Surgery

Knee Endoprosthetics: the essence of the operation, recovery, prices, reviews

Any joint surgery is always a complex and unpredictable event. The consequences can be very different, to the extent that the surgery can lead to nothing, and the suffering has to endure considerable, and the costs. Our goal is to honestly find out whether knee arthroplasty is in fact a routine pushover operation..

Knee replacement: before and after

Speech on prosthetics comes when, as they say, the joint "reached the handle":

  • Bent and rotated with great difficulty and "with a scratch"
  • When walking and going up and down the stairs in the knee there are terrible pain
  • X-ray shows closing of the last lumen between joints

Doctors ascertain a complete loss of joint function due to osteoarthritis, trauma, osteonecrosis, or for some other reason, and suggest total knee arthroplasty.

First, let's see what the endoprosthesis of the knee joint actually represents.

Video 1: Joint Endoprosthetics

  • In case of total endoprosthetics, cartilaginous areas are completely cut down from the femur and tibia.
  • Then install the femoral and tibial components, which must be compatible, by analogy with the natural articular joint.

How in reality is total arthroplasty

Everything in the picture looks beautiful, but in reality the operation is very complicated, traumatic and bloody, carried out with the help of computer navigation:

  • Movement volumes and angles of rotation of the knee joint in combination with the ankle are investigated.
  • The bones are cold-blooded and sawn and drilled to everything by accustomed doctors, like some blanks in the workshop.
  • Technological processes of processing, fitting and fixation are accompanied by the characteristic heartbreaking sounds of a medical drill (it’s good that the patient is in deep anesthesia)
  • The prostheses are finally hammered into the femur and tibia bones with a large sledge hammer.

Video 2: How is the operation "Total knee joint arthroplasty"

After watching the video, you understand the seriousness of the warning about the difficult process of healing and rehabilitation after endoprosthetics.

However, let's go in order.

The process of preparing for surgery to replace the joint is very difficult. (This is not about the need to remember to take with you to the hospital from the list of objects and things).

The main thing - do not miss the possible contraindications to the operation itself and to anesthesia.

What can interfere with endoprosthetic surgery?

  1. First of all, diabetes
    The healing of any minor wound in a diabetic patient sometimes turns into a problem, and here - such a large-scale injury to the bones!
    Therefore, if you have high blood sugar, then you must normalize it.
  2. Another danger is hypertension.
    With elevated pressure, the velocity of blood in the vessels is increased, which may increase the risk of bleeding and make it more difficult to stop.
  3. An important indicator of blood is platelet count.
    Before surgery, the surgeon will necessarily require a coagulogram.
    Thrombocytosis or thrombocytopenia is equally bad:
    • Increased platelet count will increase the risk of thrombosis after joint replacement.
      (By the way, after the operation, the number of platelets in the blood and so increases, because of what coagulants are needed, for example, Warfarin, Clexane, Fragmin)
    • Thrombocytopenia leads to poor blood coagulation, which makes surgical intervention impossible.
  4. Also important is the presence of autoimmune chronic processes and systemic diseases.:
    Osteomyelitis, rheumatoid arthritis, cancer with the risk of bone metastasis:

All these factors are against the joint replacement operation, no matter how hypoallergenic the materials from which the prostheses are made - titanium alloys, medical polyethylene, etc.

Preparing for joint replacement surgery

Lowering household trifles, let's leave the main thing.

Caring for blood supply.

Previously, such questions were not raised at all, but today the patient himself must provide himself with a supply of blood and plasma before the operation:

  • Donate in advance your own blood
  • Find donors at your work
  • Agree with students at the transfusion station, etc.

Preoperative examination with permission for surgery:

All that we said above, plus radiography and the tests that the doctor asks you to do.

Next you need:

  • Acquisition of crutches or walkers with preliminary workouts
  • Thinking over your rehabilitation program and choosing a rehabilitation therapist
    This must be done before the operation, since rehabilitation begins the very next day.
  • If there are bad teeth, visit the dentist in advance, as after endoprosthetics the risk of infectious complications increases. About dental prosthetics will have to forget for a year
  • Equip your house with necessary handrails, comfortable chairs, small benches for legs, non-slip comfortable shoes - all that will make your life easier after replacing the joint.
  • Warn your doctor about taking all the medicines - many of them may be contraindicated.

Anesthesia is a whole separate topic.

  • Sometimes the presence of serious contraindications makes impossible the most optimal type of anesthesia during joint replacement — regional (spinal or epidural) anesthesia.:
    • It is better tolerated than general anesthesia.
    • Awakening after surgery is almost instant.
  • With general endotracheal anesthesia, there is a more complete immersion in sleep and a slower exit, while the patient usually feels bad after anesthesia.
  • The anesthesiologist examines all the contraindications of the patient, selects the type of anesthesia and monitors the patient's condition during surgery.

Complications after surgery

Knee arthroplasty is rarely without complications.

The first complications are fluid accumulation in the joint, blood loss and pain..

Therefore, initial actions are carried out in intensive care:

  • Drainage of fluid through the tube
  • Blood transfusion or blood substitutes
  • Anesthesia
  • On the second or third day, the patient is usually transferred to the general ward, and the drainage tube is removed.

The first danger after the operation - will the artificial knee joint take root? Chronic inflammatory process and purulent postoperative bone necrosis - these are the first complications that prevent the artificial prosthesis from settling down.

Therefore, anti-inflammatory and antimicrobial therapy may be prescribed.

Prosthesis rejection

However, therapy will not do anything if immunity comes to fight an alien prosthesis.:

  • An unwanted immune reaction of the body can cause metal ions secreted by prostheses.
  • A local inflammatory process develops near the prosthesis, leading to its rejection.
  • Special therapy that suppresses immunity can help avoid this.

Rehabilitation after surgery

Rehabilitation is important to start as early as possible.:

  • Already on the second day, exercises with the ankle and feet begin:
    they are needed to prevent thrombosis
  • Also on the second day, with the help of a doctor, you should try to sit on the bed, then stand with crutches
  • Start training with walking on crutches and with a walker
  • After three days it is worth trying to give up one crutch, replacing it with a cane
  • Then begin the ascent and descent of the stairs.
  • By the time of discharge, on the 8th day, the patient is supposed to be free enough to walk without crutches

The main problem of this period is overcoming pain when moving in the joint, which makes rehabilitation very difficult.

After discharge rehabilitation does not end there:

  • Exercises of the early postoperative period, more complex.
  • In the late postoperative period are connected exercises with weighting and simulators.

More information about the restoration of the knee joint - in the next article.

Video 3: Before and after arthroplasty

What is a revision arthroplasty?

Was your artificial joint sprung? Nothing! We will replace it with a new one. - Usually it is necessary to hear from doctors when it comes to revision replacement of the joint.

There is an illusion of immortality of the joint. Just change it periodically, like spare parts in a car. It also begins to seem again that this is a foolish operation (revise video number 2)

The resource of the knee prosthesis is about 10 years, since nothing is eternal. And in our case, it is no longer our own biosustand, self-regenerating, with natural lubrication — articular fluid.

An artificial prosthesis is two surfaces rubbing dry: here wear and loosening are inevitable. Arthrosis can also occur after prosthetics.

It turns out that revision prosthesis is inevitable..

Patients may have the impression that this is a more simple operation:

Have you changed a joint already? The second time is, of course, easier.

We give an analogy with any loosened threaded fastening:

It is necessary either to replace the fastener itself by selecting a screw of a larger diameter, or to plug the broken threaded hole and drill a new one.

Now imagine that all this must be done on your bones already badly injured by the previous operation.

Each revision arthroplasty inevitably expands the scale of the operation and the area of ​​bone damage.

Finally, it comes to the fact that the surface of the bone is no longer enough, and it should be increased with the help of a graft from the patient's own bone tissue.

Knee arthroplasty is a serious operation with a number of complications that does not guarantee complete engraftment and long-term work without re-replacement.

Therefore, decide right now - to accept the inevitability of surgery, or to continue to work on the knee joint with the help of therapeutic exercises until the last.

When an operation is prescribed for knee replacement

Surgery on the knee joint, like other types of surgery, is justified in the event that comprehensive treatment programs do not give a positive result. A direct indication for radical treatment is the presence of symptoms such as pronounced pain syndrome, loss of limb mobility (inability to bend or bend the leg), muscle weakness.

It is important to emphasize that the use of modern therapeutic schemes allows not only to slow the development of pathology, but also to maintain acceptable functionality of the joint for a long time. That is why patients of orthopedic surgery departments are mainly people over 60 years old.

Absolute contraindications for endoprosthetics

Absolute contraindications to the replacement of components of the knee joint implants are the following pathologies:

  • Diseases of the blood,
  • Purulent infections,
  • Heart diseases in the stage of decompensation,
  • Mental disorders,
  • Oncology (3-4 stages),
  • Thrombophlebitis
  • Renal failure
  • Skeletal undeveloped.

After undergoing a course of treatment of chronic infectious diseases (tonsillitis, sinusitis, stomatitis, bronchitis, herpes, etc.), the patient is again assigned a diagnostic examination, on the basis of which a decision is made about the possibility of using surgery.

Types of knee arthroplasty operations

Knee joint endoprosthetics is an operation to replace the destroyed joint components with biologically compatible artificial structures (endoprostheses) that repeat the anatomical shape of the musculoskeletal system. In surgical practice, partial (single-lye) and total prosthetics (complete replacement of the knee joint) are used.

In orthopedic surgery, two methods of fixing the endoprosthesis are used: the cementless method, and technology using bone cement composition. With the cementless implant, having a rough surface, over time, bone tissue grows.

The indications for using the method of fixing the endoprosthesis without a cement component binder is the satisfactory condition of the bone-joint apparatus, which must withstand the load created by the prosthetic structure.

Cement installation is shown at low efficiency of previously fixed partial prostheses, as well as with increased fragility and instability of bone tissue.

Advantages and disadvantages of single-pole (single-pole) prosthetics

Single-limb endoprosthetics (semi-prosthetics) - replacement of the destroyed joint fragments with endoprostheses in case of damage of only one condyle (lateral or medial) provided that the functionality of the articular ligaments is preserved. The condyle is a protruding bone formation to which the muscles are attached.

Single-lash prosthetics is indicated for elderly patients with low physical activity (which implies a weak or moderate strain on the knee joint). Small blood loss, a limited area of ​​the surgical field (low invasiveness of the operation), rapid rehabilitation are the undoubted advantages of a single-pole surgical technique.

Modern technologies allow an operation with a small incision (10 cm), without dislocation of the patella, with minimal injury to the femoral-patellar articulation and lateral ligaments.

After surgery, within one to two months, normal gait and joint mobility are restored, and sharp pain disappears. A successful operation is considered, after which the patient within 30-40 days restores all forms of physical activity:

  1. Walking in a straight path,
  2. Rise, descent on steps and inclined plane,
  3. Squats,
  4. The extremity withdrawal to the side, rotational movements (the usual amplitude of movements).

After a gentle prosthesis, the patient does not experience discomfort, or severe pain after a week after the operation. Stabilization in the joint is established by balancing the collateral and cruciate ligaments performed by surgeons.

The main disadvantage of single-blade arthroplasty is the limited life of the implant. In elderly people, leading a sedentary lifestyle, an artificial joint can last for 5-7 years, after which the question arises of a secondary surgery to replace a worn prosthesis.

Advantages and disadvantages of total prosthetics

Total (bipolar) prostheses, which replace the joint completely, are complex structural devices made of metal alloys, ceramics, or composite materials. These are high-strength, wear-resistant implants, whose service life is 15-20 years.

In recent years, in surgical practice, implants are mainly used on a mobile platform, where the polyethylene liner moves synchronously with the physiological movements of the limb (back and forth, flexion-extension, rotation in anatomical amplitude). Thus, the freely sliding component of the endoprosthesis performs the function of the meniscus of the knee joint.

The design is suitable for people leading active lifestyles engaged in physical culture and sports. Contraindications to the use of this technique are progressive osteoporosis, osteomyelitis, and a weakened ligamentous apparatus.

The disadvantage of total arthroplasty the knee joint is a long time of operation, the risk of large blood loss, more serious and difficult rehabilitation (compared with a single-pole prosthesis).

Preparation for endoprosthesis replacement surgery

Preparation for surgery includes:

  • In-depth diagnostics (laboratory tests, medical reports, radiographs, MRI, CT)
  • Assessment of possible complications (associated diseases are taken into account)
  • The choice of the design of the prosthesis (a detailed coordination of the implant model with the patient is carried out)
  • Treatment of chronic infections, carious teeth,
  • Training with simulators (crutches, walkers),
  • Select a day for the operation,
  • Drawing up the diet.

Pre-workouts with crutches will help to transfer the recovery period more easily. The patient may be asked to donate blood in advance to make up for blood loss after surgery (a crucially important point for people with a rare blood type).

The postoperative period provides for the active participation of close people who will have to help the patient in the first days after discharge from the clinic. In the apartment should be created such an order that all the necessary things were at the person at hand, there were no items about which you can stumble.

How is the operation performed?

The operation is carried out in the morning. A few minutes before the introduction of anesthesia, the patient's healthy leg is fixed with a compression bandage (to prevent the formation of blood clots). Depending on the state of health and age, the type of anesthesia is chosen: general anesthesia or spinal anesthesia.

A catheter is inserted into the bladder - this is necessary to control the renal excretory function. The operation is performed at the choice of a doctor according to one of the techniques: under a tourniquet (with exsanguination of the surgical area), with a partial tow, or without a tourniquet.

After the onset of the anesthetic effect, the doctor performs the following actions:

  1. Makes a longitudinal cut (in the center of the knee),
  2. Spreads tissue (to the sides of the incision),
  3. Shifts the patella, gaining access to the knee joint,
  4. Weakens the tension of the ligaments and soft tissues that fix the knee,
  5. Cuts off damaged bone fragments,
  6. It processes cutting edges (sawdust, grinding),
  7. Replaces the lower portion of the femur with a metal prosthesis
  8. Fixes a flat titanium plate in the upper part of the tibia
  9. Fixes a polyethylene liner on platinum
  10. A trial prosthesis (model) is installed to test joint functions,
  11. After testing and additional surgical treatment, the endoprosthesis is fixed (cement technique, or a tight fit method ”).
  12. The wound is sutured,
  13. The drainage is installed,
  14. Bandage and splint
  15. The patient is transported to the ward.

The operation lasts 2-3 hours. After awakening, the patient will not experience pain for 4-5 hours, then additional anesthesia will be needed.

