Knee replacement pros and cons

The Pros and Cons of Minimally Invasive Knee Replacement Surgery

Both minimally invasive knee replacements and traditional knee replacements are performed to alleviate chronic knee pain due to arthritis, and both surgeries require the cutting of soft tissue and bone in order to implant prosthetic knee joint components. The difference is that a minimally invasive knee replacement uses a smaller skin incision and tends to require less cutting of other soft tissue, such as muscles, tendons and ligaments.

See Knee Pain and Arthritis

The expectation is that less invasive knee replacement techniques will allow for an easier post-surgical recovery in the short term and provide equal or better results in the long term. Whether this expectation is realistic is a matter of ongoing research. To date, experts have found minimally invasive knee replacement surgery has both advantages and disadvantages, and it is not appropriate for all knee replacement patients.

See Undergoing Total Knee Replacement for Knee Arthritis

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What Is Minimally Invasive Knee Replacement?

Several surgical approaches to knee replacement are considered “minimally invasive.” What characterizes a less invasive surgery is that the surgeon makes a smaller incision and works within a smaller surgical area than a traditional knee replacement surgery.

See Knee Anatomy

Below are four examples of how traditional and minimally invasive knee replacements are different from one another:

  1. A traditional knee replacement surgery requires an 8 to 12 inch incision down the middle of the knee. Minimally invasive knee replacement surgery requires a skin incision of only 3 to 6 inches.
  2. See Double Knee Replacements

  3. To access the knee joint during traditional knee replacement surgery, the surgeon cuts through quadriceps muscles at the front of the thigh, the quad tendon that attaches the four quadriceps muscles to the kneecap, and other soft tissue. During less invasive surgery, the incision must extend through some deeper soft tissue, but certain muscles and tendons are lifted or pushed out of the way rather than cut.
  4. In This Article:

  • The Pros and Cons of Minimally Invasive Knee Replacement Surgery
  • Traditional Knee Replacement vs. Minimally Invasive Knee Replacement
  • Deciding on Minimally Invasive Knee Replacement
  • During traditional knee replacement surgery, the kneecap is turned over 180 degrees, giving the surgeon full access to the point where the femur and tibia meet. During minimally invasive surgery, the kneecap is often simply pushed aside.
  • A surgeon performing traditional surgery will dislocate the tibia (shinbone) from the femur (thighbone) before fitting both bones with prosthetics. During minimally invasive surgery the tibia may not be dislocated from the femur.
  • Less invasive knee replacements can differ in the exact location of the incision, the shape of the incision (e.g., curved), and how the muscles and other soft tissue are cleared out of the way to make room for the surgical procedure. The type of minimally invasive approach used typically depends on the surgeon’s experience and preference. The patient’s anatomy may also be a factor.

    See Total Knee Replacement Surgical Procedure

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    Minimally Invasive Knee Replacement Requires Advanced Surgical Training

    The primary challenge of minimally invasive knee replacement surgery is that the surgeon has limited access to the knee joint, and that can affect the surgeon’s ability to create an ideal prosthetic fit and joint alignment.1,2

    See Cemented vs. Cementless Alternatives in Joint Replacement

    For example, because the patella (kneecap) is pushed aside rather than flipped over, the surgeon has a limited view and restricted entryway to the tibia and femur. Advanced surgical training and specially designed surgical tools are required for surgery.

    • 1.Alexander Berth, Dietmar Urbach, Wolfram Neumann, Friedemann Awiszus, “Strength and Voluntary Activation of Quadriceps Femoris Muscle in Total Knee Arthroplasty with Midvastus and Subvastus Approaches” The Journal of Arthroplasty 22 (2007): 83-88, DOI: 10.1016/j.arth.2006.02.161)
    • 2.American Academy of Orthopeadic Surgeons. “Minimally Invasive Knee Replacement.” Accessed January 29, 2012. orthoinfo.aaos.org.

