Knee replacement is a chance to restore limb function

Chronic articular pathologies are practically untreatable; moreover, they progress without leaving a person the right to a healthy existence. Knee arthroplasty is an operation whose essence is to replace it with an artificial implant.

Comparison of a healthy knee joint (left) and a completely destroyed one (right).

The cartilage that covers the ends of articular bones cannot be repaired if it is severely damaged. Intra-articular injections of plasma or hyaluron are a waste of money, nerves and time.

The surgeon sees this during the operation; pay attention to the unevenness, and in some places, the absence of the cartilaginous shell.

Simplified implant installation diagram.

The only treatment tactic that produces results is endoprosthetics. The industry produces modernized implants to suit the requirements of any patient. Artificial structures are created from biocompatible materials, represented by ceramics, innovative metal alloys and high molecular weight polyethylene, which do not have a toxic, allergic or carcinogenic effect on surrounding structures.

Knee replacement in the Czech Republic: guarantees, prices, rehabilitation, reviews and statistics.

Find out more

Indications for surgery

Approximately every tenth patient suffering from knee pathology requires endoprosthetics. The causes of critical disorders are the following diseases:

• arthritis of rheumatoid etiology and gout;
• deforming arthrosis;
• Bekhterev's disease;
• intra-articular or periarticular infections;
• traumatic lesions;
• severe obesity;
• hormonal imbalance.

A surgical procedure is indicated if the following pathological changes are detected:

• severe painful symptoms and serious movement disorders, in which conservative methods and minimally invasive surgery do not help or no longer make sense;
• severe gonarthrosis;
• systemic arthritic disease;
• avascular necrosis of articular bones;
• local neoplasms;
• congenital and acquired dysplasia;
• improperly healed fractures;
• post-traumatic degenerations.

Dynamics of the disease on x-ray.

Postponing surgery for grade 3-4 gonarthrosis may result in spinal deformation. This is due to lameness. The degenerative processes of arthrosis will deeply affect the bones, due to which they will become fragile, lose density, and it will become difficult to fix the implant components to them.

Which orthosis should I choose based on the degree of rigidity?

Rigid and semi-rigid models are available. The product is selected taking into account the severity of the injury or disease, taking into account the stage of treatment and the requirements for fixation. In case of injury, it is recommended to choose a hard knee brace. It is indicated for sprains, fractures, dislocations.

Easy fixation

The products do not have stiffeners. They create compression and limit movement by a third. The indication for wearing is the prevention of injuries arising from physical activity. The product is worn to speed up the recovery process in case of sprains and inflammation, at the final stage of the post-traumatic or postoperative period. Prescribed for bursitis, pain, arthrosis, synovitis, exacerbation of arthrosis. For example, in our store, in this case, the knee joint fixator “Elast 9903” is suitable.

Semi-rigid fixation

Knee pads have spokes, tires, and stiffeners. They provide unloading and support, limiting movements by half. Products are indicated for joint instability, diseases, damage to the meniscus and ligaments, and for the prevention of sports injuries.

Maximum fixation

The models have stiffening ribs and additional elements. Orthoses limit movement by two-thirds or until complete immobilization. It is prescribed to be worn if complete immobilization of the joint is necessary. They do not allow mobility in certain directions. An excellent option in this case is the knee joint limiter MPE 12003. The product is indicated for severe injuries, after operations, for osteochondropathy, and osteoporosis.

If the fixation is insufficient, problems with the joint may worsen and the rehabilitation time will be delayed. On the contrary, excessively strong fixation impairs blood circulation and reduces muscle tone. To make the right choice, it is important to consult a specialist.

Contraindications

It is allowed to be carried out even in old age. But if there are any pathologies in the stage of decompensation, for example, diabetes mellitus or hypertension, surgery will be canceled. Any infectious inflammatory foci in the body must be completely eliminated before the planned procedure. General list of contraindications:

• decompensated chronic diseases;
• local and general infections, inflammatory processes;
• anemia grade 2-3, low blood clotting;
• severe mental disorders;
• uncontrolled diabetes;
• bone tuberculosis;
• limb paralysis;
• deep vein thrombosis of the legs.

Sometimes it is necessary to carry out weight correction if the body mass index is too high, this is dangerous due to injury and displacement of the implant. There is no provision for disability after treatment.

Selection by design type

Depending on the functions and purpose, manufacturers offer two types of orthoses: hinged and without hinges.

Full coverage of the damaged area is provided by a hingeless orthosis. Open and closed models are available in different materials.

• The elastic closed knee pad provides easy fixation of the kneecap and warms. Suitable for running and walking.
• Elastic open with tension adjustment is recommended for patients with damaged ligaments, minor pain due to arthritis, post-traumatic syndrome.
• Elastic open with lateral stiffening ribs in the form of spirals, recommended for pain during squats.