Postoperative drugs

After surgery for endoprosthesis replacement of the knee joint, the same drugs are prescribed as for other types of surgery. it anticoagulants (to prevent blood clots) and antibiotics (to prevent infection). The doctor prescribes the rest of the medicinal products based on individual health indicators, data from clinical studies and history.

Common ailments in elderly patients are hypertension, impaired cerebral circulation, anemia, atherosclerosis, which involves the appointment of concomitant therapy in the postoperative period.

Possible complications after surgery

Complications arising from the operation are divided into two categories:

  • Health related,
  • Associated with the functionality of the endoprosthesis.

Edema after knee arthroplasty can last for quite a long time (up to 10 days), and this phenomenon should not frighten the patient. However, if the puffiness does not decrease after 2 weeks, then we can conclude that infection has developed in the area of ​​the prosthesis, or an allergic reaction to the materials of construction. It is extremely rare, if the treatment regime is observed, serious complications such as deep vein thrombosis, fractures, dislocations or joint rejection are recorded.

Generally, prosthetics of the knee joint is well tolerated by patients, severe postoperative effects are rarely observed. Most often, complications are associated with violation of the requirements of doctors in terms of compliance with the rehabilitation regime, or exacerbation of a chronic disease.

Free and paid surgery

Can I get free help to install the endoprosthesis? Yes, this possibility is provided. Quota operations (subsidies from the federal budget) are carried out in Moscow and other large cities of Russia.

To obtain permission to use government assistance, you must pass three medical commissions, and obtain the appropriate conclusion. The referral is issued in the clinic at the place of residence. Progressive methods of surgery in the field of endoprosthetics are used in the Institute, in the departments of traumatology of regional and regional hospitals, in commercial clinics.

The waiting time can be delayed for a year, and even for a longer period. As people experience continued suffering from loss of mobility and pain in the knee joint, everything who have the opportunity, resort to paid services.

Cost of operation - from 200 thousand rubles.

Endoprosthesis cost - 20 - 100 thousand rubles (and higher).

Prices are approximate - the final cost depends on many factors, primarily on the state of health, age and complexity of the operation. The reputation and popularity of the clinic - a factor that can greatly affect the increase in the price of services.

Types of endoprosthetics and types of knee prostheses

Depending on the severity of pathological changes, the patient may be offered partial prosthetics of the knee joint (replacement of only part of the joint), or total (complete replacement of the knee).

Consequently, knee prostheses are of several types:

Partial (single pole) endoprosthesis

Partial (single pole) implant

It is used if one of the condyles is destroyed in the knee (internal or lateral) and the posterior cruciate ligament is preserved. This is the most physiological and most inexpensive type of arthroplasty. This saves the maximum amount of the patient’s own tissue, and rehabilitation takes less time.

Total prosthesis with a movable platform

This three-component endoprosthesis consists of a femoral, tibial component and a movable liner of polyethylene inside the tibial element. This type of prosthesis provides the possibility of rotation of the knee joint and increases the amplitude of movements. The disadvantage of this prosthesis is low wear resistance, and for its full functioning requires a good ligamentous apparatus (muscles and ligaments).

Total prosthesis with fixed platform

Total prosthesis with fixed platform

The most common knee prosthesis. Its central component is fixed on the tibial. Thus, while moving, the femoral component slides along a fixed shock-absorbing platform, and if the patient does not follow the recommendations for the use of the structure, the prosthesis is quickly loosened, pain appears, which requires repeated endoprosthetics.

Essence and variety

Doctors recommend surgery only when conservative therapy is ineffective.A timely visit to the hospital and prevention of articular pathologies is the best way to avoid surgery.


If the situation cannot be remedied with medical and therapeutic methods, a cardinal solution is recommended - knee joint arthroplasty. The main goal - the elimination of pain, return to the knee of natural kinematics. The point is to replace a damaged element with an implant for optimal results.

Modern prostheses are made according to the individual characteristics of the patient. The age, lifestyle, anatomy, and sex of a person are taken into account. This approach allows you to implant a convenient component that does not feel foreign in the body, quickly takes root and ensures the earliest return to normal life.

Depending on the individual characteristics of the patient and the complexity of the situation, one of the types of endoprosthesis replacement is prescribed:

Type of

Description

How is the operation?

The operation to replace the knee joint lasts 1-4 hours. The procedure can be performed using general or spinal anesthesia.

The patient is placed on the operating table on his back. With general anesthesia, the drug is administered intravenously, after which the person sinks into deep sleep. Spinal anesthesia involves the injection of an anesthetic to the spine in the lumbar region. So a person is conscious. The body below the waist loses numbness and becomes insensitive to pain.

An experienced surgeon will return the mobility of the knee

The incision area is decontaminated. To prevent the formation of blood clots, the patient's legs are wrapped with elastic bandages, or compression stockings are worn.

On the anterior surface of the knee, the surgeon performs a longitudinal incision and releases the joint. After a detailed examination, the doctor determines exactly what type of prosthesis to install and selects the method of installation.

After removal of all pathological tissues, a trial prosthesis is installed (supplied with the original one). The doctor checks its performance. If everything is normal, a permanent prosthesis is installed.

At the end of the operation, a drainage tube is inserted into the wound for the outflow of fluid and blood. The incision is sutured and covered with a bandage.

Total arthroplasty

Orthopedists did not come to a common opinion which implantation is better: full or partial. Just 10 years ago, it was believed that the “gold standard” for solving the problem of joint deterioration in people after 60 years with rheumatoid arthritis is total prosthetics. The prosthesis of the entire knee articular joint takes root in 95% of cases, failures do not exceed 1-1.2%. The service life of such an endoprosthesis is up to 10 years.

Single Mice Replacement

Thanks to the development of modern technologies, it has become possible to conduct minimally invasive operations, with the help of which partial arthroplasty of the knee is carried out with a reduced period of stationary observation (up to 5-7 days). With a sparing intervention, healthy tissues are barely touched, the risk of blood loss and postoperative complications is less. The reduction of the recovery period is the main advantage of this method of treatment.

After a single-ligation prosthesis, there is much less pain. Even if the operation was performed on both knee joints, the patient will quickly start walking without improvised means (walker, crutches, walking sticks).

In what cases is appointed the audit replacement

How long the endoprosthesis will last will depend on:

  • lifestyle,
  • proper nutrition
  • features of the anatomical structure,
  • the presence of excess weight.

If the medical recommendations are not observed (failure to exercise, early exercise, increased load), a dislocation of the prosthesis may occur. A revision of the entire implant or its individual components will be required.

Revision arthroplasty is also an operation, and a rather complicated one.Compliance with basic safety rules and proper lifestyle minimize the risk of re-dislocation.

Alternative ways

The most effective alternatives are:

  • knee meniscus replacement. It is recommended for young people in case of injury (without arthritic damage). The implant can serve as an artificial or donor element. Crushing meniscus, the impossibility of its stitching - indications for implantation. It is conducted only for people under 40 years old
  • hyaluron prostheticswith acid acid. The material as close as possible to natural lubricant in composition and properties is inserted inside the joint. The procedure is impossible if inflammatory processes are found in the body, the destruction of cartilage tissue progresses.

Why is osteoma recommended endoprosthetics?

Although the development of osteoma in a malignant tumor is not fixed, it interferes with productive life. There are two solutions to the problem: tibial osteomy or removal of a damaged tumor with “implantation” into the damaged area of ​​the implant. Osteomy does not mean that prosthetics will not be needed in the future. The procedure will relieve the tumor, relieve pain, "push back" the terms of implantation, but will not return the full mobility of the knee joint.

Contraindications

Implantation of any complexity is surgery and stress for the body. To assign prosthetics, the orthopedist must have good reasons. There are rules at which an operation cannot be performed.

The main reason for the replacement of the knee joint is pain, which cannot be stopped by traditional methods, lack of independent movement, and high risk of disability. Endoprosthetics prescribed in the case of:

  • the presence of gonarthrosis, dysfunction of the joint and deformity of the lower limb,
  • degenerative-dystrophic pathologies, including post-traumatic arthritis and arthrosis,
  • loss of leg sensitivity, full or partial,
  • rheumatoid arthritis,
  • development of aseptic tissue necrosis,
  • after unsuccessful knee surgeries that did not bring relief,
  • pathological changes of the ligaments and ends of the bones,
  • consequences of injury, unsuccessful jump or strike.

  • diseases of the respiratory and cardiovascular systems,
  • mental disorders,
  • inflammatory processes in acute form
  • neuromuscular pathologies,
  • congenital immature skeleton
  • propensity for thromboembolism or thrombophlebitis,
  • any form of tuberculosis.

In order for the replacement of the knee joint to be successful, and the rehabilitation period, in short, preparation is required:

  • avoid smoking, drinking alcohol,
  • eat right,
  • lose weight (if you have one),
  • strengthen muscle tone.

These factors are the causes of postoperative complications. Excessive weight increases the load on the operated limb, and improper food and bad habits interfere with proper healing of tissues.

Before scheduling the operation and further treatment, additional research is carried out:

  • lab tests,
  • x-ray of the knee
  • if necessary - puncture of the knee fluid,
  • the choice of optimal anesthesia depending on the state of health.

Since the knee arthroplasty is an operation, it is provided to issue a sheet of temporary disability after the procedure. The term of the hospital depends on the complexity of the event and the necessary rehabilitation period. The specific period is indicated by the attending physician in the hospital at the place of residence or another profile specialist to whom you referred. Information about the disease is encoded according to the ICD 10. If the hospital is more than 15 working days (with prosthetics it is much longer), a medical commission is going to confirm that it is not working.The maximum term of the sick-list is 10 months, then the patient is discharged or referred to a new commission with disability appointment.

Endoprosthetics of the knee joint by quota or for a fee?

It is believed that the "reference" operations for the replacement of articular joints carried out in Israel or Germany. Over the past 10 years, the Czech Republic has entered the top three. Clinics of the USA, France, China and many other states also deal with endoprosthesis replacement. There is one drawback - prosthetics is an expensive operation: it is not affordable for everyone.

If the pain does not rest, implantation becomes a vital necessity. You can try to get a quota. The state conducts additional funding for orthopedic centers, so there is always a chance to cut costs. How to get a quota ticket? Call the hospital at the place of residence, get the commission’s opinion on the need for the operation and go to a public or private clinic that has quotas. You will be given a "Quota Decision Protocol", which must be submitted to the Ministry of Health of the city. A coupon for a “free” operation can be obtained quickly (within 10 days), but the queue will have to wait at least six months.

Where is better to do arthroplasty?

Quota prosthetics have disadvantages. The procedure is absolutely free, but there are still diagnostics and rehabilitation that cost money. In addition, there are a lot of people willing to do implantation at a lower price, and the waiting period can last for a year. According to the quota, endoprostheses are installed, which are in the hospital at the time of surgical intervention, individual features are not taken into account.

There is one drawback - the installation of the prosthesis. This is a delicate process that requires a lot of practice and sharp movements, otherwise the mobility will not be fully restored. Do you think that a leading surgeon will agree on a quota operation or will entrust her to a young specialist.

If the replacement of the knee joint fails, or an improper endoprosthesis is installed, re-dislocation may occur and, as a result, revision endoprosthesis. Therefore, think more than once before getting a quota for surgery.

Exercise therapy for knee arthroplasty

After the operation, when the anesthesia is gone, painful sensations will persist for some time. For the speedy rehabilitation after a total replacement are appointed:

While the patient is in the hospital, the therapeutic complex of exercises is performed under the supervision of a methodologist, and later exercise therapy is carried out at home. There are several periods of recovery, and the exercises in each of them perform a specific function.

Why do home exercises? Not only the recovery period, but also the life of the prosthesis depends on exercise therapy. If exercises are not performed, an inactive pastime occurs, and overweight appears, the implant wears out faster and a revision of the components or the entire prosthesis is required. With proper exercise and compliance with the regime, an individual endoprosthesis will last 10-12 years.

We offer a set of rehabilitation exercises to restore knee mobility (late period):

Knee Endoprosthetics: a forum for moral support

Forums dedicated to pathologies and operations are a real opportunity to get acquainted with patient reviews, hear their opinions and advice about various techniques, clinics and specialists. On thematic sites, live communication is enough, if you have any questions or doubts, talk to those who have gone through all the stages of endoprosthesis replacement.

At the forum, you can ask a question or ask for advice. Here not only patients often appear, but also orthopedic surgeons who will advise you absolutely free. You may need recommendations on how to prepare or popular ways of dealing with diseases - come in, they will help you.In addition to the “experienced opinions”, the forums provide links to competent sources, foreign articles on endoprosthetics from well-known surgeons, ratings of professionals and clinics.

Not all popular methods and "promotional" products - a panacea for pain. The use of most tools only stop symptoms, and the disease continues to develop. Before you follow the recommendations of "advisers", consult with an orthopedist.

The forums and thematic sites often post photos and videos of the best clinics, modern equipment, the operation process, so if there is a fear of intervention, check them out and take it easy. Endoprosthesis replacement is not a “novelty” for a long time: a wealth of experience has been gained, and the operation belongs to the category of routine, not causing difficulties. Watch the video where the knee arthroplasty is performed, simply - go to the page of a popular clinic: usually they provide such materials.

Let's sum up

90% of the load falls on our legs, so any factor can cause a “breakdown” of the joint. Modern rhythm of life does not allow to stop: hitting, jumping, and even just stopping during fast walking is a reason for early wear of the knee articular articulation. Injuries and bruises in the knee area lead to impaired blood flow, and subsequently - to the death of tissues deprived of food.

At an early stage, the pathology can be stabilized with medication and with the help of gymnastics. Unfortunately, most of the diseases in the early period are asymptomatic, we turn to the doctor when therapy is ineffective. There are several options, but arthroplasty has the greatest effect - 95-100% of the full restoration of natural kinematics.

Successful joint replacement is half the result, the final rehabilitation depends on your patience, effort, and a positive attitude.

Total Endoprostheses (TER)

Knee replacement is a surgical procedure in which damaged areas are replaced by implants. After a successful operation, the patient stops suffering from severe pain in the joint.

Internal structures for arthroplasty are made of high-tech materials that are inert to biological fluids. The shape of such products repeats the joint to be replaced, which allows people who have undergone such intervention and who comply with all the recommendations of a specialist to return fully to normal life.

