When a knee is so severely damaged by disease or injury, an artificial knee replacement may be considered. Approximately 267,000 knee replacement surgeries are performed annually in the US. The most common age for knee replacement is between ages 60 to 80 years old.
Who might be a candidate for artificial knee replacement?
The most common condition that results in the need for knee replacement surgery is osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults. Osteoarthritis is characterized by the breakdown of joint cartilage and adjacent bone in the knees. Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a knee injury, can also lead to degeneration of the knee joint. In addition, fractures, torn cartilage and/or torn ligaments also can lead to irreversible damage to the knee joint over the years.
The decision to replace the painful knee with an artificial one is a joint decision between you and your physician. Other alternative treatments may first be used, including assistive walking devices and anti-inflammatory medications.
What happens before the surgery?
In addition to a complete medical history, your physician may perform a complete physical examination, including x-rays, to ensure you are in good health before undergoing surgery. In addition, you may also meet with a physical therapist to discuss rehabilitation after the surgery and undergo blood tests (or other tests).
How is a knee replaced with an artificial knee?
Although each procedure varies, generally surgery to replace a knee usually lasts about two hours. After the damaged bone and cartilage of the knee is removed, the orthopedic surgeon will place the new, artificial knee in its place.
The two most common types of artificial knee prosthesis used in replacement surgeries are cemented prosthesis and uncemented prosthesis. Sometime, a combination of the two types is used to replace a knee. A knee prosthesis is made up of metal and plastic. A cemented prosthesis is attached to the bone with a type of epoxy. An uncemented prosthesis attaches to the bone with a fine mesh of holes on the surface in order for the bone to grow into the mesh and attach naturally to the prosthesis.
The prosthesis (artificial knee) is comprised of the following three components:
- Tibial component: to replace the top of the tibia, or shin bone
- Femoral component: to replace the two femoral (thighbone) condyles and the patella groove
- Patellar component: to replace the bottom surface of the kneecap that rubs against the thighbone
While undergoing surgery, the patient may be under general anesthesia or awake with spinal or epidural anesthesia.
Knee replacement surgeries usually require an in-hospital stay of several days. Even while in the hospital, the patient usually begins physical therapy exercises to begin regaining range of motion in the knee. Physical therapy will continue at home. Pain medication also will be administered to keep the patient comfortable.
Golf and Knee Replacement Surgery
Many patients that are seen by Dr. Olsen are dedicated golfers. Fortunately, knee replacement surgery not only restores quality of life, but of equal importance allows them to return to this game. Consider these tips when returning to the golf course after knee replacement surgery:
- Start slowly with chipping and putting before progressing to playing 9 or 18 holes.
- As you return to the course, use the golf cart at first. Eventually you will be able to walk the course. At that time use a caddy or a roller for your bag. Carrying your bag increases force across your knee joint and may excessively stress your new knee.
- Use spikeless shoes. Spiked shoes fix your stance during the golf swing and will increase rotational stress on your artificial knee.
- Avoid playing in wet weather where the chance of slipping or falling during a golf swing is increased.
- Learn to play more “on the toes”. Swinging flat-footed increases stress on the joint replacement. On the backswing, the left heel should come off the ground and on the downswing, the right heel should come off the ground. (Note– This recommendation is for right-handed golfers and the terms “right/left” need to be reversed for left-handed golfers. )
- Right-handed golfers with a right total knee replacement may benefit from “stepping through” their swing with their right leg. The right leg comes off the ground during the downswing and follow-through, and actually steps toward the target. This will effectively unload a right total knee replacement; however, no golfer with a left total knee replacement should attempt this, as it may result in excessive loading of the left knee.
- Right-handed golfers with a left total knee replacement may benefit from an open stance. This may make the backswing a little more difficult, but if the player allows his left heel to come up, he should still be able to accomplish a full turn. The open stance has the golfer facing the target, and the hips do not need to turn as drastically to the left in the impact zone, thereby reducing the stress and torque within the left knee.