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I Have Arthritis in My Knee and My Doctor Told Me I Need a
Knee Replacement - What Do I Do?
By Nathan Wei
People with arthritis will eventually need a total knee
replacement if they fail the other more conservative measures. These treatments
include medications (anti-inflammatory medicines and analgesics), physical
therapy, topical agents (arthritis rubs), intraarticular glucocorticoid
injections (cortisone shots given into the knee joint), viscosupplements
(lubricant injections into the knee joint), arthroscopy, and bracing.
Patients who have received the full gamut of conservative
medical treatment and who continue to have either severe pain or loss of
function, are considered candidates for total knee replacement.
The traditional method of total knee replacement involves
making an incision through the large muscle located at the lower end of the
inside of the thigh and slightly above the inside part of the knee- the vastus
medialis obliquus (VMO). This large muscle is a stabilizer of the patella
(kneecap) and one complication of knee replacement is patellar instability.
More recently, minimally invasive techniques using a smaller
incision are becoming popular.
Prior to surgery, a careful evaluation of the patient’s
medical history is made. Since there is the chance that there will be blood
loss, the patient may require either “banking” of their own blood or injections
of erythropoietin (a hormone) to help stimulate red blood cell production.
What occurs with knee replacement is that the surface of the
femur (upper leg bone) and the surface of the tibia (lower leg bone) are
replaced with metal and plastic implants which are cemented in. For the
operation to be successful, the surgeon will require adequate visualization of
the operative site, proper sizing of the components, and proper alignment of the
limb.
The postoperative period involves extensive rehabilitation
and takes anywhere from four to ten weeks before a patient will be "as good as
they’ll be." Complications of the procedure include patellar instability,
infection, blood clots, excessive blood loss, prolonged pain, and loosening of
the replacement parts.
In patients who have two bad knees, it is a good idea to get
them both done at the same time, if possible.
Finally, it is important that there is coordination between
the patient’s primary physicians and the orthopedic surgeons. This is
particularly true in patients with other medical problems that require
attention. oftentimes, medicines will have to be montored, discontinued
temporarily, or changed before surgery.
Careful attention to detail including the preoperative
management, the actual surgery, and the post-operative rehabilitation will
ensure a good result in most cases.
Dr. Wei (pronounced “way”) is a board-certified
rheumatologist and Clinical Director of the nationally respected Arthritis and
Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of
Medicine at the University of Maryland School of Medicine and has served as a
consultant to the Arthritis Branch of the National Institutes of Health. He is a
Fellow of the American College of Rheumatology and the American College of
Physicians. For more information on arthritis and related conditions, go to:
Arthritis Treatment
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