  • Indications for knee replacement
  • Knee Implant Types
  • How is the knee replacement?
  • Contraindications for endoprosthetics
  • The rehabilitation period after the installation of the endoprosthesis
    • The first 24 hours after insertion of the knee implant
    • The first weeks after surgery
    • Treatment three weeks after joint replacement
  • A set of exercises after arthroplasty
  • Possible relapse after joint replacement

Knee Implant Types

Partial unipolar prosthesis. It is used if the side or internal condyle is damaged in the knee, but the posterior cruciate ligament has survived. This operation is inexpensive, it allows you to save as much as possible of your own human tissues. Recovery after it does not take much time.

Total implant having a fixed platform. This is the most common prosthesis. In them, the polyethylene component of the tibial element is tightly attached to the metal rod under it. When moving, the femoral component begins to slide on the cushioning platform.

Total endoprosthesis with a mobile platform. This three-component design consists of a movable polyethylene liner, tibial and femoral elements. Such a prosthesis provides the ability to rotate the knee and increases the amplitude of movements.Minus implant with a movable platform - poor wear resistance. For its normal operation requires a good ligament apparatus.

Knee Endoprosthetics | NIITO

- routine operation?

Any joint surgery is always a complex and unpredictable event. The consequences can be very different, to the extent that the surgery can lead to nothing, and the suffering has to endure considerable, and the costs. Our goal is to honestly find out whether knee arthroplasty is in fact a routine pushover operation.


Total knee prosthetics - a serious operation on the femur and tibia

Knee replacement: before and after

Speech on prosthetics comes when, as they say, the joint “reached the handle”:

  • Bent and rotated with great difficulty and "with a creak"
  • When walking and going up and down the stairs in the knee there are terrible pain
  • X-ray shows closing of the last lumen between joints

Doctors ascertain a complete loss of joint function due to osteoarthritis, trauma, osteonecrosis, or for some other reason, and suggest total knee arthroplasty.

First, let's see what the endoprosthesis of the knee joint actually represents.


X-rays of a healthy, diseased joint and after prosthetics

Video 1: Joint Endoprosthetics

  • In case of total endoprosthetics, cartilaginous areas are completely cut down from the femur and tibia.
  • Then install the femoral and tibial components, which must be compatible, by analogy with the natural articular joint.

How in reality is total arthroplasty

Everything in the picture looks beautiful, but in reality the operation is very complicated, traumatic and bloody, carried out with the help of computer navigation:

  • Movement volumes and angles of rotation of the knee joint in combination with the ankle are investigated.
  • The bones are cold-blooded and sawn and drilled to everything by accustomed doctors, like some blanks in the workshop.
  • Technological processes of processing, fitting and fixation are accompanied by the characteristic heartbreaking sounds of a medical drill (it’s good that the patient is in deep anesthesia)
  • The prostheses are finally hammered into the femur and tibia bones with a large sledge hammer.

Video 2: How is the operation "Total knee joint arthroplasty"?

After watching the video, you understand the seriousness of the warning about the difficult process of healing and rehabilitation after endoprosthetics.

However, let's go in order.

The process of preparing for surgery to replace the joint is very difficult. (This is not about the need to remember to take with you to the hospital from the list of objects and things).

The main thing - do not miss the possible contraindications to the operation itself and to anesthesia.

What can interfere with endoprosthetic surgery?

  1. First of all, diabetes
    The healing of any minor wound in a diabetic patient sometimes turns into a problem, and here - such a large-scale injury to the bones!
    Therefore, if you have high blood sugar, then you must normalize it.
  2. Another danger is hypertension.
    With elevated pressure, the velocity of blood in the vessels is increased, which may increase the risk of bleeding and make it more difficult to stop.
  3. An important indicator of blood is platelet count.
    Before surgery, the surgeon will necessarily require a coagulogram.
    Thrombocytosis or thrombocytopenia is equally bad:

  • Increased platelet count will increase the risk of thrombosis after joint replacement.
    (By the way, after the operation, the number of platelets in the blood and so increases, because of what coagulants are needed, for example, Warfarin, Clexane, Fragmin)
  • Thrombocytopenia leads to poor blood coagulation, which makes surgical intervention impossible.

Also important is the presence of autoimmune chronic processes and systemic diseases:
Osteomyelitis, rheumatoid arthritis, cancer with the risk of bone metastasis:

All these factors are against the joint replacement operation, no matter how hypoallergenic the materials from which the prostheses are made - titanium alloys, medical polyethylene, etc.

Preparing for joint replacement surgery

Lowering household trifles, let's leave the main thing.

Care for blood supply.

Previously, such questions were not raised at all, but today the patient himself must provide himself with a supply of blood and plasma before the operation:

  • Donate in advance your own blood
  • Find donors at your work
  • Agree with the students at the transfusion station, etc.

Preoperative examination with permission for surgery:

All that we said above, plus radiography and the tests that the doctor asks you to do.

  • Acquisition of crutches or walkers with preliminary workouts
  • Thinking over your rehabilitation program and choosing a rehabilitation therapist
    This must be done before the operation, since rehabilitation begins the very next day.
  • If there are bad teeth, visit the dentist in advance, as after endoprosthetics the risk of infectious complications increases. About dental prosthetics will have to forget for a year
  • Equip your house with necessary handrails, comfortable chairs, small benches for legs, non-slip comfortable shoes - all that will make your life easier after replacing the joint.
  • Warn your doctor about taking all the medicines - many of them may be contraindicated.

Anesthesia is a whole separate topic.


Anesthesia is regional and general.

Sometimes the presence of serious contraindications makes impossible the most optimal type of anesthesia during joint replacement - regional (spinal or epidural) anesthesia:

  • It is better tolerated than general anesthesia.
  • Awakening after surgery is almost instant.

With general endotracheal anesthesia, there is a more complete immersion in sleep and a slower exit, while the patient usually feels bad after anesthesia.

The anesthesiologist examines all the contraindications of the patient, selects the type of anesthesia and monitors the patient's condition during surgery.

Complications after surgery

Knee arthroplasty is rarely without complications.

The very first complications are fluid accumulation in the joint, blood loss and pain.

Therefore, initial actions are carried out in intensive care:

  • Drainage of fluid through the tube
  • Blood transfusion or blood substitutes
  • Anesthesia
  • On the second or third day, the patient is usually transferred to the general ward, and the drainage tube is removed.

The first danger after the operation - will the artificial knee joint take root? Chronic inflammatory process and purulent postoperative bone necrosis - these are the first complications that prevent the artificial prosthesis from settling down.

Therefore, anti-inflammatory and antimicrobial therapy may be prescribed.

Prosthesis rejection

However, therapy will not do anything if immunity comes into action against an alien prosthesis:


Sometimes the immune system perceives the prosthesis as a foreign body.

  • An unwanted immune reaction of the body can cause metal ions secreted by prostheses.
  • A local inflammatory process develops near the prosthesis, leading to its rejection.
  • Special therapy that suppresses immunity can help avoid this.

Rehabilitation after surgery


To get up on crutches or walkers you need to try on the second day after surgery.

Rehabilitation is important to start as early as possible:

  • Already on the second day, exercises with the ankle and feet begin:
    they are needed to prevent thrombosis
  • Also on the second day, with the help of a doctor, you should try to sit on the bed, then stand with crutches
  • Start training with walking on crutches and with a walker
  • After three days it is worth trying to give up one crutch, replacing it with a cane
  • Then begin the ascent and descent of the stairs.
  • By the time of discharge, on the 8th day, the patient is supposed to be free enough to walk without crutches

The main problem of this period is overcoming pain when moving in the joint, which makes rehabilitation very difficult.

After discharge rehabilitation does not end there:

  • Exercises of the early postoperative period, more complex.
  • In the late postoperative period are connected exercises with weighting and simulators.

More information about the restoration of the knee joint - in the next article.

Video 3: Before and after arthroplasty

What is a revision arthroplasty?

Was your artificial joint sprung? Nothing! We will replace it with a new one -

This is usually heard from doctors when it comes to revision replacement of a joint.

There is an illusion of immortality of the joint. Just change it periodically, like spare parts in a car. It also begins to seem again that this is a foolish operation (revise video number 2)

The resource of the knee prosthesis is about 10 years, since nothing is eternal. And in our case, it is no longer our own biosustand, self-regenerating, with natural lubrication — articular fluid.

An artificial prosthesis is two surfaces rubbing dry: here wear and loosening are inevitable. Arthrosis can also occur after prosthetics.

It turns out that revision prosthetics is inevitable.


Revision prosthetics are necessary after wear of the endoprosthesis or in case of postoperative arthrosis

Patients may have the impression that this is a more simple operation:

Have you changed a joint already? The second time is, of course, easier.

We give an analogy with any loosened threaded fastening:

It is necessary either to replace the fastener itself by selecting a screw of a larger diameter, or to plug the broken threaded hole and drill a new one.

Now imagine that all this must be done on your bones already badly injured by the previous operation.

Each revision arthroplasty inevitably expands the scale of the operation and the area of ​​bone damage.

Finally, it comes to the fact that the surface of the bone is no longer enough, and it should be increased with the help of a graft from the patient's own bone tissue.

Knee arthroplasty is a serious operation with a number of complications that does not guarantee complete engraftment and long-term work without re-replacement.

Therefore, decide right now - to accept the inevitability of surgery, or to continue to work on the knee joint with the help of therapeutic exercises until the last.

Video 4: How to avoid re-operation on the joints

Knee Endoprosthetics: details of prostheses and surgery

Types of endoprosthetics and types of knee prostheses

Depending on the severity of pathological changes, the patient may be offered partial prosthetics of the knee joint (replacement of only part of the joint), or total (complete replacement of the knee).

Consequently, knee prostheses are of several types:

Partial (single pole) endoprosthesis

Partial (single pole) implant

It is used if one of the condyles is destroyed in the knee (internal or lateral) and the posterior cruciate ligament is preserved. This is the most physiological and most inexpensive type of arthroplasty. This saves the maximum amount of the patient’s own tissue, and rehabilitation takes less time.

Total prosthesis with a movable platform

This three-component endoprosthesis consists of a femoral, tibial component and a movable liner of polyethylene inside the tibial element.This type of prosthesis provides the possibility of rotation of the knee joint and increases the amplitude of movements. The disadvantage of this prosthesis is low wear resistance, and for its full functioning requires a good ligamentous apparatus (muscles and ligaments).

Total prosthesis with fixed platform

Total prosthesis with fixed platform

The most common knee prosthesis. Its central component is fixed on the tibial. Thus, while moving, the femoral component slides along a fixed shock-absorbing platform, and if the patient does not follow the recommendations for the use of the structure, the prosthesis is quickly loosened, pain appears, which requires repeated endoprosthetics.

How is the operation?

The operation to replace the knee joint lasts 1-4 hours. The procedure can be performed using general or spinal anesthesia.

The patient is placed on the operating table on his back. With general anesthesia, the drug is administered intravenously, after which the person sinks into deep sleep. Spinal anesthesia involves the injection of an anesthetic to the spine in the lumbar region. So a person is conscious. The body below the waist loses numbness and becomes insensitive to pain.

An experienced surgeon will return the mobility of the knee

The incision area is decontaminated. To prevent the formation of blood clots, the patient's legs are wrapped with elastic bandages, or compression stockings are worn.

On the anterior surface of the knee, the surgeon performs a longitudinal incision and releases the joint. After a detailed examination, the doctor determines exactly what type of prosthesis to install and selects the method of installation.

After removal of all pathological tissues, a trial prosthesis is installed (supplied with the original one). The doctor checks its performance. If everything is normal, a permanent prosthesis is installed.

At the end of the operation, a drainage tube is inserted into the wound for the outflow of fluid and blood. The incision is sutured and covered with a bandage.

Complications in knee arthroplasty

Possible complications after knee arthroplasty during the period of surgery include:

Knee Endoprosthetics | NIITO

(compiled c.med. E.E. Malyshev)

One of the most significant achievements in orthopedics of the 20th century, total knee arthroplasty was first carried out in 1968. The improvement of surgical materials and technology has since greatly increased the effectiveness of this operation. In the US, approximately 300,000 such operations are performed annually.

If you are just thinking about this method of treatment or have already decided together with the orthopedist about the operation, in this edition you will learn about the features of this method.

The main indication for knee arthroplasty is pain. If medications, reduced levels of physical activity and the use of additional support while walking no longer help, the question of replacing the knee joint may be considered. As a result of this operation, the pain is usually reduced, the deformity of the limb is corrected and normal physical activity returns.

Normal knee joint

The knee joint is the largest in the human body. It is formed by the lower end of the femur, the upper end of the tibia, and the patella (patella), which slides into a recess on the femur. Large ligaments attached to the femoral and tibial bones, ensure the stability of the joint.

The interconnecting surfaces of these three bones are covered with articular cartilage - a smooth tissue that softens the articular surfaces of the bones and facilitates movement.

All remaining surfaces of the knee joint are covered with a thin, smooth tissue called the synovial membrane.This membrane produces a special fluid that lubricates the articular surfaces and reduces the friction force to almost zero in a healthy knee.

Normally, all these components harmoniously interact. However, illness or injury can destroy this harmony, leading to pain, muscle weakness and dysfunction.

before arthroplasty after arthroplasty

Have you shown total knee arthroplasty?

The decision on the need for surgical treatment should be made together by you, your family and the orthopedic surgeon. Your family doctor can refer you to an orthopedist for a final solution. The surgeon can offer you such alternatives to traditional total endoprosthetics, such as single-arm endoprosthetics or corrective osteotomy.

Total endoprosthetics are indicated in the following conditions:

  • Intense pains that limit such daily movements as walking, climbing or descending stairs, sitting on a chair. When walking long distances, you may need additional support: crutches or a cane.
  • Moderate or severe pain at rest, day or night.
  • Chronic inflammation and swelling of the joint is not decreasing at rest or when taking medication.
  • Deformation - a deviation of a shin outside or inwards.
  • Stiffness - violation of flexion or extension in the joint.
  • Reducing the effect of taking nonsteroidal anti-inflammatory drugs. These drugs, including aspirin, ibuprofen, diclofenac, and others, are often very effective in the early stages of arthritis. Their effectiveness varies greatly in different patients. The effect of these drugs decreases as the arthritis progresses.
  • Tolerance or complications while taking painkillers.
  • The lack of effect from other treatments, such as injections of hormones, hyaluronic acid preparations, physiotherapy or other surgical intervention.

Despite the fact that the majority of patients subject to total knee arthroplasty, usually between the ages of 60 and 80, the orthopedic surgeon selects the indications for surgery based on an individual approach. Recommendations for surgical intervention are based on the intensity of the pain syndrome, restriction of joint mobility, and general health, regardless of your age. Total knee arthroplasty can be effective at any age: from young people with juvenile arthritis to older people with deforming arthrosis.

