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Knee Replacement

Knee Replacement

The Anatomy of the Knee Joint

There are three bones in a knee joint which has similar function to a hinge joint. The three bones are:

  • Thigh bone (Femur)
  • Knee cap (Patella)
  • Leg bone (Tibia)

Femorotibial joint is the joint where the femur and tibia join together whereas the joint where the patella and femur connect is called patellofemoral joint. The bending and straightening of the knee is eased by these two joints in the knee. In a total knee replacement both patellofemoral joint and femorotibial joint are replaced.

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The movement of knee is governed by the excellence of smoothness between the two bones. This smoothness is extremely important for easy function of the knee joints.  All three bones are covered with articular cartilage which is a smooth gliding surface and it covers the surfaces of the three bones which are joined together.

Normal knee functioning depends on the condition of this cartilage lining.  It also plays a key role in identifying a potential need for a knee joint replacement.


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The meniscus and lateral meniscus are the two smooth discs of cartilage that cushion the space between the bone ends. Meniscus which increases the conformity of the joint between the femur and the tibia is the inner disc. It also plays the role of joint shock absorbers by dispensing weight-bearing forces. It thus allows smooth movement and functioning of the knee by reducing friction between the joint segments. On the other hand, lateral meniscus is on the outer side of the knee joint.

The stability and functioning of the knee joint is directed by four major ligaments which are outside of the knee. Two of them are collateral ligaments which are on each side of the knee while the other two anterior and posterior cruciate ligaments. Anterior and posterior cruciate ligaments are within the knee unlike collateral ligaments and they are centrally located.


What Is Knee Replacement?

The surgical procedure to replace the weight-bearing surfaces of the knee joint is called knee arthroplasty or knee replacement. The process helps in relieved osteoarthritis disability and it also rids the patient of pain. A knee replacement is also done in case of diseases like rheumatoid arthritis and psoriatic arthritis. The surgery is more problematic in cases advanced rheumatoid arthritis, trauma, or long standing osteoarthritis, thus it can be risky. However, a knee replacement is not performer in case of Osteoporosis  because it does not lead to knee pain, deformity, or inflammation. Meniscus tears, cartilage defects, and ligament tears are among the other causes of the pain. Debilitating pain from osteoarthritis is recorded mostly in old ages.

Total knee replacement refers to a procedure in which where worn, diseased, or damaged surfaces of a knee joint are replaced with artificial surfaces through surgical method. Through the surgery strong and durable resurfacing of the joint is ensured as the materials used allow negligible friction.

There are two components in the "artificial joint or prosthesis". One of them is made of chrome or titanium while the other is called polyethylene because it is a plastic material. Total knee replacement not only helps in relieving pain but it also encourages the patients to take to moderately challenging activities such as golf, bicycling, and swimming. However, the patients find it hard to go back to activities such as jogging, or sports like tennis and skiing.

Total knee replacement is aimed at providing the patients the ease of performing painless and unlimited routine activities such as standing, sitting and walking. The surgery allows the patients to have years of faithful function if proper care is taken. According to researchers in more than 95 percent cases the surgery lasted for a minimum 15 years which is a great number.


Eligibility for the surgery

Whether you are ready for a total knee replacement or not depend on two major question and they are:

  1. Have I tried all the non-surgical treatments available?
  2. What is the impact of the knee damage on my everyday life and daily routine? Is it hampering the functions which are integral to routine or which I enjoyed performing?

If your answer to both the questions is positive then you can go ahead with your decision of getting a knee replacement done.


Types of Knee Replacements

On the basis of the degree of mechanical stability provided by the design of the artificial knee, Knee replacement is divided in four broad categories. The fours categories of knee replacement are as follows. 

  • Non-constrained
  • Semi-constrained
  • Constrained or hinged
  • Unicondylar

The most common of them all is non-constrained implantwhichworks by inserting artificial components into the knee. This system depends on the stability of the ligaments and muscles of the patient. The implant helps maintain stability in the individual.

The semi-constrained implant:- In semi-constrained implant an artificial knee is built to provide stability. This type of implant is done in cases when either the inner knee ligaments have to be removed or when more stability is required.