Hinged models have a movable joint and are made of tires, hinges, and springs. Products allow you to move in a certain direction. You can control the amplitude and angle of leg bending through the adjustments made. For fastening to the limbs, elastic straps, lacing and Velcro are used. The product is indicated for pain from a kneecap injury, meniscus damage and ligament rupture.

Preparing for surgery

The most common type of knee implant.

Diagnosis is not limited to examining only the diseased limb; both legs are subject to examination. For these purposes, it is recommended to go through:

• radiography;
• ultrasound examination (ultrasound);
• magnetic resonance imaging (MRI);
• arthroscopy (not always).

The implant platform served the patient for 16 years. Good result.

There are visits to highly specialized doctors (cardiologist, therapist, immunologist, anesthesiologist, ENT specialist, dentist), general clinical tests, examination of organs and body systems. Standard diagnostics include:

• general and biochemical blood tests;
• coagulogram;
• general urine analysis;
• determination of blood sugar levels;
• test for blood group and Rh factor;
• Doppler ultrasound of the veins of the extremities (USDG);
• electrocardiogram (ECG);
• fibrogastroduodenoscopy (FGDS);
• fluorography of the respiratory system.

Blood will also be drawn for transfusion.

In knee replacement clinics, preparation begins approximately 2 weeks before the upcoming session. Physical therapy is definitely recommended. It will help prepare the muscle complex for rehabilitation and help strengthen it. Especially when considering surgery on both knee joints.

Types of knee braces

To choose the right orthosis, it is important to understand the main types of these products. Knee braces are classified according to the following characteristics:

• preventive – used for minor pathologies in the joint, as well as during sports and constant physical activity;
• postoperative – used during the recovery period after arthroscopy of the knee joint, as well as after injury;
• regular – used for various injuries of the patella.

It is extremely important to take into account that orthoses, according to their purpose, are capable of solving different problems. Based on these indicators, the following types of orthopedic products can be distinguished:

• corrective – with regular use they correct deformities;
• compensating – when the knee muscles are weakened, they support the lower limbs;
• fixing – limit the movement of the knee joint;
• unloading – relieves excessive tension in the knee muscles.

Products are also classified according to other principles. There are orthoses with soft, semi-rigid and rigid fastening.

Liquid knee replacement

It is important to briefly provide information about liquid knee replacements. These are injectable sodium hyaluronate preparations that serve to replenish synovial fluid. Liquid knee replacement is performed by injecting a hyaluronic acid solution into the intra-articular space through a syringe. Such therapeutic tactics do not restore destroyed hyaline cartilage, but help to temporarily reduce the signs of osteoarthritis (reduce stiffness and pain) by improving the lubricating properties of the natural joint. It is applicable as symptomatic therapy for arthrosis, but is not an alternative to real endoprosthetics.

No injections can cure arthrosis!

Structure of the knee pad

The knee brace used for arthrosis is an outer frame made of elastic artificial (neoprene, elastane, lycra) or natural material (cotton fabric, wool).

He can be:

• solid (does not have fasteners),
• adjustable (detachable, with fasteners or tension regulators).

Thanks to the elasticity of the material and sewn-in tension bands, fasteners or Velcro, it fits the joint, wrapping it around the kneecap (from 20 cm in each direction). The fabric frame is reinforced with various inserts:

• stiffening ribs (spirals or steel knitting needles around the entire perimeter of the product),
• lateral hinges (metal structures in places of physiological flexion-extension of the joint).

Knee pads secure the joint in different ways:

1. Light fixation is intended for the prevention of arthrosis in the early stages, reconstruction of the knee after treatment or arthroscopy (minimally invasive surgery). They are sewn from elastic material, sometimes insulated.
2. Medium hold. Used for severely modified joints (grade 2 arthrosis). It is used to reduce pain during exercise. Steel knitting needles and spirals are sewn into the frame of such a product, creating stiffening ribs that are subject to the main load.
3. If the articular surfaces are severely affected, tight fixation is recommended. Solid metal hinges are built into the side surfaces, playing the role of an exoskeleton (orthosis). With their help, they reduce pain, friction and deformation of articular surfaces in grade 3 arthrosis. It is recommended during the recovery period after injuries and endoprosthetics (after complete joint replacement).
4. A reinforced rigid fixation orthosis (splint) completely immobilizes the leg; it is used in especially severe cases.

Using a good, high-quality knee brace can significantly alleviate the exacerbation of arthrosis and greatly delay the time of endoprosthetics.

How does a knee brace work?

