Knee replacement is a complex operation, after which the patient cannot immediately return to his usual lifestyle. The knee may hurt and feel foreign, and the patient needs rehabilitation. A course of procedures allows you to speed up the healing process, adapt to the prosthesis and avoid complications (including bacterial infections of the prosthesis, thrombosis of the veins of the extremities, displacement of the prosthesis and others).
Competent rehabilitation after knee replacement gives amazing results: the mobility of the endoprosthesis after completing a course lasting 3-4 months can be 90%, and the patient will experience virtually no restrictions on physical activity.
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
General information about quota
Knee replacement surgeries have become commonplace. Now they are performed not only in megacities, but also in large regional centers of Russia, where there are departments or specialized clinics equipped with the necessary equipment for the operation.
The procedure for registering and providing a quota does not have regional specifics, however, you can apply for free help only to government agencies that have received a license for such types of activities and approved by the Ministry of Health.
The waiting period depends on the number of quotas allocated by the Ministry of Health. This means that a hospital can operate on a limited number of patients per year (for example, 20 or 50). Therefore, you can wait in line from 3 to 12 months (sometimes more, but not much, the matter does not drag on for several years).
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
Rules for choosing a prosthesis
The choice of a knee replacement is always a joint decision between the patient and the surgeon who advises him. There are more than 150 types of such products on the modern market, and there is no general ideal solution for all. In each case, this decision will be individual.
In your search, you should rely on the following characteristics:
- age, weight, anatomical features of the person who will undergo endoprosthetics;
- the patient's level of activity;
- the type of future operation with a knee joint endoprosthesis (minimally invasive surgical techniques have largely reduced the discomfort from the procedure, but the choice of prostheses for such endoprosthesis is very limited);
- characteristics of the injury and the pathological processes to which it led;
- general state of human health, etc.
Requirements for knee replacements
Although there are many factors that determine the success of choosing a knee endoprosthesis , there is only one list of general requirements that any implant must meet. And it must be studied in detail before the search begins.
So, 6 basic requirements:
- wear resistance of the material (the operation is carried out based on the future long-term use of implants in conditions of constant activity, which determines the need for high wear resistance of the product materials, the minimum service life of the prosthesis is 15 years, the maximum usually does not exceed 20 years);
- functionality (the knee joint is one of the most mobile in the human body; accordingly, its endoprosthesis must provide a sufficient amplitude of flexion/extension without limiting knee movements);
- biocompatibility (one of the key risks of endoprosthetics is rejection of a foreign object by one’s own tissues; to reduce this risk, it is necessary to use compatible implants; a good prosthesis must be hypoallergenic);
- high-quality mechanical characteristics (high strength of the material that can withstand constant loads, easy sliding of the corresponding components of the knee endoprosthesis );
- compliance of the shape and size with the anatomical features (the implant must accurately follow the natural bends and protrusions of the bone);
- the ability to maintain shape and function for a long time (in other words, we are again talking about the durability of the prosthesis, which should not be deformed or worn out during its use).
Relieving constant pain and restoring leg mobility are the key tasks that endoprosthetics solves to improve the patient’s comfort of life. From a therapeutic point of view, the key goal of the operation is to completely restore the functionality of the knee. It is clear that there cannot be a general solution to achieve it, as well as some kind of universal standard.
And yet you need to understand that on the knee endoprosthesis there are products of different quality - more and less durable, safe. In addition, do not forget that the service life and ease of use of the prosthesis depends not only on the prosthesis itself, but also on the correct installation.
#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:
Contraindications
Factors that do not allow endoprosthetics can be divided into psychological - the patient’s moral unpreparedness for surgery - and physical. The latter include:
- problems with the cardiovascular system;
- the presence of bacterial inflammation in the body;
- problems with blood clotting – thrombophlebitis, thromboembolism;
- infectious processes in the knee joint;
- bone or cartilaginous dysplasia (for example, in pediatric patients).
Risk factors include immune pathologies, neurological and psychological disorders.
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.
Rehabilitation period
Rehabilitation after knee replacement lasts about 3 months. In the postoperative period, the administration of antibiotics, painkillers, and symptomatic treatment continues.
Rehabilitation treatment in hospital
Activation in bed is allowed already on the 1st day after surgery. From the second day, you can sit down in bed, begin static exercises for the muscles of the limb, and perform breathing exercises. Walking with a measured load on the operated limb and additional support (crutches, playpen) is possible from the 3rd day. The sutures are removed after 10-12 days.