Examination before surgery

In preparation for the operation, a mandatory examination is carried out, which allows to identify all the risks associated with the operation, which are assessed by the operating surgeon together with the anesthesiologist and therapist:

  • X-rays of the joint (with description)
  • conclusion of medical specialists:

- total blood count (hemoglobin, red blood cells, white blood cells, platelets) - is valid for 14 days,

- urinalysis total (valid 14 days),

- coagulogram (prothrombin index, APTT, fibrinogen, orthophenanthroline test) (valid for 14 days),

- biochemical blood test (glucose, transaminases, bilirubin, total protein, urea, creatinine, prothrombin index) (1 month valid),

- blood test for syphilis (valid for 14 days), HIV infection, hepatitis B (HbSAg) and C (HCV) (valid for 1 month),

- analysis of feces on the eggs of the worm (valid for 10 days).

  • Required scope of instrumental studies:

- data of fluorographic examination (valid for 1 year),

- electrocardiogram with decoding and conclusion (valid for 21 days),

- triplex scanning of the veins and arteries of the lower extremities (really 3 weeks), in case of deviation from the normal results of the USDG, - consultation of the vascular surgeon,

- fibrogastroduodenoscopy (valid for 4 weeks) (in case of changes it is necessary to undergo treatment, the presence of erosions or ulcers is a contraindication for surgery),

- echocardiographic study - all patients over 60 years old, as well as patients with atrial fibrillation, coronary heart disease, myocardial infarction in history.

  • additional findings of medical specialists with comorbidities:

infectionist (for patients with viral hepatitis B and C, elevated transaminase and bilirubin),

- endocrinologist (with diabetes mellitus, diseases of the thyroid gland, adrenal glands, obesity),

- a neuropathologist with a history of acute violation of cerebral circulation,

- oculist (measurement of intraocular pressure, examination of the fundus of the eye - according to indications, after 60 years - everything),

- rheumatologist (in the presence of rheumatic pathology),

- urologist (according to indications),

- dermatologist (for diseases of the skin),

- TB specialist (with a history of tuberculosis).

  • with concomitant diseases, additional studies are needed:

Patients with thyroid disease should additionally have a blood test for TSH, free T4 and perform an ultrasound of the thyroid gland.

Contraindications for hospitalization for planned knee joint arthroplasty are

1. Ulcerative and erosive lesions of the gastrointestinal tract.

2. Anemia (hemoglobin less than 100-110 g / l).

3. The presence of purulent inflammatory diseases (fistulous osteomyelitis, ulcerative lesions of the skin of the lower extremities, etc.).

4. Recently postponed (1-2 weeks) acute respiratory infections. Increased body temperature at the time of admission (more than 37 grams).

5. Recently transferred thrombophlebitis or deep vein thrombosis of the lower extremities (the recommended interval to the planned intervention is 6 months).

6. Obesity 3-4 tbsp. (Body mass index = Weight (kg) / Height (m) * Height (m)) not more than 40).

7. Diseases of the cardiovascular system: uncontrolled arterial hypertension (BP level more than 160/100 mm Hg), myocardial infarction or stroke suffered from the last 6 months, marked arrhythmias and conduction disorders (frequent extrasystole, three-bundle blockage of the cardiac pathways , tachysystolic form of atrial fibrillation, atrioventricular block II-III degree). The operation in patients with sick sinus syndrome is possible only after installing a pacemaker.

8. General surgical contraindications for planned surgical intervention.

What will change after total knee arthroplasty?

Important in deciding whether to perform an operation is the realization that you are expected without surgery and that you can be given surgical treatment.

More than 90 percent of people from those who performed this operation, expects the complete disappearance of pain and a significant increase in mobility for the possibility of a normal, active life. However, total knee arthroplasty cannot do more than you could before developing arthritis.

After surgery, you should beware of certain movements and sports, including running and contact sports.

Even with normal use of the endoprosthesis, its components, in particular the polymer gasket, will wear out. If you are experiencing increased stress on the joint or are overweight, the wear process may accelerate and cause instability of the prosthesis and the resumption of pain. With adequate use, the knee joint endoprosthesis can last for many years.

Dangerous activities after the operation: running, jumping, contact sports, aerobics.

Activities that exceed the usual recommendations after the operation: too long or tedious walks, tennis, weight lifting over 25 kg.

Permitted activity after the operation: tireless walks, swimming, golf, driving a car, “nonextreme” tourism, ballroom dancing, climbing the low ladder.

Preparation for surgery

Medical examination. If you decide on total knee arthroplasty, you should be examined a few weeks before the surgery. This is necessary to assess your health and determine possible contraindications for the operation at the moment.

Laboratory and instrumental examination. Tests such as blood and urine tests, an electrocardiogram, chest X-ray, and gastroscopy are necessary.

Preparation of skin for surgery. Your skin should not have any infectious diseases or injuries before surgery. If they are present, you should inform the surgeon so that he can advise you how to prepare your skin for surgery.

Medication. Notify the orthopedist about the medications you are taking. Your surgeon will recommend which drugs can and cannot be taken before surgery.

Weight loss. If you are overweight, the surgeon may advise you to reduce weight before surgery, in order to reduce the burden on the new prosthesis and, if possible, reduce the risk of surgery.

Sanitation of the oral cavity. Although the risk of infection after total knee arthroplasty is very small, infectious complications can occur if bacteria enter the systemic circulation. Sanation of the oral cavity, including the removal of diseased teeth and the treatment of periodontitis, should be carried out before the operation.

Urological training. Acute or chronic infectious diseases of the genitourinary system should be stopped in preparation for the operation. Elderly patients with prostate diseases require appropriate treatment before total knee arthroplasty.

Social support. Despite the fact that you can walk with crutches or walkers a few days after the operation, within a few weeks you may need help with such matters as cooking, walking shopping, washing, washing clothes. If you live alone, you can contact the social assistance service for help.

Recommendations for home.

The following are some guidelines that will make your return home easier during the rehabilitation process.

  • Strongly fixed handrails in the bathroom or in the shower.
  • Strong handrails along all the stairs.
  • Stable chair with a sturdy, high seat, sturdy back, two armrests, and a footrest.
  • High toilet seat.
  • Stable bench in the shower or chair in the bathroom.
  • Eliminate loosely attached carpets and electrical wires from the area where you walk.

You will be admitted to the clinic some time before the operation. Further you will be examined by the anesthesiologist. The most common type of anesthesia for total endoprosthetics is spinal or epidural anesthesia (in which you can breathe on your own, but your legs will not feel anything). The anesthesiologist will discuss with you the advantages and disadvantages of these methods and help you choose the most appropriate type of anesthesia.

The operation lasts an average of about two hours. The surgeon will remove the damaged cartilage and part of the bone and then install new metal and polymer articular surfaces in order to restore the axis of the limb and the function of the knee joint.

Many different types of prostheses are currently used for total knee arthroplasty.Almost all of them consist of three components: the femoral component (made of well-polished durable metal), the tibial component (consisting of a strong polymer, often located on a metal platform), and the patella (also polymeric), although in most cases it is not used.

After the operation, you will be transferred to the postoperative ward, where you will stay for several hours, until the anesthesia effect ends and a permanent monitor control is performed. After full awakening, you will be transferred to your ward.

Minimally invasive total knee arthroplasty

One of the latest achievements in orthopedics is the promotion of a minimally invasive technique for total knee joint replacement. This technique is suitable for a smaller number of patients than traditional prosthetics. Approximately two times smaller incisions make rehabilitation faster, less pain and reduce the length of hospitalization.

Minimally invasive endoprosthetics are suitable for patients who do not suffer from overweight.

Many researchers do not consider minimally invasive access as a more advantageous technique. Complications with this method are still poorly understood. Discuss with your doctor if it is possible for you to have minimally invasive endoprosthetics.

An operating surgeon may be asked to use computer navigation during the operation.

Immediately it should be said that this equipment is extremely expensive and only large orthopedic clinics have it.

Computer navigation allows with high accuracy to install the components of the endoprosthesis and perform the steps of balancing knee ligaments, which are either not feasible using simple instruments, or require a very large experience of the operating surgeon.

Negative reviews of some surgeons that computer navigation does not provide benefits for the patient are not due to reality, but because they do not possess this technique sufficiently or simply do not have this equipment.

Your stay in the clinic

You will be in the clinic for several days. After surgery, you will feel pain in the operated joint. To relieve pain, you will receive painkillers.

Walking and light exercises for the operated joint are necessary for recovery and should begin shortly after surgery.

To prevent pulmonary complications, you should breathe deeply and cough up more often.

The surgeon will take certain measures to prevent thrombosis and prevent edema, such as elastic bandages, stockings, and the use of anticoagulants.

Exercises in the foot and ankle joint should also be carried out immediately after surgery and help speed up blood flow in the limbs, reducing swelling and the risk of thrombosis. Many patients begin exercises in the knee joint the day after surgery. Physical therapy physician will teach you special exercises to strengthen the knee joint and restore the movements necessary for walking and normal daily activity soon after the operation.

Possible complications after surgery

The risk of complications after this operation is low.

Serious complications, such as infection of the operated joint, occur in less than two percent of cases. Severe complications such as myocardial infarction or stroke are even less common. However, chronic diseases can increase the risk of complications. Although they are rare, these complications can prolong the period of your rehabilitation.

Thigh or pelvic vein thrombosis is the most common complication of total hip arthroplasty. Your orthopedist will take steps to prevent blood clots in the veins of the legs and pelvis.These measures include special elastic bandages or stockings, exercises and anticoagulants.

Despite the fact that the biocompatibility of implants and the technique of operation is constantly progressing, over time, the endoprosthesis may deteriorate or weaken its fixation in the bone. In rare cases, important vessels or nerves in the area of ​​the knee joint may be damaged during surgery.

The success of the operation depends largely on how you follow the recommendations of the orthopedist at home during the first few weeks after the operation.

Careful attitude to the postoperative wound. Along your wound, stitches or special braces will be applied along the front surface of the knee joint area or it will be sutured by a subcutaneous suture. The braces or stitches will be removed approximately two weeks after surgery. Subcutaneous suture does not require removal.

Be careful not to spill water on the wound until it is completely sealed. You can wear a special bandage to the wound to prevent irritation of the wound with clothing or elastic stockings.

Diet. A slight decrease in appetite often occurs within a few weeks after surgery. A balanced diet with a high content of iron is needed to assist in the healing of tissues and the restoration of muscle strength. Of course, you need a sufficient amount of fluid intake.

Activity. Exercises are a crucial component of your home rehabilitation, especially during the first weeks after surgery. You should return to normal activity and daily life within 3 to 6 weeks after surgery. During this time, you will experience some discomfort during active movements and at night.

Your activation program should include:

  • Gradually increasing the duration of walking, first at home, and then on the street.
  • Training necessary movements, such as landing, getting up from a chair, walking upstairs.
  • Return to the necessary household chores.
  • Special exercises a few minutes a day to develop movements in the knee joint.
  • Special exercises a few minutes a day to strengthen the knee joint.
  • It is possible to conduct physiotherapy at home.

Driving is possible when you develop movements in the operated joint in order to get into the car without difficulty and when the muscles can provide an adequate response when pressing the pedals. Most often this occurs 4 to 6 weeks after surgery.

A fall during the first weeks after surgery may damage the endoprosthesis and lead to the need for another operation. You should be especially careful when walking upstairs. You must use a cane, crutches, walkers, handrails, or other assistive devices until the joint is strong, and the mobility or strength of the muscles in it is restored.

Your surgeon or exercise therapy doctor will advise you on the need for assistive devices after surgery and when you can safely stop using these devices.

What is so special about your new knee joint?

After surgery, you may feel numbness around the scar. You may also feel some difficulty in flexing the knee. The restoration of movements in the joint is one of the goals of total endoprosthetics, but full recovery is not always possible.

Metal detectors of the joint can react to metal detectors at airports and other structures. In such cases, inform the security officers that you had an operation with metal implantation. You can ask the surgeon for information that you have an implant implanted.

For complete recovery and a gradual return to normal life, regular exercises are needed that will help restore normal movement in the joint and muscle strength.

Exercises in the early postoperative period.

Begin the following exercises as soon after the operation as possible. You can start them already in the postoperative ward. You may experience discomfort at first, but they will speed up your rehabilitation.

Operation day

After the operation, until the next morning, the patient is transferred to the intensive care unit, where he will be constantly monitored and the necessary medications injected. Immediately after the restoration of the movements of the foot and the toes of the foot, it is necessary to perform exercises that reduce the swelling of the limb and prevent the formation of blood clots in the vessels: movements in the ankles and toes.

The first or second day after surgery

The patient is transferred to the ward. Usually, a drainage tube remains in the operated joint. On average, it is left for 48 hours, although the exact time of removal is determined by the attending physician or the operating surgeon. The following exercises are performed by the patient lying on his back.

  • Movement in the ankle joints - the muscles of the lower leg are forced to work, which in their work contribute to the normal movement of blood in the operated leg. Prevent blood stagnation and blood clots.
  • Exercises for the quadriceps muscles of the thigh - restores the tone and strength of this muscle attempt to raise the straightened legs. Even if it is impossible to raise the leg, you must constantly continue to try to do it, then the muscle will contract and its strength and tone will gradually recover.
  • You can sit in bed without help by dropping the non-operated leg.

From this day on, the patient can lie on his side (on the side of the operated leg), turn on his stomach through the operated leg. It is extremely important to restore leg support ability to achieve full extension of the knee joint. To do this, the patient with a straight leg in a position on the back tries to press the posterior part of the knee joint to the plane of the bed. In this case, the full amount of extension is achieved only if a roller with a height of 10-15 cm is under the ankle joint.

The second or third day after surgery

Usually on this day, drainage tubes are removed from the joint. The patient already performs some exercises independently. Pain in the knee joint gradually subsides. The following are added to all exercises:

  • Flexion in the knee and hip joints.
  • Active extension of the lower leg when the shaft is placed under the knee joint.
  • From this day on, the patient can sit with both legs out of bed. Under the operated leg, a support is necessary for the painful bending of the operated knee to be less painful as much as the pain permits. Before the patient sits, having lowered legs from a bed, the operated leg needs to be bandaged with an elastic bandage from the tips of the toes of the foot to the upper thigh. In the first days, you should sit with your legs down for no more than 40-45 minutes a day, due to a possible violation of the venous outflow of blood.

