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Total
Knee Replacement (TKR)
What
is Total Knee Replacement
A painful knee can severely affect your ability
to lead a full active life. Over the last 25 years, major advancements
in artificial knee replacement have greatly improved the outcome
of surgery. Artificial knee replacement surgery is now a common
procedure.
When knee cartilage wears away and bone starts rubbing
on bone, there are no options available to the patient, other than
total knee replacement. Many surgeons are experimenting with inserts,
and great progress is being made in the areas of cartilage re-growth
and replacement, but today these techniques are still experimental.
No significant results have shown successful applications in these
areas. Thus a candidate for knee replacement has no option other
than a total knee replacement. Direct Healthcare International Limited
is constantly looking for improved or innovative procedures to make
knee replacement better or avoidable. To that end we now fit the
Zimmer high flex knee using two incision minimally invasive surgery
techniques.
A total knee replacement replaces the knee cartelige
and surfaces of the knee bones with a metal implant that enables
the candidate to walk normaly and even run lightly.
Causes
of knee joint degeneration
There are many conditions that result in degeneration
of the knee joint. Osteoarthritis is the most common cause for patients
requiring knee replacement surgery. Osteoarthritis is commonly referred
to as "wear and tear arthritis". Osteoarthritis can occur
with no previous injury to the knee joint - the knee simply "wears
out". Some people may have a genetic tendency that increases
their chances of developing osteoarthritis.
The major problem in osteoarthritis is that the cartilage (the articular
cartilage) on the surface of the bone inside the joint wears away.
Once the slick protective surface of the articular cartilage is
worn away, the results is bone rubbing against bone. Bone rubbing
against bone is painful.
Fractures of the knee, torn cartilage, and torn ligaments can cause
the knee joint to function abnormally. This abnormal function can
lead to excessive wear and tear of the joint many years after the
injury - just like an out-of-balance tire can wear out too soon.
Symptoms
of knee degeneration
The symptoms of a degenerative knee joint usually
begin as pain while bearing weight on the affected knee, such as
when walking. You may start to limp. The knee may become swollen
with fluid. The range of motion of the affected knee can be effected.
The knee will bend less than normal and may lose its ability to
completely straighten out. Bone spurs will usually develop and can
be seen on X-ray. Finally, as the condition worsens, you may feel
pain may almost all of the time. Pain may even keep you awake at
night. Continued walking on a degenerating knee will cause the spine
to curve as more weight is transferred to the other leg. This will
eventually cause the degeneration in the hip, knee of the other
leg as well as the spine.
Diagnosis
of a degenerative knee joint
The diagnosis of a degenerative knee joint starts
with a complete history and physical examination by your surgeon.
X-rays are required to determine the how bad your knee joint has
become. X-rays may help suggest a cause for the degeneration in
your knee. Other tests may be required if the surgeon thinks that
other conditions may be adding to the degenerative process. Blood
tests can rule out systemic arthritis, such as rheumatoid arthritis,
or an infection in the knee.
Medical
Treatment for degenerative knee conditions
Not all degenerative knee conditions require a knee
replacement as a first treatment. Your doctor may suggest several
alternative treatments to put off replacing the knee as long as
possible. Using a walking stick may help relieve some of your pain
and allow you to walk more comfortably.
Medication
Anti-inflammatory medicinces may reduce the inflammation
from arthritis and reduce pain.
Knee
Arthroscopy
An arthroscopic procedure can be used to remove
the build up of arthritic deposits and wash out any loose deposits
present in the knee joint. Read more
Oxford
Knee or Half Knee Replacement
Also known as an unicompartmental knee replacement,
the oxfod knee is used where one side of the knee cartilage has
worn away. It allows the candidate to use the remaining part of
the cartilage for longer.
Some consider this to be a stopgap measure which may allow the candidate
up years of respite, however the candidate will almost certainly
require a full knee replacement sooner or later. Read
more
The
Artificial Knee Joint, called a prosthesis
There are two main types of artificial knee replacements:
- Cemented Prosthesis
- Uncemented Prosthesis
Both types are widely used. In many cases, a combination
of the two types are used. The kneecap, or patellar, portion of
the prosthesis is usually cemented into place. The choice to use
a cemented or uncemented prosthesis is usually made by the surgeon
based on your age and lifestyle, and your surgeon's experience.
Each prosthesis has four parts:
- The tibial component replaces the end of the
tibia. The tibia is commonly called the shinbone.