Discharge home
Discharge is made 10-12 days after surgery. Rehabilitation measures should be continued, strictly following the recommendations of the operating surgeon. If necessary, it is possible to be hospitalized in a rehabilitation center for recovery under the guidance of specialist rehabilitation specialists. Restrictions on physical activity on the operated limb should be observed for 6 weeks after surgery; during this time, the use of additional support is recommended.
The first month of recovery is best done under the supervision of specialists - in a special rehabilitation center. Here the patient is engaged in a special rehabilitation technique, including exercise therapy (physical therapy) after surgery, massage, and physiotherapy.
The patient performs the procedures independently at home for another two months. During this time, the common task of the doctor and the patient is:
- Gradual increase in the motor amplitude of the joint.
- Increasing muscle strength of the limb.
- Systematic development of the joint, return to a normal lifestyle and motor mode.
It is important that rehabilitation at home takes place without excessive stress or, on the contrary, too gentle a regime. In addition to the prescribed set of exercises, it is useful for the patient to move around the house, do simple work, gradually returning to normal.
If necessary, the patient can undergo MSEC and receive disability for the period of incapacity or change in working conditions.
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.
Consultation
During the consultation, the doctor will determine the indications and contraindications for joint replacement, conduct the necessary studies and select the appropriate prosthesis. An X-ray examination will allow you to determine the degree of wear of the joint and make the necessary measurements. You will be warned about possible risks and complications of the operation. Complications of the operation include the following:
- infection at the surgical site
- blood loss during or after surgery
- thromboembolism (blockage of a vessel with a blood clot)
Disadvantages of partial replacement
Be that as it may, partial endoprosthetics has two significant disadvantages: the fragility of the prosthesis and the need for normal functioning of the ligamentous apparatus. In people with a sedentary lifestyle, the joint will last a maximum of 7-10 years, after which secondary surgical intervention is required.
People who adhere to the right lifestyle can count on 15 or even 20 years of carefree life. Zimmer dentures are stable for 10 years in 98% of cases, 15 years in 80%, and 20 years in 70% of cases.
Biomet can surprise with the survival rate of its prostheses in 98% of cases and guarantee an implant lifespan of up to 20 years.
Description of the treatment process
Treatment is carried out in two stages: preparatory and operational. The preparatory stage is of particular importance: surgical intervention is always stressful for the body. During this stage, a full scan of the body is performed to prevent possible complications:
- Laboratory and instrumental examination (blood test, urine test, ECG, fluorography, gastroscopy).
- Preparation of the skin. Before the operation there should be no infectious diseases or damage in the operated area. If you have wounds or inflamed areas, you should consult your doctor.
- Medicines. If the patient regularly takes medications, it is worth reporting this. The doctor will determine which ones should be excluded before surgery.
- Correction of body weight. This will help reduce the load on the new prosthesis and the volume of surgical intervention.
- Sanitation of the oral cavity. Although the risk of infection is small, infectious complications can occur if bacteria enter the systemic bloodstream.
- Urological preparation. The issue of relieving acute and chronic diseases of the genitourinary system is being addressed. For example, for elderly patients with prostate diseases, a special surgical technique is used.
The operation itself is performed in a certain stage:
- First, an antiseptic treatment of the joint area is done, then the leg is covered with film.
- The surgeon makes a small (up to 10 cm) soft tissue incision through the anterior surface and carefully exposes the damaged joint.
- Pathological cartilage and bone areas are removed.
- The structural components are then aligned, the top layers of the femur and tibia are removed, and the sawn components are polished.
- A small channel is made in the tibia into which the posterior sleeve of the prosthesis is installed.
- Another part of the prosthesis is installed on the femur, similar to the structure of the removed part of the femur.
- At the end of the operation, the wound is washed, hemostasis is done, and the wound is drained. The incision is sutured using an interrupted suture. The process is completed by applying a tight sterile bandage to the operated area.
In some cases, a computer navigation method is used, which makes it possible to install the components of the endoprosthesis with high accuracy and to perform balancing of the joint ligaments, the implementation of which is questionable when using simple instruments.
The duration of the operation does not exceed two hours. First, the patient is sent to the intensive care unit, where the body's vital signs are closely monitored. After some time, the patient is transferred to the general ward, where rehabilitation measures begin.
Knee replacement in the Czech Republic: guarantees, prices, rehabilitation, reviews and statistics.
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