On your knees!
Knee problems are so common as we get older and when you consider the strain and movement your knees are put through every day, it is not surprising that sometimes they begin to wear out.
The knee is a hinge between the two sections of the leg and is a complex joint, or really two joints. One part of the knee is between the upper thigh bone and the shin bone in the lower leg and there is another, smaller, joint between the kneecap and the upper leg. The ends of the bones in the knee joint are covered with cartilage, a smooth but tough tissue that protects the bones and allows them to slide easily over each other. There is also a synovial membrane in the knee that produces fluid to lubricate the joint to reduce friction and help movement.
There are a number of reasons why knee replacements are undertaken. Often the cartilage can wear away so that the bones start to rub against each other, causing real pain and hindering mobility.
The good news is that today, knee replacement surgery, or arthroplasty, is quite common and has a very high success rate. At the moment around 70,000 knee replacements are performed in England and Wales every year, with the numbers increasing. Many of the patients are over 65 and there is an equal mix of men and women undergoing the procedure.
In a knee replacement, the worn ends of the bone are removed and replaced with metal and plastic parts. The end of the femur bone is replaced by a curved piece of metal, and the end of the tibia bone is replaced by a flat metal plate. These are fixed using a special “cement” substance and a plastic spacer is placed between the pieces of metal to act like cartilage and promote easy movement without friction.
The operation is considered reasonably straight forward and usually takes between one and three hours. Generally knee replacements are very successful with no problems, but about one in 20 do suffer complications, although most of these can easily be treated.
Infection, as with any major surgery, is always a risk. Other problems that can occasionally occur include the fracture of the bone around the artificial joint and the formation of excess scar tissue which could restrict the movement in the knee. Blood clots (deep vein thrombosis, or DVT) are always a risk when there is reduced movement in the leg, but your medical team will advise on how to counteract this risk.
In a few cases the new knee joint may not be totally stable, in which case further surgery may be needed to correct it.
Generally, though, the operation is immensely successful. After the operation, patients are encouraged to walk quite soon and physiotherapy is a very important part of the recovery process. Usually, patients find they are able to drive around six weeks after the operation and once the new knee has settled down, they often find they have a new lease of life as they can once again move around normally without pain and restriction in their knee.
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