    The Pros and Cons of Knee Replacement

    The knee joint is one of the most important in the body, but most people don’t give it a second thought until it begins to break down. There are a number of reasons it may do so, including a torn meniscus, bursitis, rheumatoid arthritis, gout and age. In the not-too-distant past you’d have to live with the often excruciating pain of bone rubbing on bone. Today, thankfully, you have the option of having your knee joint repaired or replaced. Below we’re going to examine the pros and cons of knee replacement.

    A Quick Look at the Pros and Cons of Knee Replacement

    Knee replacement surgery can provide a long term solution to this once vexing problem. But it’s not a solution without risks or possible downsides. Here are some pros and cons.

    Knee Replacement Pros

    – Immediate relief from chronic and debilitating knee pain.
    – Relatively short recovery period.
    – Full range of motion is regained.
    – Renewed ability to perform routine tasks.
    – Renewed ability to exercise and thereby enhance overall health.

    One of the most important pros of knee replacement and of regaining pain-free, full range of motion is the ability to begin exercising once again. Often, when people suffer from debilitating knee pain they become sedentary. This has an enervating effect on their overall wellbeing. Being able to exercise once more can remedy a host of ills.

    Knee Replacement Cons

    – Swelling of the knee may not abate for 2 to 3 months after surgery.
    – Scarring across the front of the knee.
    – Numbness on the surface of the knee.
    – May affect natural walking motion.
    – Possible need to replace after 10 – 15 years.

    Not all of the cons of knee replacement will be experienced by everyone who has successful knee replacement surgery. Some may regain perfect motion in the gait and no numbness of the skin. Others may experience numbness, but the swelling in their knee may go down after 1 or 2 weeks. The cons of knee replacement then will be different for each person.

    How You Can Make Recovery Easier

    There are certain steps you can take to ensure the process of recovery from knee replacement is as straightforward and hassle free as possible.

    – Physiotherapy – Regular physiotherapy will allow you to regain flexibility and strength quicker.
    – Losing Weight – There are few things that will benefit you more in your postoperative life then taking steps to lose excess weight.
    – Wear compression hose – Compression hose help prevent swelling in the lower legs that can lead to deep vein thrombosis (DVT) and blood clots.
    – Stay in touch with your doctor – Don’t wait to contact your doctor if you have any concerns or are experiencing anything unusual.

    Total knee replacement is the kind of procedure that can literally give you your life back. Your life will go from one of pain and inactivity to one of restored health and freedom of movement. To learn more about the pros and cons of knee replacement or to discuss knee replacement alternatives contact Orthopaedic Riga at 0207 993 8535.

    Weighing the Pros and Cons of Joint Replacement

    “You should try everything else first, including medication, physical therapy, swimming, ice, heat — the whole gamut. But if nothing is working, you have to ask yourself if pain and disability are ruining your quality of life. If the answer is yes, it’s time to talk about surgery.”

    Joint Replacement Risks

    Joint replacement surgery, of course, is not without risk. A serious concern is the risk for heart attack, which is up to 31 times higher in people after joint replacement surgery than in the general population, particularly in the first two weeks post-op, according to a study published in the Archives of Internal Medicine in 2012.

    “This risk is due to the body’s increased tendency to form blood clots after any major surgery,” Dr. Rasquinha explains. “The risk can be minimized by having a cardiology evaluation before surgery and taking medications to prevent blood clots after surgery.” Also, he says, anyone who smokes should quit before having surgery.

    Other risks that accompany joint replacement surgery include bleeding, infection, injury to a nerve or blood vessel, and loosening of the new joint over time. However, Rasquinha says that “these risks can be reduced to under 5 percent with good management before and after surgery.”

    Joint Replacement Benefits

    On the upside, recent research suggests long-term benefits from joint replacement surgery. They’re worth considering when pondering your decision because 95 percent of hip replacements last 15 to 20 years, and 85 percent of knee replacements last 20 years.