The working principle of the knee brace is as follows:

• The form-fitting frame stimulates muscle contraction, lymphatic drainage (discharge of lymph and toxins) and blood circulation. Thus, it removes swelling, improves tissue regeneration and healing.
• The loads on the joint elements are evenly distributed, and the articular surfaces rub against each other less (their deformation and destruction are reduced).
• The bandage fixes the joint in a physiological position, preventing its hyperextension, displacement of elements, ruptures of muscles, ligaments, menisci, and synovial capsule.
• When walking (and other movements), the design absorbs shocks and shocks, softens the friction of the articular surfaces and the load on the knee joint.

The design is able to absorb sudden movement and, thanks to this, is a preventive measure against accidental injuries.

Main qualities of orthoses:

• reliable fixation of the knee,
• stimulation of blood supply and lymphatic drainage,
• protection from injury and damage,
• massage and warming effect.

Indications and contraindications for use

Indications

Knee pads, orthoses and bandages are used as part of complex therapy for:

• arthrosis (osteoarthrosis),
• meniscus tears,
• sprains and ligament tears,
• dislocations,
• in the postoperative and post-traumatic period,
• for the prevention of joint diseases.

The main task of the knee brace is to provide the joint with the necessary level of immobilization (stability) and fixation to restore function.

Contraindications

When a therapeutic bandage is contraindicated:

1. For some skin diseases (for example, pyoderma - purulent skin lesions).
2. For varicose veins and thrombophlebitis.
3. If there are wounds in the knee area.
4. During purulent processes.

When choosing, you should consider the material from which the knee pad is made. Sometimes synthetics can provoke an allergic reaction.

Types of therapeutic knee braces

TypesPurpose

Selection rules

General rules

Only a rheumatologist or orthopedist can choose the type of therapeutic knee brace, focusing on the following parameters:

• degree of damage,
• preservation of knee function,
• specific location and severity of pain.

The patient just has to choose a more or less expensive model, manufacturer, give preference to the material of manufacture and decide on the size.

General rules:

1. Buy knee pads exclusively in specialized stores.
2. Before purchasing, it is better to try on the product, walk around in it, and sit down (this will allow you to evaluate the comfort of the model).
3. When choosing a solid and adjustable knee pad, give preference to the latter, even if it is more expensive (this will allow you to adjust the volume if necessary).
4. Evaluate the quality of workmanship - the seams in contact with the skin must be absolutely flat, the straps, tapes, locks and Velcro must be functional, the product must fit tightly and perfectly follow the shape of the joint.
5. Look on the Internet for reviews of the selected model and manufacturer.

Material

When choosing a material, take note:

• wool and cotton are eco-friendly, natural, breathable, but not elastic fabrics; they are best chosen for a warming and light massage effect,
• Lycra, polyester and elastane - synthetic fabrics that are breathable, have good elasticity, density and fixing properties,
• Neoprene is a synthetic, very durable (almost eternal) and elastic material, but the skin underneath tends to sweat.

Due to the optimal price-quality ratio, buyers often choose polyester, lycra and elastane.

Size

How to decide on the size:

• to determine the size of the knee pad, measure the diameter of the knee at the center of the kneecap,
• measurements are taken standing, the leg is straightened and relaxed,
• Before measuring, pay attention that the knee is not swollen, edematous,
• if the resulting number is not a whole number, round down (for example, knee circumference = 32.4 cm, round to 32, since the material tends to stretch a little),
• You can be guided by the size scale of Russian manufacturers when choosing a domestic product (for example, S corresponds to a knee circumference from 30 to 36 cm, L – from 40 to 44 cm, etc.).

Foreign manufacturers set their own parameters and sizing chart, which can differ greatly from domestic ones, so before purchasing the product you need to first try it on (and possibly more than once).

Manufacturers and prices

The best manufacturers of orthopedic therapeutic knee braces:

1. Orlett and Medi (Germany) produce expensive, but very high quality and durable products. In case of serious disorders in the joint, German manufacturers should be paid attention first.
2. Nebat (Turkey) – fairly high-quality products, a wide range, good pricing policy. The optimal choice for those who do not have money for expensive German orthoses.
3. Orto (Taiwan) - some samples are not inferior in quality to Turkish and even German ones. A wide range and the optimal combination of price and quality allow you to replace the orthosis if it quickly becomes unusable (according to customer reviews, this happens often).

The cost of a knee brace varies depending on the type, material of manufacture, degree of fixation and some other parameters. Currently, a quality product costs from 1,800 to 20,000 rubles.