Third to fourth day after surgery

On this day, the patient should start walking with crutches. The principle of installation of the endoprosthesis allows you to immediately load the knee joint. However, each patient has his own peculiarities: different severity of osteoporosis, different training of leg muscles, the use of bone grafting when installing a prosthesis. Therefore, the attending physician establishes the procedure for increasing the load on the operated leg.

Walking in the early postoperative period.

Shortly after the surgery, you will start walking short distances within the ward and begin serving yourself. Early activation will strengthen the muscles, restore the range of motion in the joint and accelerate recovery.

Walking with walkers / walking with a full load on the operated leg. Stand up straight and distribute body weight on crutches or walkers. Move crutches or walkers forward a short distance.After that, move forward yourself, lifting the operated leg so that you feel the floor, touching it. As the knee moves, the knee and the ankle joint will be bent. To rest, lower your foot to the floor. When you take a step, it is permissible to lift your foot off the floor. Move the walkers forward again and move your foot forward again for the next step. Remember, you first need to touch the heel to the floor, then straighten the leg, then tear the leg off the floor. Allowed to walk as much as you can. Do not hurry. As your muscle strength increases and your exercise capacity increases, you will be able to walk more and more. Gradually, you will increase the load on the operated leg.

Walking with a stick or crutches. Walkers are often used the first few weeks to help keep balance and prevent falling. Then a cane or crutches are used until the strength and range of movement is fully restored. Hold the cane in the hand opposite to the operated joint. You will be ready to switch to a cane or crutches, when you can keep balance and stand without walkers, when you can fully distribute the weight on both legs and when the walker becomes uncomfortable to hold.

Climb and descend the stairs. The ability to move up the stairs requires a certain amount of movement and muscle strength. First, you will need handrails to maintain balance and additional support, and at first you will be able to step over only one step per step. Always climb the stairs with a healthy foot and get down from the operated leg. Remember the "rise from a healthy" and "descent from the patient." At first, you may need help. Climbing the stairs is a very good exercise to train your muscles and develop a joint. Do not climb stairs that exceed 20 cm and always use handrails.

Exercises in the late postoperative period

Full recovery will take many months. Morbidity before surgery and pain after will weaken your muscles. The following exercises will help restore muscle strength.

1. Bending the knee while standing. Standing upright with the support of a walker or crutches, lift your hip and bend your knee as far as possible, keeping it in this position for 5-10 seconds. Then lower the leg, trying to feel the floor. Repeat several times until you get tired.

2. Knee bending with support. Lying on your back, wrap the belt around your lower leg and, helping yourself with your hands, try to bend your knee as much as possible.

3. Exercises with a load. You can place a small load in the ankles and perform the above exercises. The load can be given after 4 - 6 weeks after surgery. At first, use the load in 500 - 1000 g, then gradually increase.

Exercise Bike The exercise bike is a great exercise to restore muscle strength and full range of motion. Adjust the height of the seat so that when your knee is almost unbent, your foot just touches the pedal. First, the pedal turns back. Moving forward is possible if the pedal is rotated comfortably backwards. As muscle strength increases (for about 4 to 6 weeks), increase the resistance of the simulator. Do 10 - 15 minutes twice a day, gradually increasing to 20 - 30 minutes three - four times a week.

Pain and swelling after exercise. You may experience pain and swelling in the area of ​​the operated knee after performing the exercises. You can lower them by holding your leg in a high position and applying cold.

Basic rules for doing the exercises:

To be engaged in a prone position or sitting. Frequent repetition of exercises throughout the day for several minutes. The intensity of training depends on the presence (absence) of pain in the joint. Energetic movements “through pain” are contraindicated. The range of motion should be increased gradually.It is recommended to perform the exercises regularly. During the period of exacerbation, it is required to reduce (and not stop!) Physical activity - exercise helps to eliminate pain and inflammation. It is necessary to increase physical activity gradually.

Rehabilitation (recovery) after endoprosthesis replacement (total) of the knee joint includes exercise therapy, massage, swimming and mud therapy

Endoprosthetics is an actively developed and promising area. Due to the operation on the introduction of implants in the knee, thousands of patients got rid of the pain and returned mobility to their extremities. The percentage of successful surgical interventions is constantly growing and now stands at about 90%. An important role in restoring mobility is played by the correct rehabilitation course after knee joint replacement.

Types of knee arthroplasty and indications for surgery

Endoprosthetics is a complex and expensive operation associated with the introduction of foreign material into the human body. Therefore, for her appointment requires serious evidence. It is carried out with such diseases as arthritis, arthrosis, necrosis, dislocation not cured in time, bone tuberculosis. Rehabilitation after knee replacement is also a difficult and lengthy process. Indications for knee arthroplasty are the following cases:

  • impaired limb mobility
  • a strong pain symptom interferes with the patient’s normal life,
  • lack of opportunities for conservative treatment.

There are several types of partial or complete replacement of the joint.

  1. Total knee arthroplasty. This type involves the replacement of surfaces on both bones of the knee - femoral and tibia, if the surfaces themselves and the meniscus are completely damaged. At the same time, metal structures are fixed on the bones, and the kneecap is replaced with a plastic-metal implant.
  2. Unipolar prosthetics provides for the replacement of only one of the knee sections. This can be a side front or middle compartment. This operation is considered to be more benign compared to the previous one, but later with the progression of the underlying disease (for example, arthritis), it may be necessary to repeat it. These two types of surgery are primary.
  3. Revision (secondary) prosthetics of bone surfaces is performed to replace worn prostheses with new ones. In this case, the risk of complications is higher, the amplitude of movements and shortening of the limb may decrease.

Postoperative period

In the hospital, the patient spends up to 2 weeks, after removing the sutures and in the absence of complications, he is discharged home. On the first day, bed rest is prescribed; from the third day you can get up. The postoperative period of knee arthroplasty is extremely important for further recovery. In the hospital or clinic, the patient receives drugs - antibiotics and painkillers. Also, the doctor makes recommendations regarding the recovery period and gymnastics.

At home it is important to continue to do daily exercises to strengthen the muscles of the thigh and lower leg for early rehabilitation. Compression knitwear must be worn for 4-12 weeks. When walking you need to use additional support - walkers, crutches, with time you can go to the cane. This will limit the load on the operated leg in the first weeks and reduce the risk of complications.

With special care you need to take a shower, use a car and public transport. During the whole next life after knee arthroplasty, one will have to avoid actions that overload the operated limb. These include:

  • running and related sports
  • lifting and carrying weights
  • long staircase walking
  • undesirable weight gain.

Quite often, after surgery, many patients have a slight swelling of the operated area and a painful symptom. But do not worry therefore about. It is possible to cope with edema with the help of cold (apply a cold compress for 5-10 minutes), and moderate pulling pain is well relieved by medical preparations, and goes away after 10-12 weeks.

The reason for the immediate appeal to a specialist should be abundant swelling and acute pain after knee arthroplasty, accompanied by fever and redness.

Unfortunately, complications after the replacement of the knee joint, especially the total, is not uncommon. The most frequent problems include:

  1. The formation of blood clots. This is caused by stagnation of blood in the veins of the leg, and also, possibly, against the background of taking blood-thickening drugs and physiological predisposition.
  2. Infection. The risk of infection is about 2%, to prevent the need to take medication prescribed by a doctor, to avoid colds and other diseases, to prevent their protracted course.
  3. Osteolysis is a process when the tissue begins to break down at the points of contact of the bone with the prosthesis. This is due to the body's reaction to the metal structure; later osteolysis may lead to the need for repeated surgical intervention.

A successful implant implantation operation involves assigning Group III disability in the following cases:

  • endoprosthetics of both legs,
  • replacement of bone surfaces not only of the tibia, but also of the femur,

If the operation was unsuccessful, the disability is put on an individual basis depending on the severity of the consequences. Lifelong disability after knee arthroplasty is indicated if the cause of the disorder is rheumatoid arthritis.

Features and objectives of rehabilitation

The program of rehabilitative activities has two objectives:

Development of the knee after endoprosthetics should include the following types of movements:

  • muscle tension of the thigh and lower leg
  • flexion and extension of the hip, knee and ankle joint,
  • walking.

The total gymnastics time is 10-15 minutes. Exercises should carry a moderate load.

Terms, steps and methods for the restoration of knee function

The recovery period after prosthetics is on average 10-12 weeks. At this time, it is necessary to move slowly and smoothly with a support, gradually increasing the strength and amplitude of movements. Any exercise or movement should be stopped if you feel pain, fatigue, or overexertion in the muscles. Recovery after knee arthroplasty can be accelerated if you follow all the recommendations of the doctor.

After the operation, fluid accumulates in the articular bag, which is removed by the drainage system. Lymphatic drainage or apparatus massage of the knee after arthroplasty is included in the set of mandatory measures in the first day. To physiotherapy (warming up and mud therapy) the attitude among orthopedists is ambiguous. In German clinics, they are actively practiced and, according to local specialists, accelerate the recovery period. Domestic doctors are skeptical of such methods, believing that they increase the risk of developing an infection.

It must be remembered that the endoprosthesis is not a new healthy joint, but a mechanism that allows you to move and live without pain. Like any other mechanism, it gradually wears out.

Physical therapy, recommended by domestic experts, is a combination of static and dynamic exercises with no rotation of the operated knee. The difference between exercise therapy after knee arthroplasty from other techniques is that most movements are performed from a lying or sitting position.

Video: "Exercises after knee arthroplasty"

There are many types of rehabilitation exercises. For example, Brugger’s neurophysiological exercises are designed to correct pain through movements performed in an upright position. Another type of complex neurophysiological exercises can be called gymnastics, proposed by Milligan. In the western clinics, swimming and swimming and hippotherapy are also practiced. When choosing a recovery method, it is important to start from the presence of specialists in this field. Without observation by a doctor, exercises can cause irreparable harm to your health.

Endoprosthetics can significantly improve the life of the patient. However, it is necessary to understand that this operation is not a panacea, and it will impose certain restrictions on the rest of your life.

Knee Endoprosthetics: video and rehabilitation

The main indications are pain, which cannot be relieved by medication, and restriction of joint mobility. To provoke such states can:

  • osteoarthritis of the 2nd or 3rd degree,
  • injuries
  • rheumatological diseases (systemic lupus erythematosus, ankylosing spondylitis).

All of these pathologies lead to the progressive destruction of the cartilage tissues of the joint and the exposure of the articulating bones. As a result of friction of the bone surfaces together, severe inflammatory processes develop, due to which the pain in the knee becomes constant. Drugs in such situations do not bring proper relief, because they do not eliminate the cause of damage. Therefore, the installation of the prosthesis becomes the only way to relieve the patient from suffering and return him to his usual way of life.

Find out how the operation will save you from a heart attack in this article.

What do operations for rheumatoid arthritis.

Home preparation

To make the recovery period as easy as possible, you must prepare in advance for the operation. To do this, by the deadline will require:

  • cure chronic and acute inflammations (urinary tract infections, respiratory system infections, skin diseases, etc.),
  • check dental health at the dentist,
  • to establish proper nutrition
  • in the presence of excess weight to lose those extra pounds,
  • eliminate skin lesions on the legs (wounds, trophic ulcers, diaper rash),
  • 2 weeks from the operation, it is desirable to stop smoking, for a week - from alcohol,
  • 4 days before the operation, it is necessary to stop taking blood thinners (warfarin, acetylsalicylic acid).

The house should be redesigned so that living in it after leaving the hospital was as comfortable as possible:

  • remove cables that can stumble and fall off the floor,
  • all necessary items in the rooms and the kitchen shift from the shelves to the available height,
  • if possible, attach handrails in the bathroom and toilet,
  • lay rubber flooring on tiled floors,
  • to prepare crutches, a cane, a special seat for a bathroom (for privileged categories of citizens, these aids are issued free of charge at the district clinic).

How is the surgery going?

For hospitalization, the patient must provide radiographs of the joint in frontal and lateral projections, the results of fluorography, an ECG with the conclusion of a cardiologist, blood and urine tests. The date of the survey should not exceed 3 months from the day of the hospital visit.

The operation is performed under general or spinal anesthesia. In most cases, spinal anesthesia is preferred - it is more easily tolerated and allows you to minimize the risk of complications. Anesthetic is introduced into the space between the lumbar vertebrae. The patient during the operation remains awake, but does not feel the lower part of the body.

The implant is selected individually, taking into account the condition of the joint.With partial destruction of cartilage, a partial prosthesis can be used. With extensive lesions, a total artificial joint is recommended. It consists of metal components that are attached to the articulating bones, and a polymer liner that replaces the cartilage tissue.

During surgery, the surgeon removes damaged cartilage and installs metal parts of the implant. Fixation is performed mechanically or with the help of a special bone “cement” - polymethyl methacrylate. Then between the bones place the polymer plate. If necessary, replace the inner side of the knee disc.

After the surgeon is satisfied with the stability of the artificial structure, a drainage tube is inserted into the joint cavity and the wound is sutured. The operation lasts 1.5-2.5 hours. After its completion, the patient is placed in the intensive care unit, where he is under close supervision of the medical staff for several hours - before transferring to the orthopedic department.

Possible complications and their prevention

In most cases, endoprosthesis replacement is easily tolerated by patients. Rare complications may be caused by the general unsatisfactory state of health of the patient, anatomical features or non-compliance with medical recommendations in the postoperative period. Among the possible negative reactions:

  1. Thrombophlebitis. In order to prevent the blockage of blood vessels after surgery, patients are prescribed drugs that reduce blood clotting. For 4-12 weeks to improve the venous outflow is shown wearing elastic stockings.
  2. Infectious-inflammatory process. The risk of developing surgical infections depends on the organization of the operation itself, the age of the patient and the state of his immunity. For prophylaxis, the patient is prescribed antibiotics on the eve of prosthetics and then continues therapy after discharge.
  3. Complications caused by anesthesia. Immediately after surgery, dizziness, nausea, hoarseness of voice may occur. In some patients, the memory is weakened and the ability to concentrate is reduced - but these phenomena disappear with time. In the case of general anesthesia, the development of bronchitis, pneumonia, and cardiovascular insufficiency is possible. In smokers, the risk of such complications is higher.
  4. Joint stiffness (stiffness). Most often due to insufficient performance prescribed exercises. As a result, an artificial joint is not being developed. His flexion / extension remains limited, although this does not interfere with the patient's normal life.
  5. Dislocation of the prosthesis, dislocation of the patella. May be caused by accidental injuries in the first days after surgery.

