Knee Replacement Surgery

When patients come to me complaining of knee pain, the first thing I recommend is a thorough examination. I want to get a clear sense of the source and severity of the pain before recommending any course of treatment. Knee pain can be triggered by a variety of causes that may not be suitable for a partial or full knee replacement such as

  • Torn meniscus
  • Inflammatory arthritis (such as gout) 
  • Tendonitis
  • Knee cap (patella) malalignment
older man suffering from knee pain

Once we have eliminated these alternative causes for knee pain, we generally know that knee pain is caused by the knee joint itself. The knee is a hinge joint that allows the leg to bend and straighten. There are three bones that make up the knee joint: the patella (kneecap), the tibia (shinbone), and the femur (thighbone). The knee joint is held together by a network of ligaments, tendons, and muscles. The knee joint is also protected by a piece of cartilage called the meniscus.

The knee joint is lubricated and cushioned by synovial fluid. The knee joint starts to degenerate when this fluid breaks down. This can lead to osteoarthritis, which is the most common type of knee arthritis. 

drawing of the knee anatomy

Anatomy of the Knee

If knee pain is severe and significantly impacting your quality of life, partial or total knee replacement surgery may be the best treatment option. Total knee replacement surgery is a major operation, so it is not a decision to be made lightly. However, knee replacement surgery can relieve pain and help you regain mobility.

In many cases, knee pain can be alleviated with nonsurgical measures such as non-steroidal anti-inflammatory medication (NSAID) which is generally recommended first, use of a cane in the opposite hand of the involved knee which is very helpful, and weight loss, which is most effective if a person is markedly overweight.  However, we find that it takes quite a bit of motivation for patients to do the hard work of losing weight and improving physical activity. Therefore, when these methods fail to provide relief, surgery may be necessary.

xray of normal knee

Normal Knee

Xray of knee with advanced arthritis. Arrow pointing to bone-on-bone

Advanced Degenerative Arthritis
of the Medial Compartment
(Note Bone-on-bone on right side)

Total Knee Replacement vs. Partial Knee Replacement 

Many people believe that a total knee replacement is the only option when they are dealing with severe knee pain. However, there are actually a number of different options available, and highly-educated surgeons are now recommending less invasive procedures when possible. 

What is a Partial Knee Replacement?

Studies show that keeping the native knee ligaments and resurfacing only the most involved portion of an arthritic knee may be the best option for many patients. These patients often recover faster and have better motion than those who have a total knee replacement. In fact, the satisfaction rate for patients with total knee replacement hovers around 80% while partial knee replacements have an average satisfaction rate of 90%.

One example of a partial knee replacement is changing the covering on the patella, which can help to reduce friction and pain. Another option is to change the opposing surface on the end of the thigh bone, which can help to improve the range of motion. There are also a number of different artificial joint options available, which can be customized to each individual patient. As a result, it is important to consult with a surgeon to find out what the best option is for you.

xray of partial knee replacment

Partial Knee Replacement

Why choose Nebraska Hand & Shoulder for Your Knee Replacement Surgery

At Nebraska Hand & Shoulder Institute, our goal for patients requiring knee joint replacement is to conduct the surgery as safely as possible and get the best outcome. Ideally, a person is mentally and physically fit enough that the procedure can be done as an outpatient, allowing the patient to go directly back to their home to continue to recuperate rather than the added cost and risk of being in the hospital around a lot of illnesses.

Advantages of a Partial Knee Replacement

Partial knee replacements are becoming more popular due to their benefits over total knee replacements.

  • The surgery is much less invasive
  • Partial knee replacements cause less trauma to the surrounding tissues and muscles
  • Partial knee replacement allows for tension of normal ligaments which allows a greater range of motion for the knee after surgery
  • Patients can expect a quicker and easier recovery
  • There is a lower risk of complications, such as blood clots, with a partial knee replacement

What is total knee arthroplasty?

