therapy Should I Have After Knee Replacement Surgery?

Most patients need physical therapy (physiotherapy) for about 3 months after knee replacement surgery. During this period, it is appropriate to apply 2-3 sessions of physiotherapy per week at the patient's home.


We have 2 goals here. First of all, to gain the range of motion of the knee joint as much as possible and to strengthen the muscles of the knee region. Strengthening the muscles of the knee region after surgery means less pain after surgery. It also prolongs the life of the knee replacement surgery in the long term.


What are the Risks of Knee Replacement Surgery?

As with any surgery, knee replacement surgery has its own risks. Each patient is evaluated separately about the risks and necessary precautions are taken. The likelihood of these risks is very low.


Risks after knee replacement surgery include infection, clotting, problems with the prosthesis and incomplete pain relief.


Infection after knee replacement: Even if all necessary precautions are taken, the infection rate after knee replacement surgery is not zero even in the most developed countries of the world. However, precautions must be taken. Before the operation, be sure to be examined by your dentist. As part of the preoperative preparations, urine, nasal and skin cultures should be taken from the patient. The purpose of these cultures is to understand whether the bacteria in the patient's natural flora are resistant or not. In addition, as Dr. Utku Erdem Özer, in all my prosthesis surgeries, we wear a suit called space suite for my entire team, including myself, during the operation. The purpose of wearing this suit is to minimize the risk of infection. The patient is closely monitored especially in the first 1 month after surgery. If superficial infections are caught early and the necessary intervention is made, the problem is solved before the infection grows.



Diz Protezi Ameliyatında Giydiğimiz Kıyafet
Clothing We Wear During Knee Replacement Surgery


Clots after knee replacement: There is a risk of clot formation, especially after major operations on the spine, pelvis and lower limbs. One of these operations is knee replacement. To prevent this, patients are given blood thinners after surgery, during hospitalization and for about 2 months after discharge home. Blood thinners are given as injections during hospitalization and can be switched to tablets after discharge.


It is important to remember that the first way to reduce the risk of clot formation is to get the patient walking as soon as possible after knee replacement surgery.


No Relief of Complaints After Knee Replacement Surgery

In 1% of patients, the pain does not completely disappear in the 1st year of surgery, the most important reason for this is thought to be that the prosthesis does not fit the patient's bone adhesion. In my own surgeries, I prefer the brands with the most options.

 

How Much Does Knee Replacement Surgery Cost?

The cost of knee replacement surgery varies depending on many factors. The price varies depending on which hospital the surgery will be performed in, whether it will be unilateral or bilateral, and the brand of the prosthesis. For current price information, you can contact us by clicking this link: whatsapp contact 


Conclusion:

Knee replacement surgery offers an important solution for patients suffering from pain and limited mobility due to advanced knee joint diseases. This procedure significantly improves quality of life, allowing patients to return to their daily activities and lead a more active life.


In the postoperative period, with proper rehabilitation and strict adherence to the doctor's recommendations, a successful recovery is expected. Our patients are provided with all the necessary support to maximize the success and long-term results of the surgery.


Remember that each patient is unique and the treatment plan should be customized according to individual needs. Remember that knee replacement surgery is an important step towards restoring your freedom of movement and stepping into a pain-free life.


Thanks for reading our article. If you wish, you can browse the home page from the link utkuerdemozer.com.




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