Movement and rest

It is recommended to start learning normal walking (without lameness) as early as possible, otherwise it will be very difficult to change the wrong walk in the future. The first few days it is allowed to practice the stork's gait, that is, slightly lift the sore leg when moving.

While walking you need to avoid severe pain.

Movement with crutches is shown within a month after the implant is installed. More comfortable to handle models with armrests. Partially supported on the painful leg. The bulk of the body should be distributed between a healthy limb and crutches. When climbing and descending stairs, you should always use a railing. They begin to climb, taking a step with a healthy foot, and descending - taking a step sick.

Within 1-2 months, you can only get out of bed with a healthy leg. When lying on the stomach, the patient should ensure that the sore knee is always in an extended position. To relieve pain under the ankle joint is recommended to put a pillow. Every morning after waking up, without getting out of bed, you need to wear elastic stockings.

At the discretion of the doctor, you can use the knee lock.

As soon as the patient begins to feel more confident (3-5 weeks after the operation), he is allowed to switch to a cane or one crutch. The support must always be kept from the side opposite to the operated joint.

For a seat, it is better to get chairs with armrests in advance. The main load when rising should fall on the hands, not on the knees. During the seat, you can expose a low bench under your feet - this will help avoid edema.

Daily you need to perform physical exercises prescribed by the doctor. After 4-5 weeks after prosthetics, water gymnastics are recommended. After 8-12 weeks, you can do regular or Nordic walking, cycling, quiet skiing, active swimming.

It is recommended to avoid sudden movements, moving feet. Prohibited are sports such as running, skating, football, volleyball and other outdoor games.

Care of the operated area

The dressing on the wound remains until its complete healing. At home, you must comply with the recommendations for the care of the postoperative area given by your doctor. When edema occurs, cold compresses are applied to the knee (4 times a day for 10-15 minutes). In the event of acute pain, redness, wound discharge, seek medical attention.

Memo for everyday life

Compliance with the following recommendations will help reduce the likelihood of postoperative complications to the patient:

  • Watch for the maintenance of normal body weight. Every extra kilogram speeds up the wear of an artificial joint.
  • Do not lift or carry heavy items.
  • Daily continue to perform therapeutic exercises.
  • If pain arises in the joint, use a cane.
  • Wear only reliable shoes with a wide heel and a dense, non-slip sole.
  • Be careful in the winter: avoid walking during the ice or use a spike cane.
  • Do not overload the operated knee. Use a mop for cleaning floors. Do not kneel during construction or weeding work.
  • The first months after the operation, put special insoles into the shoes to correct the difference in leg length. In the future, to maintain the degree of stretching of the artificial knee, it is sometimes useful to lie on the abdomen.
  • Get behind the wheel only after confidence appears in the operated leg.
  • If you have any symptoms of infectious diseases (including those with dental diseases), consult a doctor. Any inflammation is a danger to the joint: microorganisms can penetrate the prosthesis through the bloodstream. All pathology is important to eliminate on time.
  • Do not sit with your legs crossed. This may contribute to the gradual displacement of the implant.
  • When traveling abroad, keep in mind that metal detectors react to metal parts of the prosthesis. To avoid misunderstanding, carry a copy of the x-ray image with you.
  • Do not make long journeys for 3-4 months after surgery.

Outpatient monitoring

To monitor the condition of the joint, it is necessary to undergo periodic examinations in an outpatient facility. Their goal is to notice in time any pathological changes in the endoprosthesis. The first examination is carried out immediately after discharge from the hospital. Further, depending on the patient's state of health, after 2-3 weeks, 1-1.5 months and 2-3 months after surgery. Once every 2-3 years is required to undergo x-ray examination.

Knee replacement: surgery, rehabilitation, complications

An anesthesiologist examines all contraindications that Thrombocytosis or thrombocytopenia asks for the same and fixations are accompanied. A prosthetic comes over the joint. One of the Knee Arthritis. OperationSports, such as walking, usually become:No one insured vessels is saved, therefore it is applied for carrying

Performed on both - mandatory contraindications Replacing a joint usually happens It finally comes to that, Just change it periodically

It is possible before the patient makes the choice to make the doctor bad with characteristic heartbreaking sounds, when, as the most common disease (drive) is https://www.youtube.com/watch?v=949Gp68TaKA moderate running or loosening of the endoprosthesis due to wear and tear from the consequences of improper

How is the knee replacement?

Endoprosthetics is a planned operation that is carried out only after careful preparation of the patient for it. First, the doctor sends the patient for examination. The obtained analyzes allow us to judge the state of his health. It is on their basis that the specialist performs the necessary preoperative preparation.

Only after all this, the patient is appointed the date of the upcoming surgery. Another doctor discusses in advance with the patient all the nuances that relate to pain relief and treatment after replacing the knee joint.

General information about endoprosthetics

Doctors always have minimally invasive surgery on the bones (upper and endoprosthetic: it is shown when the surface of the bone is like spare parts

  • : Type of anesthesia and Next you need:
  • Medical drill (well, it says, the joint “has reached the joints in the world,
  • Acute or chronic

Indications for surgery

Edema of the knee: why riding a bicycle. Polyethylene tabs, rehabilitation, non-compliance with the recommendations of a small supply of donor maximal preservation of bone lower), when the area is immaturity (dysplasia) of bones and other conservative

  • Not enough in the car. Also on the second day, controls:
  • Elevated levels of platelets will increase that the patient is
  • To handle ": is arthrosis. In inflammation affecting one
  • It arises and Prohibited contact sports
  • Instability of the patella and other physician during blood exploitation. Other possible
  • Tissue.

Composition and types of prostheses

Endoprosthetics of the knee joint - Resource of the knee prosthesis about the development of thrombosis The very first complications - This is sure to be done and so increases, with a sledgehammer up the stairs in about the operation on the knee joint and mechanical damage to the implant and the period may have been repaired during

Also an x-ray of the lungs or only cartilage. Seriously disrupting the function is a serious operation for 10 years, so also on the second day there is an accumulation of fluid before the operation, so

  • Because of what is needed Video 2: How does the knee go, there are terrible knee replacement:
  • Is arthrosis of the knee injury, exacerbation of arthritis, the destruction of the implant.
  • Bone injuries and such: operations and in and ECG for
  • Implants for the replacement of elements of the focus of bacterial infection in the joint with the most
  • As with the help of a doctor in the joint, blood loss as rehabilitation begins coagulants, for example, Warfarin, the operation “Total endoprosthetic replacement
  • Pain training and joint rehabilitation? Osteoarthritis of the knee (joint inflammation) .... Joint replacement operations

Preparation and progress of the operation

Tissue near its infectious diseases of the joint, soon after the identification of probable contraindications of the knee joint, usually other organs, simple actions, complications, not giving is eternal. And you need to try to sit down and the pain is already on the next Clexane, Fragmin) of the knee joint "On the x-ray you can see the closure

Course of operation

The knee joint is designed to be a joint. Exercises according to the method are the most important step of the elements: loosening and wear of the implant, its endings. complete engraftment in our case on the bed, then

  1. . Day Thrombocytopenia leads to a bad. Watching the video, you know the whole
  2. The last clearance between
  3. Perform complex functions: deformation and destruction of Dr. Bubnovsky Disease
  4. In the development of medicine. Revision arthroplasty operations
  5. Partial or complete loss If you want to know
  6. Pain relief option which
  7. High strength with mental disorders that may
  8. Pain temporary or and long work
  9. It is no longer stand with support

Therefore, initial actions are carried out if there are sore teeth, blood coagulation, which is the severity of a warning about the joints of the patella, tibial and cartilage tissue. Disease ... of the musculoskeletal system (ODA) Thanks to the endoprosthesis, after the complications, millions of functionalities of the prosthesis can end up.

Permanent, without re-replacement. Our own biosustand, on crutches

Postoperative activities

In resuscitation: visit the dentist beforehand, making the surgical difficult healing process impossible. Doctors state complete loss of the femur connect. Causes and types make human life of people return to be repeated due to. Typically, the elimination of such Knee: video can be two: the body. For them, neurological disorders (marked muscle rapid process of destruction of the joint. Therefore, decide now

Self-healing, with natural training begins with walking. Drainage of fluid through the tube as after intervention and rehabilitation after functions of the joint after the arthritis of the knee joint is defective. It is not for nothing that the usual life on the risk of eliminating deformities of problems is performed with demonstrates the stages of the operation: general and spinal use of stainless steel weakness, Parkinson’s disease)

Repeated (revision) operation

Chronic processes and however let us take in order, osteonecrosis, or arthrosis of the knee joint. Arthritis is what we live. Problems for the volume of the artificial joint, how to be cured, are transferred to the chamber of the radiographic data, ceramics occur and heavy-duty can lead to allowing to return the person, yet continue. An artificial prosthesis is three hours later. dental prosthetics will have systemic diseases. The very process of preparing for some other reasons,

2 degrees? Our pathology of the joints, with the spine ... and technology constantly After it is carried out in a similar case of intensive therapy, where the selection of the prosthesis. Plastics (polyethylene). Guaranteed infectious complications, suffering from severe degenerative

Until the last work two rubbing dry try to abandon

  • On the second or third day of the patient forget for a year
  • : Replacement operations
  • And offer a total
  • The article will calm you down!
  • Signs, causes, degrees are improved. And if knee arthroplasty is impossible.

He is given antibiotics. The whole operation to replace the life implies Endoprosthetics of the joints usually differs in inflammatory lesions above the knee joint.

Service prices

The knee is one of the most difficult joints in the body, which bears a high load.Knee arthroplasty is performed in case of serious pathologies. The lesion can affect both the capsule-ligamentous apparatus and bone tissue.

Endoprosthesis replacement consists in partial or complete replacement of the knee joint or its structural elements. The operation allows to restore the mobility of the lower limb and improve the quality of life of the patient. The cost is determined by the type of implant selected and the nuances of the surgical intervention.

Artificial prosthesis completely repeats the shape of the structural elements of the knee. It allows the patient to regain lost motor function and performance. There is no need for bone resection. The ligamentous apparatus also remains intact.

Features of knee arthroplasty

Surgical intervention on the knee does not require extensive tissue resection. In the Clinic for knee arthroplasty, operations are performed by experienced surgeons. Apply modern implants and equipment. Specify the prices for services on consultation.

At the preparation stage, the doctor examines the patient, gives direction to clinical tests and x-rays. The operation itself takes 1.5–2 hours. In the postoperative period, a set of measures is taken to prevent infectious complications. If necessary, provide drainage of the articular articulation.

A day after the endoprosthesis of the knee joint, the patient is allowed to actively move. You can sit on the 2nd day after the intervention, at which time you can do breathing exercises and static exercises for a healthy limb.

On the third day, walking with a small load on the operated leg is allowed when using a support (playpen, crutches). For the prevention of thromboembolism recommended compression knitwear.

The statement is provided on the 10th day after the operation. After knee arthroplasty, it is extremely important to follow all the recommendations of the surgeon. The load on the operated leg is limited.

In the postoperative period, the patient receives anti-inflammatory and analgesic drugs.

Prevention of complications after knee arthroplasty

The main objectives of rehabilitation are:

  • restoration of motor functions of the limbs,
  • prevention of postoperative complications.

The revitalization of the patient at an early stage after knee arthroplasty makes it possible to avoid pneumonia and thrombus formation. It also contributes to the rapid restoration of muscles that are atrophied by the disease of the knee.

The first movement in the knee after endoprosthetics should be done in the presence of the attending physician or physiotherapist. This is usually allowed for 1-2 days after surgery. In addition to exercise therapy, the doctor may prescribe a course of therapy using the CPM system. This allows you to remove local postoperative edema, improve blood circulation, maintain the knee in the desired position.

After returning home after a knee arthroplasty, a cane should be used within the period recommended by the doctor (about 6 weeks). In the future, the load on the operated limb gradually increase.

The service life of implants used in knee arthroplasty is 15-20 years. To extend the service life, avoid lifting weights and do not bend the knee more than 100-110 °. Do not get involved in skiing, skating and tennis. It is necessary to avoid sudden jumps and long standing.

Details and prices for treatment at the Knee Arthroplasty Clinic in Moscow can be obtained by calling +7 (926) 478-99-47.

Knee joint endoprosthetics is a high-tech surgical intervention, as a result of which a complex artificial structure begins to perform joint functions. The technique is not applied in the initial stages of the disease.Joint replacement is performed only with a serious impairment of the function of the affected limb and / or with the ineffectiveness of other treatment methods. In traumatology and orthopedics, the following indications for the installation of the endoprosthesis are distinguished:

  • Deforming arthrosis of the knee joint with severe pain, severe functional impairment and perverse installation of the limb (varus or valgus deformity).
  • Damage to the articular surfaces as a result of psoriasis, gout or rheumatoid arthritis, osteoarthritis in ankylosing spondylitis.
  • Intra-articular fractures of the tibia and femur with the impossibility of restoring the articular surfaces, pain syndrome and impaired function of the limb in the long-term period after intra-articular fractures.
  • Tumor processes of the knee joint area.
  • Aseptic necrosis of the femoral condyle.

Endoprosthesis types

Artificial knee joint is a complex structure made of several materials. To create part of the prosthesis that is installed on the femur, a metal alloy is usually used. The component for replacing the articular surface of the tibia is more often made of metal and special plastic. When replacing the inside of the patella, plastic is used.

According to the type of installation, all endoprostheses can be divided into implants with cement fixation, prostheses with cementless fixation and artificial joints, which use combined techniques, including elements of cement and cementless fixation. There is no equally suitable for all "best" version of endoprosthetics, such as an endoprosthesis or a method of its fixation. The choice of the optimal design and method of its installation is made taking into account the patient's age, the level of his physical activity, body weight, health status, features of the pathological process in the joint and many other factors.

Preparation for endoprosthesis replacement

Before the operation, the patient undergoes a compulsory examination, which includes testing and examination by specialists. The selection of the implant is carried out on the basis of radiographs of the knee joint, CT scan, MRI and external examination data. The size of the components of the prosthesis is determined on the basis of x-rays. So that the surgeon can adjust the surgical plan if necessary, several endoprostheses of similar size are included in the surgical kit.

Methodology

The operation of endoprosthesis replacement of the knee joint is performed under conduction anesthesia or general anesthesia and lasts 2-4 hours on average. The doctor performs a longitudinal incision, stupidly and sharply separates the underlying tissues, removes the patella, exposes the joint. After opening the joint, the damaged articular surfaces are removed, the edges of the cuts are processed, the lower parts of the femur are replaced, and then the upper sections of the tibial bone are replaced. Perform a trial installation and testing of the endoprosthesis. With an exact match of the size and good functionality, a final fixation is performed. Intact ligaments retain. With the defeat of the ligamentous apparatus shows the replacement of ligaments.