Total knee arthroplasty, also known as knee replacement surgery, is a procedure that involves replacing the knee joint with an artificial implant. This artifical implant, usually made of a high-density polyethylene on one side, is supported by cobalt chrome molybdenum base, and the opposite side is comprised of polished chrome molybdenum. These are very strong and durable materials. It is typically done to relieve pain and restore mobility in people who have severe knee damage from conditions such as osteoarthritis or rheumatoid arthritis.

The surgery is usually performed under general spinal (most popular) or general anesthesia. With general anesthesia, you will be asleep during the procedure. With spinal anesthesia, you are drowsy but breathing on your own, or you can be awake enough to carry on a conversation with your anesthesiologist. Your surgeon will make an incision in your knee and then remove the damaged bone and cartilage. The new implant will be placed into position and secured with screws or cement.

While this procedure is usually very successful, it is not without risk. There is a small chance of infection and blood clots following surgery, and the artificial joint may eventually need to be replaced. 

For these reasons, I always take a close look at all of the available options before recommending surgery to my patients. In some cases, less invasive procedures such as patellar resurfacing or trochleoplasty may be appropriate. These procedures have a lower risk of complications and may provide significant relief from knee pain. Ultimately, the decision about which surgical procedure is best for each individual patient depends on many factors. I always take the time to discuss all of the available options with my patients so that they can make an informed decision about their care.

knee replacement implants

Knee Implants

xray of knee after full knee replacement surgery

Side View of Total Knee Replacement Post Surgical

Knee replacement surgery is generally covered by insurance

Knee replacement surgery is often covered by insurance, so there is no need to worry about the cost. 

If you are considering knee replacement surgery, talk to the professionals at Nebraska Hand, Shoulder, & Orthopaedics about the potential benefits and risks. Together, you can decide if knee replacement surgery is right for you.

Preparing for knee replacement surgery

Your doctor will most likely recommend that you stop smoking (if you are a smoker) for at least a month before surgery because that improves your resistance to infection and smoking has been shown to slow healing. Additionally, some doctors will not perform knee surgery until you are at an appropriate weight. It is essential that you have your house thoroughly cleaned, take a thorough shower (preferably with chlorhexidine scrub, but at a minimum, with Dial antibacterial soap) the night before surgery, and come to the facility in freshly laundered clothing. You will also need to arrange for someone to drive you home after the surgery and help you out at home for the first few days or weeks. If you have pets at home, make sure that your dog or cat is unable to get near your wound after surgery.

Benefits of knee replacement surgery

Knee pain can keep you from enjoying an active and fulfilling lifestyle. Knee replacement surgery can offer several benefits.

Improve your overall health

Knee replacement surgery can help improve your quality of life by relieving pain and restoring mobility. It can also help you return to activities and hobbies that you enjoy. The surgery is usually successful in alleviating knee pain and improving knee function.

Knee replacement surgery can also help improve your overall health. People who have knee pain often limit their physical activity, which can lead to obesity, heart disease, and other health problems. Knee replacement surgery can help you stay active and avoid these health risks.

In general, knee replacement surgery has a high success rate. As with any surgery, knee replacement surgery carries some risks and complications. These include infection, bleeding, blood clots, and knee stiffness. However, most people who have knee replacement surgery experience few, if any, complications.

three photos - grandma on ground with baby, man gardening, man biking

Recovering from knee replacement surgery

After your surgery, you will go to a recovery room where nurses will closely monitor you. You will likely experience some pain and swelling after the surgery, but this can be controlled with medication. You will also need to use crutches or a walker for several weeks as you heal.

Most people who have knee replacement surgery experience a significant improvement in pain and function. There are, however, some risks associated with the surgery. These include infection, bleeding, blood clots, and knee stiffness.

Before having knee replacement surgery, your doctor will likely do a physical exam and order X-rays of your knee. You may also need to have your blood tested and measured in case a transfusion is necessary. Other diagnostic tests will also be performed. If you are diabetic, your serum glucose must be at an optimal level in order to reduce the risk of infection.