Knee Joint Replacement

Knee joint replacement is a procedure that involves replacing an injured or ailing knee with
an artificial joint, or prosthesis.

The prosthesis is made of metal alloys, plastics, and polymers. It mimics the function of a
knee. According to the American Academy of Orthopaedic Surgeons (AAOS), replacement
knees can fit your needs and specifications. When selecting a prosthetic knee, your doctor
will take into account your:

 age

 weight

 activity level

 overall health

The procedure to remove your old knee and replace it with a prosthesis usually takes less than
two hours, but recovery and rehabilitation can last months.

Another name for this procedure is knee arthroplasty. Knee replacements are a very common
surgery. The AAOS notes that more than 600,000 knee replacements occur every year in the
United States.
Damaged cartilage and bone are removed from the knee joint. Man-made pieces are then
placed in the knee.

These pieces may be placed in the following places in the knee joint:

 Lower end of the thigh bone -- This bone is called the femur. The replacement part is
usually made of metal.

 Upper end of the shin bone, which is the large bone in your lower leg -- This bone is
called the tibia. The replacement part is usually made from metal and strong plastic.

 Back side of your kneecap -- Your kneecap is called the patella. The replacement part
is usually made from a strong plastic.

You will not feel any pain during the surgery. You will have one of these two types of
anesthesia:

 General anesthesia -- This means you will be asleep and unable to feel pain.
 Regional (spinal or epidural) anesthesia -- Medicine is put into your back to make you
numb below your waist. You will also get medicine to make you sleepy. And you
may get medicine that will make you forget about the procedure, even though you are
not fully asleep.
After you receive anesthesia, your surgeon will make a cut over your knee to open it up. This
cut is often 8 to 10 inches (20 to 25 centimeters) long. Then your surgeon will:
  Move your kneecap (patella) out of the way, then cut the ends of your thigh bone and
shin (lower leg) bone to fit the replacement part.

 Cut the underside of your kneecap to prepare it for the new pieces that will be
attached there.

 Fasten the two parts of the prosthesis to your bones. One part will be attached to the
end of your thigh bone and the other part will be attached to your shin bone. The
pieces can be attached using bone cement or screws.

 Attach the underside of your kneecap. A special bone cement is used to attach this
part.

 Repair your muscles and tendons around the new joint and close the surgical cut.

The surgery takes about 2 hours.

Most artificial knees have both metal and plastic parts. Some surgeons now use different
materials, including metal on metal, ceramic on ceramic, or ceramic on plastic.

Why the Procedure is Performed

The most common reason to have a knee joint replaced is to relieve severe arthritis pain.
Your doctor may recommend knee joint replacement if:

 You are having pain from knee arthritis that keeps you from sleeping or doing normal
activities.

 You cannot walk and take care of yourself.

 Your knee pain has not improved with other treatment.

 You understand what surgery and recovery will be like.

Most of the time, knee joint replacement is done in people age 60 and older. Younger people
who have a knee joint replaced may put extra stress on the artificial knee and cause it to wear
out early and not last as long.
Implant Components

Implants are made of metal alloys, ceramic material, or strong plastic parts. Up to three
bone surfaces may be replaced in a total knee replacement:
 The lower end of the femur. The metal femoral component curves around the end
of the femur (thighbone). It is grooved so the kneecap can move up and down
smoothly against the bone as the knee bends and straightens.
 The top surface of the tibia. The tibial component is typically a flat metal platform
with a cushion of strong, durable plastic, called polyethylene. Some designs do not
have the metal portion and attach the polyethylene directly to the bone. For
additional stability, the metal portion of the component may have a stem that
inserts into the center of the tibia bone.
 The back surface of the patella. The patellar component is a dome-shaped piece of
polyethylene that duplicates the shape of the patella (kneecap). In some cases, the
patella does not need to be resurfaced.
Components are designed so that metal always borders with plastic, which provides for
smoother movement and results in less wear of the implant.
Implant Designs

For simplicity, the knee is considered a "hinge" joint because of its ability to bend and
straighten like a hinged door. In reality, the knee is much more complex because the
bone surfaces actually roll and glide as the knee bends.

Current implant designs recognize the complexity of the joint and more closely mimic
the motion of a normal knee. For example, ligaments keep the joint stable in a healthy
knee. Some implant designs preserve the patient's own ligaments, while others substitute
for them.

Several manufacturers make knee implants and there are more than 150 designs on the
market today.
Implant Materials

The metal parts of the implant are made of titanium or cobalt-chromium based alloys.
The plastic parts are made of ultra high molecular weight polyethylene. Some implants
are made of ceramics or ceramic/metal mixtures. Whether metal or ceramic, implants
weigh between 15 and 20 ounces, depending on the size selected.

Material Criteria

The construction materials used must meet several criteria:

 They must be biocompatible; that is, they can be placed in the body without
creating a rejection response.
 They must be able to duplicate the knee structures they are intended to replace.
For example, they are strong enough to take weightbearing loads, flexible
enough to bear stress without breaking, and able to move smoothly against each
other as required.
 They must be able to retain their strength and shape for a long time.