No. 1. When is knee replacement surgery recommended?
Arthrosis is the wear and tear of the load-bearing surfaces of cartilage. At the initial stage of treatment of osteoarthritis, they resort to conservative methods - physical therapy, medications, physiotherapy. If with their help it is not possible to get rid of pain and improve the mobility of the knee, the question of prosthetics arises. The decision about the need to install an artificial joint is made by the doctor based on the x-ray, MRI results and the patient’s personal discomfort.
Intra-articular injections of Noltrex help postpone surgery indefinitely
Surgeries on the knee and hip joints
Open surgery is performed for extensive intra-articular injuries that cannot be repaired using a minimally invasive arthroscopic method. For example, if the joint capsule is torn or a significant part of the joint is damaged.
During the procedure, the traumatologist performs ligament plastic surgery;
- carry out open reduction of fragments;
- perform arthroplasty;
- remove the cyst.
Patients are usually afraid of complications after extensive surgery and long-term rehabilitation. The skill of our traumatologists and the modern equipment of the clinic minimize risks. After the procedure, the traumatologist and rehabilitation specialist draw up an individual recovery program and monitor the entire process. The clinic offers all types of rehabilitation: restorative massage, manual therapy, physiotherapy, plasma therapy and classes with an instructor.
The cost of joint surgery is determined based on the complexity of the injury or disease and the location of the intervention.
No. 3. How is the operation performed? Will it hurt?
During the operation, general anesthesia or spinal anesthesia is used. The procedure takes from an hour to an hour and a half. The doctor makes access through a short skin incision on the inside of the joint. The worn surfaces are processed so that the artificial joint can be accurately fitted to the bone.
To ensure that the patient does not subsequently experience pain, he is prescribed systematic pain relief. At the preparation stage, femoral catheters are inserted into the groin area, which allow the administration of local anesthetics during the critical period (the first few days after the intervention).
After endoprosthetics you will have to take painkillers for a long time
An exclusive endoprosthetics operation was performed in Smolensk
Medicine
Medicine
August 12, 2021 at 5:30 p.m.
At the Federal Center for Traumatology, Orthopedics and Endoprosthetics in Smolensk, an exclusive primary knee replacement surgery was performed using the new design of the Persona prosthesis.
As noted by the chief physician of the Federal Center for Traumatology, Orthopedics and Endoprosthetics of the Ministry of Health of the Russian Federation (Smolensk), Anatoly Ovsyankin, the field of surgery and traumatology is quite actively developing in relation to technologies and techniques of surgical intervention. And the unique operation carried out at the Smolensk Center is an example of this. The new design of the knee joint prosthesis was used in Smolensk for the first time.
“Today, the selection of implants is a very important point in preparing a patient for surgery. Our center has everything necessary to carry out such operations. First of all, we are engaged in individual planning of patients, and before the operation we calculate and select this or that implant, its size, characteristics. Such planning allows you to individually select the right implant,” noted Anatoly Vasilyevich.
The new artificial joint is called Persona. This prosthesis has a so-called Fusion system, which allows you to evaluate the tension of the ligamentous apparatus when surgeons install this implant, and accordingly, balance the knee joint. This, according to doctors, during the recovery stage of the patient helps him quickly adapt, with maximum preservation of the functional ability of the prosthesis. Because it is very important for patients to maintain the range of motion that they have lost, as well as to eliminate the pain syndrome that plagues patients with joint disease.
“Such an individual approach today gives more results in improving the quality of treatment and comfort for the patient in the postoperative period. Patients recover faster. In this case, not only the initial satisfaction of the patient after the operation is important - when he was cured and he got back on his feet, the pain that haunted him went away - but also the comfort of life. But it is not assessed immediately, but when the patient begins to walk actively enough, he returns to his normal life. We always monitor the operated patients, assess their condition in the long term of treatment, and this indicator – comfort – is very important for our patients, and of course, for our doctors,” emphasized the head physician of the Federal Center.
Prosthetics is a complex scientific work; in the manufacture of implants, metal alloys, special spraying systems, and synthetic materials are used. This is modern technology, the future is already here. So, the new artificial knee joint, first used in the Smolensk region, belongs to the new designs; this is, as doctors say, a “4th generation knee.”
It is worth noting that this design of the prosthesis has just begun to appear in clinics, and Smolensk was one of the first to implant this model into a patient.