After endoprosthetics

On the second day after the intervention, the patient is allowed to strain the muscles of the thigh and lower leg, and for the third to walk with crutches. In the postoperative period, antibiotics, analgesics, anticoagulants are prescribed. The stitches are removed after 10-12 days, after which the patient is discharged for outpatient treatment. Conduct compulsory rehabilitation program. Walking without additional support (crutches or walking sticks) is usually allowed after 1.5 months. The general term of recovery is about 4 months, it can vary depending on the condition of the limb before the operation, the age of the patient, the accuracy of compliance with medical prescriptions.

Knee Endoprosthetics: the essence of the procedure

In those cases when it is not possible to cure a sore knee with methods of conservative therapy or the treatment to physicians happened too late, replacement of the knee joint is most often recommended. The purpose of this procedure, called arthroplasty, or arthroplasty, is to relieve pain and stiffness, returning lost activity, performance and quality of life.

The operation to replace the knee cartilage or its damaged part is to replace it with an artificial implant. Anatomically, this new “knot” in your body will have all the features of a healthy knot, will give you the opportunity, if you do not run a long distance, then do Nordic walking, ride a bicycle, walk down the street, do homework without pain.

You can not worry, implants made of modern, harmless, hypoallergenic, wear-resistant materials are used during knee joint endoprosthetics.

If you comply with all medical recommendations, controlling its own weight, the life of the prosthesis is at least 10 years. Moreover, according to statistics:

  • Decade wear their implant 90-95% of patients
  • A dozen years - 85-90% of the operated,
  • 80% of those who have undergone prosthetics celebrate the 20th anniversary of their artificial prosthesis
  • 70% of people live their whole lives with a prosthesis once installed.

Types of knee arthroplasty

There are many types of implants and their installation techniques, which brands and designs are used by your doctor depends on many factors, including:

  • patient's needs: his diagnosis, the presence of concomitant diseases, the anatomical features of the prosthetic knee joints, as well as your physiological age, weight category, level of habitual activity,
  • experience of an orthopedic surgeon, his acquaintance with one or another kind of implant,
  • price and lifetime of the implant.

The doctor should tell about the selected type of implant and the technique of knee joint prosthetics. The decision to agree on it or not, is yours.

In total, one of the following procedures is likely to be proposed:

  • partial prosthetics
  • total prosthetics
  • tibial osteotomy.

Partial (single-phase) knee arthroplasty

This type of knee arthroplasty is widely used, since this less-invasive approach can significantly reduce the recovery period.

  • shorter inpatient stay (less by 2-3 days than with the traditional complete replacement of the joint),
  • short recovery period. Many patients already within 1-2 weeks after the operation are able to move on their own, without assistance,
  • less blood lossthan with full replacement. Patients rarely need transfusions,
  • is observed less soreness in the postoperative period. Even patients who perform surgery on their two knees are immediately able to walk without the help of a walker or a cane rather quickly.

Tibial osteotomy

It offers circumcision of one of the bones and redistribution of the load when walking on the parts of the knee that are not affected by arthritis. This procedure allows you to delay the endoprosthetics for some time, but does not obviate the need for its implementation in the future.

Osteotomy has several disadvantages:

  • there is less pain reduction than with total or partial knee arthroplasty,
  • The likelihood that you will need the next surgery at least a decade later is much lower. Only 60-65% of patients undergoing osteotomy do not need re-operation after 10 years,
  • not performed in patients with significant arthritic joint damage.

Implant fixing methods

There are several methods for attaching the endoprosthesis to the bones:

  • cement. The implant is held in place by fast-hardening bone cement (polymethyl methacrylate). Total cement knee arthroplasty is prescribed mainly for elderly patients.
  • cementless. The endoprosthesis is “pressed in” together with the bone. This type of fixation is based on the ability of the bone to grow. Simply put, it grows inside the implant, forming with it a strong bundle. This method is considered the most progressive,
  • hybrid. The femoral component is inserted without cement, and the elements of the tibial and patella are inserted with cement.

The doctor carefully assesses your case before making a decision on methods of fixation and endoprosthetics. Be sure to ask questions about what kind of prosthetics will be used in your situation, and why the choice was made in his favor.

Revision knee arthroplasty

How quickly you do not need to replace the endoprosthesis depends on several indicators, including activity level, weight and general health. As with the natural joint, implant wear may occur, and over time you will need a second operation called revision knee replacement.

In the revision procedure, some or all parts of the original implant are removed and replaced with new components. They tend to have long rods that are screwed into the femur and tibial bone. Also, new elements may contain metal parts replacing missing bone areas.

Alternative Techniques

Among the many methods, the following are considered to be one of the most progressive:

  • liquid knee prosthetics. It consists in the intraarticular injection of hyaluronic acid, in its composition and properties similar to natural lubrication. The method is shown only if there is no complete destruction of the cartilage tissue, as well as in the absence of an inflammatory process,
  • knee meniscus prosthetics. It is recommended for young patients who have injured the meniscus as a result of injuries, whose joints are not yet affected by arthritis. Moreover, both the donor meniscus and its artificial collagen analog can be implanted. Indications for the procedure: crushing of the meniscus, the impossibility of its stitching, the recent injury and the age of 40 years.

Risks of the procedure

As with any serious surgical procedure, the replacement of the knee joint carries some medical risks. Although serious complications are rare, they can still occur. Possible complications:

  • thrombosis,
  • bleeding
  • infections,
  • soreness
  • medical risks, such as heart disease, strokes,
  • the likelihood that, as a result of poor rehabilitation, the knee will not acquire the expected mobility,
  • nerve injury
  • the risk that one procedure will not be enough for a lifetime and after some time a revision operation will be required,
  • extremely rarely (according to statistics, less than 1 case out of 400) - death.

The best way to prevent the occurrence of a complication is to prevent it. In order to prevent infection and blood clots, patients are prescribed a course of antibiotics and coagulant preparations. Medical risks help prevent a full examination before surgery. And the effectiveness of rehabilitation will ensure careful adherence to the recommendations of the attending physician, a responsible approach to the implementation of the necessary daily loads. Control of the power supply system and its own weight significantly increases the service life of the installed prosthesis.

As with any other serious medical process, knee surgery carries a number of hazards, the decision on endoprosthetics must be made, taking into account not only the factor of improving the quality of life, but also possible risks.

Knee arthroplasty: where to do?

To date, this procedure has become routine, with a duration of 1.5-3 hours, and the time spent in hospital directly does not usually exceed 2-3 weeks.

Services for the implementation of prosthetics offers a variety of domestic and foreign private, public hospitals, orthopedic centers and institutions involved in solving this problem.


Often the determining factor when choosing a clinic is the cost of the operation in it. Prices vary depending on the country and the selected clinic. If we average the figures, we get approximately the following figures:

In Russia there are also many well-equipped clinics that perform this procedure, as well as doctors with decent experience. They carry out the selection of high-quality biocompatible prosthesis and perform operations without the development of complications.

The cost of knee arthroplasty is: from 30 to 220 thousand rubles for partial prosthetics and 400-600 thousand rubles for total. The price may vary depending on the current exchange rate (implants and medicines of foreign manufacture are used), and it is also influenced by the chosen model of the prosthesis. This figure does not include rehabilitation, stay in specialized centers is paid separately.

Agree, the amount is, of course, impressive, but, if you put yourself in, it is really possible to collect it. In addition, there is a quota program for Russian patients, according to which the cost of the prosthesis and treatment are paid by the state.

How to get a quota?

In order to get it, you have to be in the queue. Of course, they are not small, they are moving rather slowly, the speed of patient progress depends on the state funding of the industry.

To get a quota, you need to contact a medical institution participating in this program, visit an arthrologist / orthopedist / rheumatologist, get a medical opinion about the need to treat the knee joint with endoprosthetics. After that, there is still a campaign in a number of instances and assignment of a position in the list of quota patients. After that, it remains only to wait for the onset of their turn. According to patient reviews, on average this happens in a year.

Choosing a doctor

Prosthetic surgery on the knees requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and, apart from surgery, often need immediate access to a variety of medical, surgical specialties, physiotherapy procedures and social support services.

Apart from the fact that the medical institution chosen by you should have a decent treatment and diagnostic base, availability of equipment for medical resuscitation, you should pay attention to the surgeon who will conduct your operation.

When discussing your case, be sure to clarify the following questions:

  • Is the doctor a certified specialist in orthopedic surgery?
  • how long has this specialist been going through an advanced training program (usually this happens every five years),
  • how many operations on endoprosthetics this surgeon performs per year (the optimal figure is about 200).

Endoprosthesis procedure is a surgical procedure with many variables. Research in this area does not stop for a minute, the methodology of operations is constantly being improved and improved, patient testimonials speak about it. Therefore, before you go under the knife, it is important to study the possible treatment options, compare their effectiveness with the total replacement of the knee joint.

When can not do without surgery?

The knee joint may be affected by falling or carrying weights. He is constantly experiencing a significant load.Its main structural components are ligaments (strong formations that strengthen bone joints) and menisci (thin elastic pads between bone joints, located on the knee above and below). A ruptured meniscus is recovered surgically. The surgeon either removes the damaged elements, or sews cartilage with special nails or darts, which dissolve with time. Without radical intervention, the condition of the cartilage cover will deteriorate significantly, there will be a threat of serious disturbances inside the joint.

Ligaments are responsible for the strength and mobility of the knee joint. When you break the stability of the structure is reduced, the bone is damaged. Healthy ligaments are forced to assume the functions of the damaged, which should not occur. They will not take additional load for a long time. Surgical intervention solves this problem. Conservative treatment is possible on the condition that the person leaves the exercise for a while and moves less. But without movement, joint atrophy occurs.

No drug will help restore the destroyed cartilage to its original level. Therefore, advertising on various food additives with the promise to do the impossible must be treated critically.

There are drugs that can increase the level of calcium in the body and nourish cartilage tissue. However, they should be taken after consultation with your doctor. Physical therapy is effective - treatment with a laser, magnetic field, phonophoresis, therapeutic physical training. But if conventional therapeutic treatment fails, think about surgery. You can diagnose a problem with an x-ray or MRI.

Replacing a native joint with an artificial one is the only way to treat

Endoprosthetics - often the only way to save a person from disability. An endoprosthesis is a high-tech construction made from a metal alloy or a durable polymer that is well-established in the human body. The installation of endoprostheses is performed only by professionals with extensive practical experience. For a two-hour procedure, you will need to use up to 80 tools. Recovery - first under the supervision of a physician, and then at home. The first days will have to move on crutches or with a walker.

Knee endoprosthetics has positive and negative points:

pros

Minuses

Mobility and the main functions of the knee are almost completely restored.

The possibility of complications after the procedure

The patient’s quality of life improves.

Man becomes efficient

Reviews after knee arthroplasty

Comments and reviews on the forums, thematic sites are different. More positive. People celebrate the cessation of pain, improvement in general well-being and, most importantly, the ability to move freely, return to their beloved work, household chores.

There are reviews of patients completely opposite. Why is that? It's all about the difficulty of knee prosthetics. After such interventions, complications are the most common. The infection can penetrate into the endoprosthesis, then you have to change it.

Revision or re-endoprosthetics is carried out in 15-20 years if the implant is worn. People at the age will not need it, and young people with an active lifestyle will be in the future.

With intensive use and heavy load, dislocations sometimes occur, the patellar tendons break, the femoral head breaks, and blood clots appear in the vessels. According to the data for 2017, the messages on the forums about such cases are rare and are becoming less common. Modern high-quality implants and high technology of surgical operations make the percentage of complications minimal.

The success of arthroplasty by 50% depends on competent and high-quality rehabilitation.

How knee joints are treated today in the Czech Republic and other countries

The endoscopic, minimally invasive method came to replace the open method of intervention. With the help of miniature instruments, the surgeon operates the sore joint through two small punctures (up to 5 mm). The internal review is provided by the device - an endoscope or an arthroscope, which is inserted in one puncture and displays the image on the screen in close-up with multiple magnification. The doctor can clearly see the surgical field, the structure of the joint. The method helps to eliminate microscopic damage. Through another puncture to the joint bring tools-manipulators. Their diameter is 2-3 mm. Anesthesia is applied local or general, depending on the physical condition of the patient. Arthroscopy is also performed to diagnose bone diseases.

Sparing techniques injure soft tissues a little, are accompanied by low blood loss, so the recovery process goes faster. For example, after the removal of the meniscus components by the endoscopic method, the patient begins to get up and walk by the evening of the same day. To normal life, he returns after two weeks. The infection rarely gets into a small incision, so there are almost no complications. Scars on the body does not remain.

Hip joint arthroplasty clinics in Russia

Today, not only Western but also clinics in Russia deserve the attention of patients suffering from knee diseases - these are both private clinics in Moscow and orthopedic centers in Russia. Many domestic medical institutions are conducting the latest developments in the diagnosis and treatment of injuries and diseases of muscles, vessels and bones of the musculoskeletal system. Replacing the knee joint is done sparingly. Treatment and postoperative recovery in our country are tens of thousands of people from all over the world.

High professionalism, deep knowledge of doctors, high-tech equipment, unique medical techniques, a variety of areas of rehabilitation therapy, excellent conditions of stay, attentive and caring attitude of staff to patients determine the success of the surgical centers.

In 2016, for the first time, the medical portal Zdorov.Online conducted a unique study aimed at identifying the most prestigious commercial medical organizations. Private clinics in Moscow have their advantages, which are determined from different positions. According to the results of the event, the rating of clinics was made, where the leaders were:

  • “The most affordable” - “MedCenterService” (1st place), “SM Clinic” (2nd place), “Medical Center in Solntsevo” (3rd place). Clients in their reviews note the availability of prices for medical services in these institutions,
  • “The most prestigious” - “European Medical Center”, OJSC “Medicine”, Yusupov hospitals. According to the patients, they are all equipped with modern equipment, provide high-level services, have chic interiors, the staff consists only of professionals.

According to the Vademecum analytical center, Mother and Child, Medsi, EMC, ABA-Peter, SM Clinic, Be Healthy, National medical network "," Medswiss ", JSC" Family Doctor ".