    For instance, researchers have found that people with osteoarthritis who had a hip or knee replaced were 40 percent less likely to have a heart attack or stroke than were those who didn’t have the surgery. The findings, which stemmed from a study involving 2,000 people, were presented at the 2014 annual meeting of the American Academy of Orthopaedic Surgeons.

    RELATED: 6 Warning Signs of Rheumatoid Arthritis

    A study presented at the group’s meeting the previous year found a reduced long-term risk for death, heart failure, depression, and diabetes in people with osteoarthritis who had a total hip replacement, compared with those who did not have the surgery.

    “These results are not surprising when you consider how much life changes when you can walk and move without pain,” Rasquinha says. “Chronic pain and disability are linked to depression and heart disease. After surgery, physically and emotionally, your quality of life improves.”

    What About Rheumatoid Arthritis?

    Though osteoarthritis usually is caused by years of wear and tear on specific joints, rheumatoid arthritis is an inflammatory disease that affects the whole body. Most joint replacements and most of the research on joint replacements are related to osteoarthritis. However, about one of every four people with rheumatoid arthritis will also need a joint replacement.

    “Because rheumatoid arthritis is an inflammatory disease, risk factors may be higher,” says Stacy Ardoin, MD, an assistant professor in the division of rheumatology and immunology at Ohio State University’s Wexner Medical Center in Columbus. For instance, she says, “rheumatoid arthritis by itself is a risk factor for heart disease.”

    Because of this, before deciding on joint replacement surgery, “it’s important to have all your risk factors evaluated by a doctor who understands rheumatoid arthritis,” Dr Ardoin says.

    As for the surgery itself, she suspects that the short-term risks and long-term benefits are similar for people with rheumatoid arthritis rather than osteoarthritis. “The period in the weeks after surgery carries increased risk due to increased stress and immobility,” she says, “but in the long run, the benefits of less pain, more mobility, and possibly less medication decrease risks for cardiovascular disease and other diseases associated with rheumatoid arthritis.”

    Weighing Your Risks and Benefits

    “Only you can decide when the pain and limitation of arthritis is affecting your quality of life enough to consider surgery,” Ardoin says. “Your doctor can help you understand the risks, but the point where the benefits outweigh the risks is different for every patient.”

    Losing weight if you are overweight, quitting smoking, limiting alcohol use, and doing muscle-strengthening exercises are healthful steps you can take before surgery. Work with your doctor and understand the plan for managing your risk factors both before and after a joint replacement. If you do that well, there’s a good chance the long-term benefits of joint replacement will outweigh the short-term risks.

    Orthopedic surgeons perform almost 700,000 knee replacements in the United States each year, and the procedure has a high success rate in alleviating pain and restoring an active lifestyle. It’s not uncommon for patients to have arthritis in both knees, so they may need to decide, along with their surgeon, whether to have both knees replaced at the same time. The procedure, known as a bilateral knee replacement, has both pros and cons, which must be carefully weighed before a decision is made.

    Pros of Bilateral Knee Replacement

    • Having both knees replaced at the same time enables patients to get back to their normal lives more quickly.
    • Patients have one surgery, one hospital stay and one course of rehabilitation.
    • Patients generally take less time off from work.

    Cons of Bilateral Knee Replacement

    • Studies show there is a greater risk of complications, including cardiovascular problems and blood clots.
    • Patients lose more blood, so there is a higher rate of blood transfusions.
    • Recovery and rehabilitation are much more challenging because greater physical and emotional strain is placed on the body. Rehab is also more difficult because patients are unable to rely on a stable leg for support.
    • Patients who have a double knee replacement must go to a facility for rehab after surgery. After a single knee replacement, many individuals go straight home and have physical therapy at home.