Bottom line: pros and cons of knee pads

Positive qualities of good orthoses Cons

Recommendations for use

Some tips for use:

1. You should not wear a knee brace for more than 3 hours a day so that the muscles and ligaments do not completely atrophy.
2. Wear the brace when the load increases.
3. The product should fit tightly, but not squeeze the knee (otherwise blood microcirculation will be disrupted, and the orthosis will do more harm than good).
4. The appearance of swelling while wearing a knee brace indicates that you have chosen the wrong size.
5. The more pronounced the degree of arthrosis, the stronger the fixation of the knee pad should be.
6. The most universal type is hinged; you can choose it if several bandages are recommended at the same time for arthrosis.
7. The product must be washed by hand (preferably with washing soap or baby powder), and dried without wringing (pat dry with a cotton cloth or terry towel).

Choose a knee brace responsibly: according to current legislation, their exchange or return is prohibited.

Description of the surgical process

The type of anesthesia is determined by the anesthesiologist. We think everyone knows what general anesthesia means. As for the second type, most likely, not everyone understands the essence and principle of action of pain relief, let us clarify.

Epidural anesthesia is a type of regional anesthesia, the meaning of which is to deliver it into the epidural space of the spine (in the lumbar region) through a catheter of a special composition that blocks the transmission of impulses from the nerve plexuses of the spinal cord. The lower part of the body becomes insensitive. The person does not feel any pain at all, but remains conscious. It is possible that the anesthesiologist will additionally connect an intravenous system that supplies an effective sedative drug to relieve nervous tension or put you into a deep medicated sleep.

The easier the anesthesia, the easier it is for everyone, the patient, the traumatologist and the anesthesiologist.

Once the anesthetic has started working, total knee replacement begins.

1. The joint is accessed from the front of the knee by cutting through the soft tissue, bypassing the patella. The incision is small, it is approximately 12-14 cm.
2. Gently released from the anatomical space.
3. Since the design for total knee replacement has a complex geometry, the surgeon performs several high-precision cuts of the femur and tibia to ensure its correct fit.
4. Afterwards, a “blank” of different sizes is placed to select the best one.
5. After making sure that the bones are prepared correctly, the specialist begins to install the permanent parts of the prosthesis in their final place.
6. At the end, the area within which the surgical operations were performed is washed with an antiseptic liquid. Then a temporary drainage system is inserted into the wound to drain wound fluid, the incision is sutured and covered with a sterile bandage.

The patient lies on the operating table, his leg is bandaged, the operation is about to begin.

After discharge from the hospital, you should register at a treatment and rehabilitation center. In such medical institutions, highly competent care is provided after total cemented knee arthroplasty or cementless, partial prosthetics and revision surgery.

Knee replacement in the Czech Republic: guarantees, prices, rehabilitation, reviews and statistics.

Find out more

Types of orthoses

When thinking about how to choose the right knee orthosis, you need to pay attention to the following parameters: the purpose of the product, the method of influencing the joint, the degree of rigidity, the type of structure and the material used.

Types by purpose:

• medical and rehabilitation – create conditions for recovery after injury;
• functional – ensure restoration of mobility in case of irreversible changes;
• preventive – recommended for people at risk, patients with minor changes in the joint.

Depending on the method of influencing the joint, the following types are distinguished:

• fixing – reduces or relieves pain;
• unloading – reduces the impact on parts or the entire joint;
• compensating – provides compensation for the damaged segment;
• corrective – eliminates deformation.

Problems solved by the FormTotikstm Medical System

In clinical practice, the doctor is faced with the fact that even after treatment, patients may again experience discomfort or, even worse, pain returns to them. Every day, a great responsibility falls on the shoulders of a doctor. The doctor’s goal is to shorten the rehabilitation period, prevent relapses, and return the patient to health—life without physical limitations.

It is important to maintain a lasting positive result of treatment. If the patient returns to his normal lifestyle without orthopedic correction, his problems may return.

Doctors from more than 30 countries around the world confirm the following results of treatment with foot orthoses using the FormToticstm system:

• · relief from pain;
• · restoration of the functions of the musculoskeletal system;
• Stimulation of foot sensitivity;
• balance and muscle-joint balance;
• · formation of optimal gait.

The FormTotics system foot orthosis redistributes the load on the foot and significantly reduces the risk of injury due to the balanced work of muscles, which increases the endurance of the entire body, provides good shock absorption, effectively relieves pain and fatigue in the legs and back and provides reliable protection for the joints. The FormTotics Medical System includes a clinical assessment of the function of the foot and the entire musculoskeletal system before and after the manufacture of orthoses, functional testing followed by original molding under load.

The system is intended for use in clinics, outpatient clinics, hospitals, sanatoriums and other medical and preventive organizations, medical and physical education clinics, beauty salons, aerobics and fitness centers, sports and health centers.