Knee Relacement (Continued)

 


MANAGEMENT:

Initial management is non operative or conservative. This includes the use of painkillers, anti-inflammatories, physiotherapy and activity modification.  In cases which do not respond to medication, an intra articular steroid injection has shown to provide temporary benefit.  In patients with moderate arthritis who are relatively young but have mechanical symptoms such as locking or giving way, keyhole surgery is considered where the knee joint is cleaned out.







KNEE REPLACMEMENT:

When the arthritis is too advanced or patients do not respond to non operative treatment,  a partial or a total knee replacement is considered.  In total knee replacement the surgeon resurfaces the knee joint with an artificial knee with metal and plastic component.  In the majority of cases the knee replacement is fixed to the patients bone with bone cement.  In selective cases where only one compartment of the knee is involved and the rest of the knee has been found to be entirely normal, a partial knee replacement could be carried out.  This operation is less morbid and is done through a smaller incision resulting in a quicker recovery.    








POST-OPERATIVE:

Most patients, after a knee replacement, are mobilised either on the day of the operation or the day after.  The leave hospital after two to three nights stay.  They are asked to use crutches for approximately four to six weeks.  Post-operative physiotherapy is incorporated in the management.







OUTCOME:

A total knee replacement is still one of the most successful operations.  The majority of patients experience pain relief and good functional outcome.  However, a proportion of patients may still have moderate residual discomfort despite a technically successful knee replacement.  Activities like kneeling, squatting etc may be limited after a knee replacement.







RISKS AND COMPLICATIONS:

Complications such as infection, stiffness, wound healing problems; deep vein thrombosis and pulmonary embolism etc are uncommon but are seen occasionally after knee replacement.    Appropriate prophylaxis is carried out to prevent known complications such as infection and vein thrombosis.