“The Persona prosthesis is not just a new prosthesis that has entered the market, it is a completely different structure. The endoprosthesis is closer to the normal anatomy of the knee joint, it takes into account and incorporates other aspects of biomechanics, which allows the patient to recover better, and the function of the joint will be returned to its previous level - as it was before the disease,” emphasized the trauma surgeon of the Endoprosthetics Center invited to perform the operation bones and joints of the city clinical hospital named after S.P. Botkin Alexander Zhuchkov.
The head of the operating unit of the Federal Center, traumatologist-orthopedist Vyacheslav Gorozhankin noted that the best specialists from all over Russia are regularly invited to Smolensk, and frequent guests are foreign doctors and professors. They train Smolensk colleagues and conduct master classes. Smolensk doctors regularly improve their professional level.
The coronavirus pandemic made adjustments to the plans of the doctors; a number of meetings and events that were supposed to be held at the Center could not be held, but the doctors were in touch all this time - they organized webinars and speeches through video conferences. So the operation that took place is the first in-person event in the last few months.
This team approach, the development of new technologies, and the exchange of experience are beneficial to patients, because it improves the quality of medical care. Let us note that Smolensk specialists have already accumulated extensive experience - more than 6.5 thousand operations are performed annually at the Federal Traumatology Center in Smolensk, and the lion's share is endoprosthetics.
It is worth noting that this Thursday, here at the Federal Center for Traumatology, Orthopedics and Endoprosthetics, another exclusive operation will be performed - hip replacement using the technique of 3D printing of an individual augment. As chief physician Anatoly Ovsyankin explained, if a patient develops serious defects in bone tissue, and because of this problem it is impossible to install a joint implant, an operation is performed to restore or replace the tissue. In this case, 3D printing technology is used.
“This is a very modern technology - creating additively manufactured models. So far, no more than a hundred such operations have been carried out in Russia, and on Thursday this technology will be used for the first time here, in Smolensk,” said Anatoly Ovsyankin.
Photo: Yulia Orlova
Yulia Orlova
#4: How risky is it?
If the preparatory steps are carried out correctly, if all conditions are met, then the risk of complications is not great. The probability is about 5%. “Troubles” happen more often not because of poor qualifications of the surgeon, but because of the patient’s improper handling of the “new knee.” During the rehabilitation period, a person will have to adhere to the rules for several months after joint replacement, otherwise there is a risk of damaging the prosthesis.
Should I have surgery for arthrosis of the knee joint? Doctor's opinion:
Orthopedics and complex trauma
The main directions of therapeutic and diagnostic work are:
- Consultative reception of patients with diseases of the musculoskeletal system, injuries and their consequences (consultative office of traumatology and orthopedics).
Currently, most patients receive advice on the same day of treatment.
- Minimally invasive interventions (arthroscopy) on large joints (knee, shoulder, ankle, elbow).
Minimally invasive interventions can reduce the patient's hospital stay, and the use of high-tech instruments allows the intervention to be performed as accurately and correctly as possible. Joint operations are performed through several punctures. In total, this allows the patient to move independently the next day without additional support. Interventions on the knee joint are performed within the framework of the compulsory medical insurance policy and within the framework of additional federal funding (VMP, quota).
- Endoprosthetics of the hip and knee joint.
Endoprosthesis replacement allows you to return to an active lifestyle in case of joint destruction (osteoarthritis). Prosthetics are performed within the framework of the compulsory medical insurance policy and within the framework of additional funding from the territorial compulsory medical insurance fund (VMP, quota).
- Reconstructive surgical interventions for foot deformities (flat feet, consequences of fractures, etc.).
Surgical interventions for foot deformities are performed within the framework of the compulsory medical insurance policy.