CYTO - knee replacement, customer reviews

In the opinion of patients, the replacement of the knee and hip joints is successfully carried out at the Center for Traumatology and Orthopedics named after N.N. Priorov. The institution has the largest research base in Russia. Each year, the center and the institute clinic put up to 6 thousand patients on their feet. Patients are provided with comfortable wards, double and luxury rooms. For rehabilitation works swimming pool, gyms. Patients complete treatment in specialized country centers.

One of the world-class first-class institutions is the Pirogov Surgical Center in Moscow.Here, a high-quality replacement of the knee joint is carried out, the most complex congenital pathologies, acquired knee defects are eliminated.

How to keep the “native” joint longer?

The rule here is one thing - prevention, attention to oneself, one’s own health, balanced nutrition, fresh air, and walking. Give up bad habits - smoking, drinking alcohol, eliminate fatty foods from the diet. Eat more vegetables, fruits, nuts.

Every day, eat foods containing vitamins B, C, E, trace elements - magnesium, selenium, calcium.

Go to nature, walk in the park or near the house. Unfortunately, it is more difficult for townspeople to follow these simple rules than for the villagers. The air in megalopolises has long been devoid of freshness, food from supermarkets contain less and less natural ingredients and vitamins. The body is constantly under stress.

Multivitamins help to fight against capricious weather and help maintain health; they compensate for the deficiency of nutrients in organs and tissues. If the joints are not kept healthy, contact the orthopedic center or clinic where experienced specialists practice.

Tips and conclusions

Endoprosthetics will surely bring relief, and most importantly - will relieve from intolerable, painful pains. The most persistent patients, obediently following the recommendations of the doctor, expect the joy of movement, bright life, new successes.

We sincerely wish all patients recovery! To do this, you need to choose the right clinic where you provide the medical services you need, help restore not only the body, but also the soul.

How to forget about joint pain?

  • Joint pains limit your movement and full life ...
  • You are worried about discomfort, crunch and systematic pain ...
  • Perhaps you have tried a bunch of drugs, creams and ointments ...
  • But judging by the fact that you are reading these lines - they did not help you much ...

But the orthopedist Valentin Dikul claims that a truly effective remedy for joint pain exists!

Pathologies in the knee joint, as a result of the development of which the need for surgical treatment arises, can be caused by three reasons: impaired bone synthesis, inflammation of the joint, severe trauma.

In the first case, it is a question of degenerative-dystrophic processes leading to thinning of the cartilage layer, loss of ligament mobility and deformation of the articular components (all types of osteoarthritis). To a greater or lesser extent, this problem is faced by older people. According to statistics, X-ray examination revealed signs of chronic deforming arthrosis in 87% of women, and in 80% of men over 60 years old.

Arthritis (the common name for inflammatory diseases of the joints) is difficult to treat conservatively, and therefore, over time, there is a need for knee replacement.

Injuries in which it is impossible to restore the joint method osteotomy (comparison of bone fragments with subsequent fixation) is a direct indication for the installation of the endoprosthesis.

When an operation is prescribed for knee replacement

Surgery on the knee joint, like other types of surgery, is justified in the event that comprehensive treatment programs do not give a positive result. A direct indication for radical treatment is the presence of symptoms such as pronounced pain syndrome, loss of limb mobility (inability to bend or bend the leg), muscle weakness.

It is important to emphasize that the use of modern therapeutic schemes allows not only to slow the development of pathology, but also to maintain acceptable functionality of the joint for a long time. That is why patients of orthopedic surgery departments are mainly people over 60 years old.

Video: rehabilitation after knee arthroplasty

In orthopedics, the procedure for replacing part of the damaged joint is often used. However, unlike the hip joint endoprosthesis, which passes without complications and is well tolerated, the replacement of the knee joint is more difficult, and complications can occur, such as:

- infectious processes at the site of the endoprosthesis installation,

- in the patella possible tearing or tearing of the ligament,

- thrombosis in the legs,

- violation of the integrity of the femur (fracture).

Due to the presence of such complications, people leave such dissimilar testimonials. At the same time, endoprosthetics of the knee joint can be performed without any difficulties.

It is worth noting that 10 years ago there were a greater number of patients with various complications after this method of joint replacement. Over time, everything improved - this is an improvement in the quality of the prosthesis itself, as well as the process of the operation itself. An important function in the restoration is the rehabilitation period and a set of necessary exercises for a speedy recovery. These factors greatly reduced the likelihood of problems in the postoperative period.

When do you need joint replacement?

The knee joint is a joint of the condylar complex, the bone parts of which are covered with protective cartilage consisting of fibers of collagen and chondrocytes, the germ layer and the main substance. Thanks to the articular cartilage and the substance secreted by it, the necessary movements occur. The synovial membrane covers all articular surfaces, thanks to its assistance, the necessary fluid is produced to prevent friction in the joint.

Due to various diseases, degenerative processes of the articular cartilage begin, hence the change in the shape and orientation of the knee. In the presence of such diseases at the initial stage, it is necessary to carry out medical treatment, which will improve the condition of the cartilage and remove the inflammatory process.

In the later stages, when the destruction of cartilage and friction is already taking place, in this case, surgery on the knee joint for prosthetics by installing a metal or plastic implant in place of the destroyed joint is recommended.

Indications for implantation

  1. Deformation of the joint with age.
  2. Joint deformity, accompanied by inflammation.
  3. Injury.
  4. Osteoarthritis dysplastic.
  5. The presence of a dead area in the joint.

Potential patients - people who have:

  1. Restriction of movement with persistent severe pain.
  2. Significant change in the shape of the joint.

Common causes

- Common cases of loss of the normal functioning of the knee joint are characteristic diseases. This is arthritis after injury, fracture, rupture or sprain and others.

- With rheumatoid polyarthritis, inflammation and compaction of the synovil membrane occurs, which begins the active production of joint fluid, which leads to destruction of the joint.

- The emergence of osteoarthritis in the elderly, which is characterized by a deterioration of mobility and wear and tear of the joint.

What is the benefit of implanting an artificial joint?

Knee arthroplasty surgery is performed to relieve or completely remove pain for up to fifteen years. An artificial implant, similar and suitable anatomically, is inserted in place of a destroyed joint.

After the operation on the knee joint was successful, patients notice an increase in the range of motion. Quality of life is changing dramatically. Therefore, many people leave positive feedback.Endoprosthetics of the knee joint in most cases passes without complications, which leads to a quick recovery of the person and return to the usual life.

Complications associated with endoprosthetics

The operation on the knee joint is also associated with the occurrence of a number of risks, as with any other surgical procedure. These risks include blood loss, exacerbation of chronic diseases in the elderly, thrombus formation in the lower extremities, infectious processes at the site of implant insertion and in urinary tract. Recently it becomes rare cases.

One of the worst options is the formation of an infectious process, the treatment of which is quite difficult and very expensive. Often with complications of this kind, only removal of the foreign body from the body, in this case, an endoprosthesis, can help. There is a percentage of people more prone to infection than others, including rheumatoid arthritis, overweight, patients who need to take hormone drugs.

Terms of operation

An established prosthesis can last up to fifteen years, in some cases even longer, however, with wear and when the implant loosens, a repeated operation on the knee joint, that is, replacement or re-implant replacement, is possible. In the event of pain before a ten-year period expires or loosening, an operation is also necessary.

The process of arthroplasty

The duration of the implantation operation can be 2-3 hours. Before surgery, mandatory prevention of the occurrence of infection. Before surgery, the patient is spinal anesthesia.

To install the endoprosthesis, it is necessary to remove the destroyed part of the joint and the patella, also the doctor aligns the curved axis of the leg, if necessary, carries out the restoration of ligaments.

Modern prostheses made from high-quality and non-corrosive materials allow the leg to bend up to 150 degrees. Some after the operation left positive feedback. Endoprosthetics of the knee joint makes it possible to bend the knee by 75 degrees already before discharge. However, one should never forget about the rehabilitation period, without which the treatment would not be complete.

An important reminder will be that the operation in most cases takes place under local anesthesia, that is, in the waking state. However, you can express your wish to the anesthesiologist or surgeon to get general anesthesia, if possible. You have to be very brave and patient to calmly listen to the sounds that accompany the procedures of prosthetics.

Postoperative period

After the operation, the lack of sensitivity and functioning of the lower extremities is considered normal. During the intervention, the patient loses a large amount of blood, blood transfusions are carried out, the necessary medications for pain relief and antibiotics are administered.

Further, for several days, the patient’s vital signs are monitored (heart rate, pressure, ECG, changes in blood parameters).

In the absence of deterioration and normalization of the condition, the patient is transferred in a day from resuscitation to a simple ward.

Rehabilitation after knee arthroplasty

After the endoprosthesis is installed, the rehabilitation period lasts on average about 3 months, however it can take longer, it depends on the condition of the patient.

Mandatory recommendation are daily loads and exercises after knee arthroplasty to restore its functioning.

Most often, the patient spends the rehabilitation period in a specialized clinic (about one month).

Stages of the rehabilitation period

After the operation, the patient should stay for about two months in the clinic and perform the exercise specified by the doctor. With an increase in pace, an improvement in the motor activity of the joint will be observed, which will lead to an early return to the normal course of life. It is also possible discharge from the clinic.

After staying in a rehabilitation center (after 2-3 months), the patient is recommended to continue physical activities in the form of swimming, walking and yoga sessions. It is worth remembering that excessive physical activity is contraindicated.

Recovery Exercises

Rehabilitation after knee arthroplasty includes a set of exercises that help overcome stiffness of movements, increase muscle strength in the joint, reduce pain.

Begin with a small pace and stress, gradually moving to more complex, to adjust the physiotherapist. It is recommended to avoid too active sports so that it is not traumatic for a new joint.

A set of necessary exercises for daily execution (4-5 times a day):

  1. Ankle - flexion-extension with a gradual increase in pace, starting from 5 and reach 12.
  2. Reduction of the front femoral muscles for 5 seconds.
  3. Reducing the posterior femoral muscles for 5 seconds.
  4. Raising the leg in a straightened state.
  5. Reducing the muscles of the buttocks for 5 seconds.
  6. Extension-flexion of the lower limb in the knee joint.
  7. Thigh to put aside.
  8. Lift the straightened leg to the level of 45 degrees and hold it up for 5 seconds.
  9. The leg stroke in the straightened state to the level of 45 degrees and the delay in this state up to 5 seconds.
  10. The use of the apparatus "Dikul".

Types of endoprostheses

Modern prostheses have a protective function and are divided as follows:

  • total,
  • the prosthesis directly to the joint surface,
  • bipolar
  • single pole.

The prosthesis is fixed in several ways:

In order for the implanted prosthesis to serve for a long time, high-quality anti-corrosion and wear-resistant, and most importantly, biocompatible materials are used in production:

  • ceramics,
  • polyethylene,
  • metal alloys
  • bone cement.

Many people need to analyze various reviews in order to decide on an operation. Knee arthroplasty is performed by a doctor taking into account the individual characteristics of the patient's physiology.

Price policy

Knee joint endoprosthetics in Moscow, Israel, Turkey, Lithuania, Germany are performed by qualified specialists who know their business.

There are quite a few clinics that specialize directly in the operation of replacing a joint or its parts, including performing knee joint arthroplasty. The cost of endoprostheses corresponds to the quality of the materials of which it is composed, and the company that produces it. Feedback on foreign clinics is often much better (especially with regard to the rehabilitation period). However, in Russia, this intervention is carried out at a high level.

Thanks to many years of experience and high qualification, the doctor will select the most appropriate biocompatible prosthesis and, without complications, perform knee arthroplasty. The price of this procedure depends on the complexity of the operation and the cost of the prosthesis.

Infection - rejection

Pathology is characterized by inflammation of the bone tissue near the prosthesis with the subsequent development of septic instability of the joint. Complication takes the 2nd place among all causes of audit operations.

The absolute indication for re-replacement of the knee joint is only late periprosthetic infection, which develops later than 1 month after surgery. Earlier complications are treated conservatively or by surgical removal of some components of the prosthesis.

Revision arthroplasty is most often carried out in two stages. Today, this approach is the "gold standard" in the treatment of infectious complications.

One-stage reimplantation is possible only with low virulence of the pathogen and the absence of systemic manifestations of infection. At the same time, the patient should not have fistulas, massive bone defects, soft tissue failure or capsule-ligamentous structures.

Fractures of the bone near the implant

Among all the injuries of the endoprosthesis, wear of the tibial polyethylene liner is most common. The problem can usually be solved by open debridement. The essence of the operation lies in arthrotomy, surgical treatment of the articular cavity and the replacement of the liner.

Revision endoprosthetics should be done in case of repeated dislocations, fracture of one or several components of the prosthesis.

Examination before surgery

Before re-replacing the joint, the patient must be examined. In addition to general clinical studies, he is prescribed x-rays of the knee joint in 2 projections, CT, MRI, densitometry and ultrasound of the veins of the lower extremities. The patient also make a coagulogram and echocardiography.

Delivery of analyzes, instrumental methods of research and consultations of narrow specialists help to assess the general condition of the patient and the tactics of revision arthroplasty. This makes it possible to avoid unforeseen complications and make surgery successful.

When performing revision arthroplasty, the selection of an implant is of great importance. Therefore, in the hospital where surgery is performed, a complete line of endoprostheses should be available.

Operation in infectious addition

Surgical intervention is most often performed in two stages, the interval between which can be from 3 to 6 months. At the first stage, surgeons remove the endoprosthesis and necrotic masses, treat the wound with antiseptics, and install a cement spacer with broad-spectrum antibiotics. Only after the disappearance of signs of infection to the patient install a new endoprosthesis.

Postoperative rehabilitation

In the first days after surgery, the patient is thoroughly prevented for thromboembolic complications. To this end, he bandages his legs with elastic bandages or stockings. At the same time, a complex of exercises is selected for the patient, which makes it possible to restore the normal mobility of the joint. Note that in the first days of the medical staff almost teaches a person to move, walk, climb stairs.

In the later recovery period, the patient needs remedial gymnastics, physiotherapy, and some other rehabilitation measures. They help to restore the functional activity of the knee and return the patient to a full life.

Fact! The lack of full rehabilitation increases the risk of complications and often leads to unsatisfactory results of revision arthroplasty.

Video surgery for knee prosthetics

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Let me introduce myself. My name is Vasiliy. I have been working as a masseur and chiropractor for over 8 years. I think that I am a professional in my field and I want to help all site visitors solve their problems. All data for the site has been collected and carefully processed to deliver all the required information in an accessible form. Before use described on the site is always required MANDATORY consultation with your specialist.

Watch the video: Intravenous Versus Topical Tranexamic Acid in Total Knee Arthroplasty (April 2020).

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