Constraint or hinged:-

When a patient’s knee is severely damaged and no other replacement can be supported by the person’s ligaments. In such situation the knee has serious limitations as far as movement is concerned.  The treatment is mostly prescribed to patients in their later years of life. Since it is not a durable option, this implant is advised in rare cases. A hinged mechanism is used to join the two components of the knee.


A Unicondylar knee:-

Unicondylar knee replacement also known as, unicompartmental knee replacement, is done when the knee is partially damaged most damaged by arthritis. In such case only half of the knee joint is replaced keeping the healthier portions intact. Only the severely damaged portions are removed and replaced so that total knee replacement is not required. This type of replacement has three major benefits including less scarring, shorter recovery times and a fuller range of motion. When the patient is active and young doctors prefer to perform this knee replacement in place of the other. This is also prescribed when a particular area is damaged because of arteritis.


Exercising following Knee Replacement

It is important to exercise regularly to avoid complications after knee replacement. It also helps you build strength which in turn promotes easy motion and movement of knee. This way you will feel a noticeable difference in your overall activity before and after surgery. It might not be very easy and comfortable initially because you haven’t used your muscles in a long time. However, try not to give up and keep your exercise routine regular to ensure success of your knee surgery. It is advisable to take physician’s advice before trying any exercise.


Quadriceps Setting

If you are a beginner and you are too lazy to exercise then you should start with Quadriceps Setting.  This exercise helps in muscle contraction as well as in increasing extension of the knee. Quadriceps Setting strengthens both your legs which tend to get weaker post replacement. To get maximum benefit, do this exercise in regular interval every hour a day. Initially you will find it difficult to perform the exercise but eventually you will begin to see great improvement.  Follow these simple steps:

  • Lie in bed and keep your legs straight. Let your hands rest at the sides.
  • Push the back of the knee downward into the bed and simultaneously tighten the quadriceps muscles
  • Hold this position for a minimum four to five seconds and relax. Repeat the exercise 10-20 times for each leg.

Terminal Knee Extension

Terminal knee extension exercises can be performed in a sitting, standing or lying position. This is another helpful exercise frequently recommended by doctors and therapists for restoring mobility and strength to a painful knee. Follow the easy steps to perform the exercise on a regular basis.

  • Lye flat Lie down on your back on a hard surface  and place a pillow under the operated knee or you can also use towel rolled up into a bolster. Position the knee joint at approximately 40 degrees from full extension.
  • Concentrate on contracting your shin and quadriceps muscles to straighten your knee.
  • Hold the position for at least 5-10 seconds then return to your starting position slowly and relax.
  • Perform one to three sets of 10 to 15 repetitions with each leg.

Heel Slides (Knee Flexion)

This exercise helps in increasing the range of knee flexion at the joint as well as improving knee range of motion. You can get the improvement reviewed by your physical therapist who will record the amount of flexion on a daily basis. Follow these easy steps to perform the exercise.

  • Lie down on your back on a hard surface.
  • Move the heel slowly towards the buttocks as far as comfortable.
  • Hold the position for 10-15 seconds and return back to the normal position.

Straight Leg Raising

Straight Leg raising is an easy exercise which strengthens the quadriceps and the flexor muscles. Though the exercise is easy to perform, patients must be careful in the initial days. You will be able to perform 20 repetitions comfoably. Follow the steps mentioned below to do it acuuretely:

  • Lye in flat  on your back with both legs out straight.
  • Lift your leg about six to ten inches off the floor while keeping the involved leg straight.
  • Count till ten and slowly come back to normal position.
  • Repeat in sets of 10-20 for each leg.

Pillow Squeeze

This exercise helps strengthen the hip adductors or groin muscles which in turn helps improve motion and movement. For overall improvement of your knee it is essential that you strengthen the entire leg. Follow these easy steps to do it right:

  • Hold a pillow between the knees if you can endure the pressure. In case you feel uncomfortable you may place it slightly above the knee joint.
  • Then squeeze the pillow and hold for ten seconds.
  • Relax for a few seconds and repeat this exercise 10-20 times.
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