The list of pathologies and injuries that we successfully treat in our department:
Knee-joint:
- damage to the menisci of the knee joint
- mediopatellar fold syndrome
- damage to the ligamentous apparatus of the knee joint
- Patella dislocations
- synovitis
- osteochondropathy, free chondromic bodies
- arthrosis (sanitation arthroscopy, resection of exostoses)
Shoulder joint:
- rotator cuff injury
- habitual shoulder dislocation
- impingement syndrome
- SLAP syndrome
- biceps tendon injury
- adhesive capsulitis
Elbow joint:
- arthrosis (sanitation arthroscopy, resection of exostoses)
- osteochondropathy, free chondromic bodies
Ankle joint:
- impingement syndrome
- damage to the ligamentous apparatus of the ankle joint
- arthrosis (sanitation arthroscopy, resection of exostoses)
- osteochondropathy, free chondromic bodies
Spine:
- minimally invasive spinal surgery
- intervertebral disc herniation
- instability
- spondylolisthesis
- spinal stenosis
- hemangiomas of the vertebral bodies
- failed surgery syndrome
- spinal injuries
- other degenerative diseases of the spine
Reconstructive surgical interventions for foot deformities:
- flat feet
- plano-valgus foot
- hollow foot
- valgus deformity of the first finger (removal of “bones”)
- Morton's neuroma, hygroma removal
- hammertoe deformity of 2-3-4 toes
- Taylor's deformity (“bump” at the base of the little toe)
- arthrosis of the foot joints
- carpal tunnel syndrome
- Haglund's disease (osteochondropathy of the calcaneus)
- plantar fasciitis (“heel spur”)
- consequences of foot fractures
Surgeries for injuries to the Achilles tendon, injuries to the biceps tendon, excision of hygromas, soft tissue formations in the area of large joints, removal of Baker's cyst, excision of the synovial bursa for non-infectious bursitis of the knee and elbow joints.
If you have the results of instrumental and laboratory studies (including x-rays, MRI, CT), you must provide them for consultation.
No. 8. Are there any strict recommendations for those who have an artificial prosthesis installed?
Undoubtedly! The success of the implantation of the prosthesis and its functionality depends on how well you follow them. After discharge from the hospital, you must continue to perform the prescribed physiotherapeutic exercises, you need to step on your feet correctly, wear shoes with soft flexible soles and lacing, and rely on crutches until you achieve stable walking.
In the first 12 weeks after surgery, avoiding impact loads on the knee, bringing the legs into the X or O position, kneeling or squatting, lifting and carrying heavy objects, compression loads and heavy physical labor. The rehabilitation period after joint replacement can be considered successfully completed when confirmed by the doctor.
Recovery
A patient after knee replacement surgery will remain in the hospital for 1 to 3 days, depending on how well the rehabilitation is going. There will be some pain after surgery, but the day after the procedure, medical staff will encourage patients to stand up and try to walk, usually with assistance. It is important to follow the rehabilitation instructions.
Physiotherapeutic sessions are aimed at strengthening the knee joint. They may be painful, but they significantly reduce the risk of future complications.
Patients who do not receive care at home may have to stay in the hospital longer.
No. 9. What sports can I do after endoprosthetics?
The optimal sports for people with implanted knee joints are general gymnastics, swimming, cycling or exercise bikes. Hiking, golfing, walking and light jogging, and skiing are also allowed, with the exception of extreme descents. Horse riding and tennis options are being considered.
If you want your prosthesis to last a long time, avoid playing sports with a ball, avoid skiing, and do not participate in athletics.
After endoprosthetics, you will have to give up playing with the ball
There are a lot of questions about joint replacement for knee arthrosis. This is not surprising: it is better to find out all the details in advance, make sure that there is no alternative, and prepare mentally for the upcoming complex rehabilitation. In many cases, surgery can be avoided if you regularly undergo a course of intra-articular injections of synovial fluid prosthesis. Will this treatment help you? This question should be asked to the orthopedist first.
Features of the structure of the knee joint
The knee joint plays an important role in human motor function. It is the second largest in the body after the hip joint. The body of the joint consists of two surfaces: the tibia and femur. The surface is covered with hyaline cartilage. The cavity in the spaces between the ends of the articular bones is occupied by menisci - special cartilaginous formations. The sides and back of the knee are supported by ligaments and tendons. In the anterior part is the patellar ligament. When a ligament ruptures, the joint loses support and becomes unstable, making it difficult to move.
The bones that make up the joint are surrounded by a special capsule. Since the vessels do not supply the joint with nutrients, their supply is due to the presence of synovial fluid.
Preparation for joint replacement
The first step is a comprehensive examination of the patient, taking laboratory tests, taking an ECG, conducting an X-ray examination of the joint or taking a tomogram. These measures are necessary both to clarify the diagnosis and to determine the tactics of the operation, as well as to select the optimal design of the endoprosthesis (today there are more than 70 of them). In some cases, the opinions of related specialists are necessary.
If the patient is taking anticoagulants (aspirin and its derivatives), it is necessary to notify the doctor, who will most likely order such medications to be stopped several days before surgery. Drugs of this kind slow down blood clotting, which can cause complications both during the operation and in the recovery period.
You should not eat or smoke for six hours immediately before surgery.