    The Best Candidates

    With careful patient selection, the overall success rate is high for bilateral knee replacement. Candidates for the procedure must be in excellent health, aside from the arthritis, with no underlying medical problems. They must have no history of heart or lung disease. They also need to be psychologically prepared for the intensive rehabilitation double knee replacement entails.

    At HSS, bilateral knee replacements are not performed in individuals over 75 years old due to the greater risk of complications in older patients. Same-day double knee replacement is also out of the question for individuals of any age with a serious medical condition. Severely overweight patients who have a BMI over 40 would not be candidates for the bilateral procedure.

    Advances in Total Knee Replacement

    Not long ago, many people thought that if you had one knee replaced, the pain and rehab would be so taxing you wouldn’t want to come back for surgery on the other knee. But with today’s advances in surgical techniques, anesthesia and pain management, the recovery for a single knee replacement at a high-volume joint replacement center is much easier and faster than it was in the past. At Hospital for Special Surgery, virtually every patient comes back for the second knee replacement, generally waiting at least three months in between surgeries.

    Know What to Expect

    Whether having two separate procedures or both knees replaced simultaneously, the orthopedic surgeon should have a detailed discussion with the patient about what to expect. Because of the special considerations involved in bilateral knee replacement, it’s especially important to choose a highly experienced orthopedic surgeon who specializes in joint replacement.

    Patients should also choose a hospital that performs a high volume of joint replacements, such as HSS. The entire staff will be accustomed to dealing with the needs of patients before, during and after the surgery.

    Knee replacement is a big step, but knowing the facts can help patients make an informed decision. After the surgery, most patients will tell you that in terms of arthritis pain relief and improved mobility, they wished they had done it sooner.

    Dr. Geoffrey Westrich, Orthopedic Surgeon, specializes in knee and knee replacement, including revision surgery and complex cases at Hospital for Special Surgery. He is director of research of the Adult Reconstruction and Joint Replacement Service at HSS.

    To people outside the medical field, joint replacement surgery might sound like a solution that’s considered only after all other options have been exhausted. But joint replacement surgery has become very common, even though some studies have suggested certain procedures are being performed unnecessarily.

    A 2014 study published in the journal Arthritis and Rheumatology found that one-third of patients who undergo knee replacement surgery may not be appropriate candidates for the procedure because their symptoms are not severe enough to merit aggressive intervention like surgery.

    The decision to undergo surgery is always a patient’s to make. Weighing some pros and cons of joint replacement surgery can help patients make the most informed decisions possible.

    Pros

    The Cleveland Clinic notes that many patients who have undergone joint replacement surgeries have experienced dramatic improvement within a relatively short time after undergoing the surgery. Much of that improvement is related to pain, which for many people becomes overwhelming prior to surgery.

    Another benefit to joint replacement surgery is the recovery time. For example, the Cleveland Clinic notes that patients who have knee replacement surgery are usually standing and even moving the joint the day after their surgeries. Within six weeks, those same patients are typically walking comfortably with very little support. While each patient is different, any fears that joint replacement surgery will require patients to be immobile for months after surgery are unwarranted.

    Joint replacement surgery also can be a long-term solution, whereas the alternatives might not be. The Cleveland Clinic says that roughly 85 percent of knee implants will last 20 years, and that life expectancy figures to grow as technology advances.

    Cons

    As beneficial as joint replacement surgery can be, it’s not without downsides. Cost is one such disadvantage. How much a patient pays for the surgery depends on his or her coverage, but AARP notes that the average knee replacement surgery costs $31,000. Such costs can be prohibitive for aging men and women who are no longer working.

    Another potential disadvantage to going under the knife, especially for those who are borderline candidates for replacement surgeries, is the likelihood that surgery won’t have a significant impact on quality of life. A 2017 study published in the journal BMJ found that knee replacement had minimal effects on quality of life, especially for patients whose arthritis was not severe.

    Joint replacement surgeries are common. When deciding if surgery is their best option, patients should consider the pros and cons of going under the knife before making their final choice.

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