Knee Arthroplasty Surgical Procedure

knee replacement surgery, also known as knee arthroplasty, is a highly successful and highly effective procedure involving the removal of damaged knee joint and replacing it with an artificial implant (prosthesis) to relieve pain, improve function and improve quality of life.   

Knee replacement surgery can offer significant pain relief and improved mobility for those suffering from severe knee problems. By understanding the procedure, benefits, and recovery process, you can make an informed decision and take steps toward a pain-free, active lifestyle.  

knee replacement in Cuba is carried out by highly skilled and highly experienced orthopaedic surgeons for patients who are suffering from knee pain that has not responded to conservative treatments and / or whose pain disrupts daily activities. Patients with conditions such as the ones below are candidates for hip replacement.  

• Osteoarthritis: Degenerative joint disease characterized by the breakdown of cartilage.  

• Rheumatoid Arthritis: An autoimmune condition causing inflammation and joint damage.  

• Post-Traumatic Arthritis: Arthritis following an injury to the knee joint.  

• Avascular Necrosis: A condition where the blood supply to the knee is reduced, causing bone tissue death.  

• Knee Deformities: Structural abnormalities such as severe bowing in or out of the knee.    

• Failed Previous Knee Surgery: Cases where previous knee surgeries, such as partial knee replacement or other reconstructive surgeries, have not provided adequate relief or have led to complications.  

• Severe Knee Injury: Traumatic injuries that cause extensive damage to the knee joint, including fractures, dislocations, or major ligament tears.  

Indications for Knee Replacement Surgery  

Patients who benefit most from knee replacement surgery often have:  

• Severe knee pain or stiffness that hinders simple activities such as walking, climbing stairs, and getting in and out of chairs.   

• Moderate to severe knee pain that persists while resting, both day and night.  

• Ongoing knee inflammation and swelling that do not respond to rest or medications.  

• Noticeable knee deformity, such as bowing inwards or outwards.  

• Lack of significant improvement with other treatments, including anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or previous surgeries.  

• Reduced quality of life and the ability to perform daily activities and enjoy life due to knee pain and functional limitations.  

Benefit of Knee Replacement  

Knee replacement procedure provides many benefits for individuals with severe knee pain and dysfunction.   

• Significant pain relief. 

• Improved mobility and function. 

• Increased independence. 

• Reduced risk of complications from prolonged immobility. 

• Minimal dependence on medications. 

• Cost-effectiveness in the long run. 

• Enhanced quality of life.  

Types of Knee Replacement Surgery  

• Total Knee Replacement (TKR): Involves replacing all three compartments of the knee (medial, lateral, and patellofemoral).  

• Partial Knee Replacement (PKR): Also known as a unicompartmental knee replacement, this procedure involves only part of the knee replaced to help preserve as much original healthy bone and soft tissue as possible.   

Bilateral Knee Replacement:    

Bilateral knee replacement, where both knees are replaced, is generally not performed in a single surgical session due to several significant risks and complications. These include:  

• Increased Risk of Infection: Performing two knee replacements simultaneously heightens the chances of postoperative infections.  

• Excessive Blood Loss: The potential for substantial blood loss is greater when both knees are operated on at the same time. 

• Prolonged Surgery Time: Longer surgical durations increase the likelihood of complications related to anesthesia and overall patient stress.  

• Phlebitis and Thrombosis: The risk of developing blood clots in the leg veins, such as phlebitis and thrombosis, is higher with bilateral procedures.  

• Extended Recumbency: Prolonged bed rest required after simultaneous surgeries can lead to additional health issues and delays in recovery.  

• Challenging Rehabilitation: Recovering from two knee surgeries 

 simultaneously is more demanding and requires intensive rehabilitation, which can be physically and mentally exhausting for the patient.  

Given these challenges, surgeons typically advise against performing bilateral knee replacements in one session. Instead, they recommend staging the surgeries with a minimum waiting period of four weeks between procedures. This approach allows:  

• Adequate Healing Time: The body needs sufficient time to heal and recover from the initial surgery before undergoing another major operation.  

• Gradual Rehabilitation: Patients can focus on rehabilitating one knee at a time, making the recovery process more manageable and effective.  

• Reduced Complication Risks: Staggering the surgeries helps to minimize the risks associated with blood loss, infections, and anesthesia.  

• Better Overall Outcomes: Allowing a gap between surgeries can lead to better overall outcomes, both in terms of physical recovery and mental well-being.  

This phased approach to bilateral knee replacement ensures a safer and more controlled recovery process, ultimately leading to improved functionality and quality of life for the patient.  

The Procedure  

Before procedure:  

• Patient Assessment: Consultation with orthopaedic surgeon, comprehensive evaluation of the patient’s medical history, physical examination, and imaging studies (X-rays, MRI, CT scans) to determine the extent of the deformity and plan the surgery.  

• Blood Tests: A series of blood tests are conducted to ensure that the patient is fit for surgery and to identify any potential health issues that could affect the procedure or recovery. This includes complete blood count (CBC), blood chemistry panel, coagulation tests, blood glucose test, C-reactive protein (CRP) test, and erythrocyte sedimentation rate (ESR)  

During the procedure:   

• Positioning: The patient is positioned supine, lying on their back on the operating table. The operative leg is slightly flexed, typically at a 90-degree angle, to provide optimal access to the knee joint.  

• Anesthesia: General anesthesia or regional anesthesia (spinal or epidural) is administered to ensure the patient feels no pain during the surgery.   

• Incision: A surgical incision is made on the front of the knee to access the joint. The length of the incision can vary depending on the type of knee replacement.   

• Bone and cartilage Removal: The damaged cartilage surfaces at the ends of the thigh bone (femur) and shin bone (tibia) are removed along with a small amount of underlying bone.   

• Patella preparation: The undersurface of the kneecap (patella) is prepared and may be resurfaced with a plastic component.  

• Implant placement: The knee implant components are meticulously positioned and secured to replace the damaged parts of the knee joint, ensuring proper alignment and functionality  

• Ligament Adjustment: The surgeon checks the alignment and balance of the knee and adjusts the ligaments around the knee to ensure proper function and stability.  

• Wound Closure: The incision is closed with sutures or staples. A sterile bandage is applied to protect the wound.  

After the Procedure     

• Physical Therapy: Physical therapy typically begins within the day of surgery to promote mobility and prevent complications such as blood clots. 

• Assistive Devices: The patient may use crutches, a walker, or a cane to aid in walking and reduce stress on the new hip joint.