- The femoral component replaces the end of the
femur, the groove where the kneecap slides. The femur is commonly
called the thighbone. It is the largest bone in the body.
- The patellar component replaces the surface
on bottom of the patella. The "top" of the kneecap is
the part you can feel through your skin. The "bottom"
is the on the other side, and slides up and down in the femoral
groove whenever you bend or straighten your leg.
The femoral component is made of metal. The tibial
component is usually made of two parts - a metal tray that is fitted
directly onto the bone, and a plastic spacer that provides a bearing
surface. The plastic used is very tough and very slick - so slick
and tough that you could ice skate on a sheet of the plastic without
much damage to the plastic.
A cemented prosthesis is held in place using an
epoxy type cement that attaches the metal to the bone. An uncemented
prosthesis has a porous surface that permits the bone to grow into
the cavities within the surface of prosthesis and attaches the prosthesis
to the bone.
The Direct Healthcare
International Knee Replacement Program
Planning your Journey
Our staff will assist you in planning your journey. This is especially
necessary when undergoing knee surgery to ensure that you return
home in comfort.
Before Surgery
Please read our knee surgery brochure carefully or information on
how to best prepare for your surgery.
Once you have Arrived
When you arrived hospital staff will great you and ensure that you
are settled in the privacy of your own room in the family B&B
unit. You will be asked your dietary preferences and be given a
short guide to the hospital and its facilities.
Your Hospital Stay
The next day after the preliminary consultation, your consultant
surgeon will carefully assess your condition and will decide with
you which surgery is best suited. There is a short pre-surgery questionnaire
to complete and it is likely that some investigations will be done
at this stage, such as a blood test and x-rays.
You will be fully briefed on what to expect and how to prepare for
your operation. The surgeon will ensure that you are comfortable
and explain all about your surgery. The anaesthetist will visit
you and answer any questions you may have.
After Surgery
A physiotherapist will visit and instruct you in a program
of exercises to assist your restoration to peak physical condition.
Within a short while you will be safely on the road to recovery!
The typical program
Our program offers you the opportunity to swiftly obtain the corrective
surgery you need, taking advantage of the benefit of our experience
and expertise in the field of orthopedic surgery.
Our orthopedic surgery program takes you step by step through the
procedure; from your outgoing journey and preparation, through to
your physiotherapy program and aftercare pathway leading to full
health and fitness.
- Day 1 - Arrival + settle in to the hospital’s
family B&B unit
- Day 2 – consultation + preoperative x-rays
+ blood tests
- Day 3 – Admission to hospital bed + surgery
+ possible overnight in ICU
- Day 4 – In hospital + first day of physiotherapy
- Day 5 - In hospital + physiotherapy
- Day 6 - In hospital + physiotherapy
- Day 7 - In hospital + physiotherapy
- Day 8 - In hospital + physiotherapy
- Day 9 - In hospital + physiotherapy
- Day 10 - In hospital + physiotherapy
- Day 11 - In hospital + physiotherapy
- Day 12 - In hospital + physiotherapy
- Day 13 - Postoperative check and departure
An additional weeks stay with physiotherapy is available
on request. This is particularly suitable to those of senior age
or where the muscle activity has reduced in recent months leading
to low muscle strength.
The DHI Fully Inclusive
Surgery Option
- MRSA test
- Comprehensive consultation and full clinical
workup incl X-Rays, CT Scans and bone density scans where appropriate.
- Surgery (all hospital, surgery & anaesthetist's
fees)
- Round Trip Flights (UK, Denmark & Ireland),
Eurostar or Ferry for two (door-to-door pickup is available in
many areas).
- Complete Chauffeur service (to & from
airport, Eurostar or Ferry, hotel to hospital transfers)
- B&B accommodation at St Rembert’s
Hospital for a friend or family member
- DHI Additional Medical Cover (terms &
conditions apply)
The DHI Basic Surgery
Only Option
- MRSA test
- Surgery (all hospital, surgery & anaesthetist's
fees)
Optional extras available are
- MRSA test
- Airport pickup and transfer service (to &
from airport, Eurostar or Ferry)
- B&B accommodation at St Rembert’s
Hospital for a friend or family member
- DHI Additional Medical Cover (terms &
conditions apply)
- Post operative visit by a DHI physician to
your home (UK only
Exercise programs to
return you to peak physical condition after surgery
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