Total knee replacement is indicated in patients with knee arthritis that has not responded sufficiently to conservative treatment with anti-inflammatories and analgesics. Knee replacements are usually performed in older people when stiffness and / or pain significantly affect activities of daily living.
Total knee replacement is a well established operation with good longterm clinical results. The procedure basically involves opening the knee joint and replacing both joint surfaces with a metal on plastic articulation.
The Cape Joint Surgery surgeons are both super-specialist fellowship trained knee surgeons with extensive experience in the diagnosis of knee problems in adults and children.
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If there is a knee deformity present at the time of surgery, this must be addressed with the total knee replacement. Modern arthroplasty implants allow a surgeon to place ingrowth-type femoral- as well as tibial implants into most knees. This obviates the necessity for cemented fixation and creates an environment where the patient’s own bone grows into the porous coated implant and basically fuses with it. Rotating platform type polyethylene (plastic) tibial implants are extremely forgiving with excellent clinical results and they ensure a decreased amount of wear particle production. Inflammation induced by excessive polyethylene wear wear is the leading cause of joint replacement loosening. Once the procedure is completed, an intensive physiotherapy regime is begun in order to mobilise the knee and to re-establish a functional range of motion.
Personalized knee replacement – what does it mean?
When performing a TKR one is faced with two techniques or philosophies, you either cut the bone regardless of the natural alignment and ligament tension to achieve a straight knee or you consider each patient individually and try and restore the natural alignment of that specific knee respecting the ligaments and and soft tissues with minimal invasion and limited tissue damage.
To me, the latter procedure is the more personalised replacement. Restoring the natural alignment is likely to give a more comfortable natural functioning TKR and is all dependent on the technique at the time of surgery and not the custom cutting block used.
In fact with the custom cutting block if the surgeon tries to adjust the knee at the time of surgery to adapt to the tissue tension the entire exercise of scanning and designing a cutting block becomes obsolete and a waste of money.
The custom cutting blocks are just a method of implantation of a standard TKR implant and not a custom implant as is often misunderstood by patients that think that the CT or MRI scan is used to design a specific implant for them. The custom blocks follow a different philosophy of trying to give a straight knee regardless of the natural alignment of the patient and the soft tissue tension.
The use of computer assisted TKR has highlighted the importance of not committing to a straight knee but rather aim to restore the natural alignment with minimal tissue damage to achieve less pain and more rapid rehabilitation after surgery. This personalized TKR can best be achieved with experience and not equipment that prescribes the surgery.
Computer-assisted Total Knee Replacement
We are able to utilize the Computer-assisted Total knee replacement technique. This enables the surgeon to create a computer model of the knee, which assists with accurate placement and alignment of the knee component. Computer assisted Total knee replacement surgery improves the accuracy of the operation. This can improve the performance of the knee and reduce the rehabilitation time due to the fact that the ligament balancing is done in a more controlled manner.
Pain management during and after TKR
The recent advances in pain management during and after TKR and early rapid rehabilitation has improved the patient experience related to TKR. Early mobilization reduces the hospital stay and many complications related to TKR. Patients feel better quicker and are more in control throughout the process. Many patients that have recently been for another Total Knee replacement on the opposite knee have commented that it was much easier this time round. Most patients get up and walk on the day of surgery and can go home after two to three days.
Both Dr Engela and Dr Martin has extensive extensive experience with computer assisted Total Knee Replacement.
A total knee replacement is a surgical procedure that requires 5 – 7 days of hospital admission and approximately 4 – 6 weeks of post-operative rehabilitation and recovery.
We would require a consultation and appropriate X-rays in order to determine whether a patient is suitable for a total knee replacement. On many occasions, while a patient may be suffering from significant osteoarthritis of his knees, a total knee replacement may not yet be indicated. In those cases we will ensure that the conservative treatment of the osteoarthritis is optimised and follow the patient up periodically until he or she develops severe pain, incapacitating knee stiffness or a rapidly progressive deformity, all of which are absolute indications for a total knee replacement procedure.
