Knee Pain

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down. If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in all of medicine. According to Frost and Sullivan research, almost 70,000 joint replacement surgeries were performed in India in the year 2011. Since then the demand for knee replacement has risen exponentially.

Whether you have just begun exploring treatment options or have already decided to have total knee replacement surgery, this page will help you understand more about this valuable procedure.

Knee Anatomy

Knee Anatomy

The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities. The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.

The menisci are located between the femur and tibia. These C-shaped wedges act as “shock absorbers” that cushion the joint. Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.

All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee. Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and significantly reduced function.

Causes

Normal and Arthritic Joints

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

  • Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

  • Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.


  • Candidates for Surgery

    There are no absolute age or weight restrictions for total knee replacement surgery. Recommendations for surgery are based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

    When Total Knee Replacement (TKR) Is Recommended

    There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:

  • Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker

  • Moderate or severe knee pain while resting, either day or night

  • Chronic knee inflammation and swelling that does not improve with rest or medications

  • Knee deformity — a bowing in or out of your knee

  • Failure to substantially improve with other treatments such as antiinflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries


  • TKR Procedure

    Patients frequently expect total knee replacement (also called knee arthroplasty) surgery to exchange virtually all skeletal structures from the end of their femur (thigh bone) to the top of their tibia (shin bone). A TKR might be more accurately termed a knee “resurfacing” because only the surface of the bones are actually replaced. For the most part, the patient’s tendons and ligaments are preserved to allow the new artificial surfaces to glide and rotate much like a normal knee joint. The worn, arthritic surfaces are removed and replaced with the artificial joint, while the healthy tissue is left intact.

    There are four basic steps to a knee replacement procedure.

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.

  • Position the metal implants (prosthesis). The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or “press-fit” into the bone.

  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.

  • Insert a spacer. A medical-grade polyethelene spacer is inserted between the metal components to create a smooth gliding surface.