Total knee replacement

It is a solution in the advanced form of knee arthritis, especially when other conservative treatments such as medication, intra-articular injections or physical therapy have failed. During the operation, the damaged articular surfaces are replaced with special metal prostheses (implants) and in this way pain relief is achieved and the normal movement and function of the knee is restored. Historically, the first modern total knee arthroplasties were performed in the 1970s. Since then, the continuous progress and improvement of techniques and materials has made it a successful and safe operation.

What do we call knee arthritis?
The general term arthritis describes an inflammatory condition of the joints characterized by destruction of the elements of the joint, the menisci, the subchondral bone and mainly the articular cartilage. The most common forms of arthritis are osteoarthritis, rheumatoid arthritis and post-traumatic arthritis. The knee is one of the most frequently affected joints.
Patients mainly complain of pain, which is described as unbearable, and which at night prevents them from resting during sleep, and of a significant limitation of their daily life with the inability to perform basic movements, difficulty in getting up from a sitting position and a reduction of walking distance.

When does a patient need total knee replacement?
The decision to replace the knee is made taking into account the patient’s lifestyle, the expected benefits and the risks of the operation. The factors that require surgical treatment after the existence of arthritis is primarily confirmed radiographically, are the affected daily functionality and severe pain. There is no right age for joint replacement. If the patient can no longer endure the pain and the affected quality of life and wishes to be active, the operation can be performed regardless of age, as long as the overall health condition allows it. Usually, of course, the candidates for the operation are older as arthritis is more common after 60 years.

How is knee replacement done?
The knee joint consists of the lower part of the thigh, the upper part of the tibia and the patella. We usually replace the surfaces of the femur and tibia and less often the patella.
Total arthroplasty usually lasts 1-1.5 hours and can be performed under regional anesthesia (spinal or epidural), which is preferred, or under general anesthesia. Initially, an elongated incision is made on the anterior surface of the knee, the length of which depends on the characteristics of each patient and the severity of the arthritis. Bone preparation is then performed, where the worn articular surfaces are removed along with a thin section of bone, followed by the placement of metal implants in the femur and tibia and a synthetic material (polyethylene) between them. Fixation of the prostheses is done either by using orthopedic cement or they are placed directly on the bone and held by the process of osseointegration, i.e. by functional and structural connection of bone and implant. Modern prostheses offer long-term durability of total arthroplasty and allow activity levels almost identical to the normal knee.

Digitally guided knee arthroplasty
In recent years, modern computer navigation systems have been developed, which offer guidance during osteotomies and placement of arthroplasty materials. These are special software of the latest generation, which process in real time the data from sensors placed with special guides on the patient’s bone, while the possibility of pre-operative planning with computed tomography is also offered. Their advantages include greater precision in osteotomy, placement of prostheses and restoration of the mechanical axis of the lower extremity.

Robotic knee arthroplasty
The use of a robotic arm, which the doctor controls during the operation, is one of the most modern developments in knee arthroplasty. The operation is performed with the same principles as in classic arthroplasty with the difference that the doctor uses the robotic arm for the osteotomies, the placement of the prostheses and the balancing of the knee. Preoperative planning with CT or MRI is also possible in this case. The advantages of the method are the greater precision in the placement of the prostheses, the restoration of the correct mechanical axis and the reproducibility of the result. Disadvantages are the longer duration of the operation, the increased cost and the limited availability of equipment nationwide. Unfortunately, robotic arm is not yet available on our island.

Fast Track Rehabilitation Protocols
Fast Track post-surgical recovery protocols can be used in most patients and with all arthroplasty techniques, classic, digital or robotic. Their application allows the patient to walk quickly, ideally immediately postoperatively, and to leave the hospital within 24-48 hours. They are accompanied by an acceleration of recovery and a lower incidence of complications.
It is a series of actions and techniques that are applied both pre-operatively and concerning the preparation of the patient, as well as intra-operatively and post-operatively. It is the result of teamwork between the surgical, anaesthesiology, nursing and physiotherapy team, as well as the patient himself, whose active participation is decisive for their success.

How long does an arthroplasty last?
The success of an arthroplasty is determined beyond the reduction of pain symptoms and the restoration of mobility of the joint, by its durability over time. The lifespan of modern arthroplasties is an average of 15 years and many last more than 20 years. Large randomized and independent studies have shown that the long-term results of knee arthroplasties are comparable regardless of the technique applied, be it classical, digitally guided or robotic. That is, whichever method is used, as long as it is done correctly, the pain relief and the lifetime of the operation will be similar. In the end what matters is to have a painless functional knee that will mostly last over time.

Total knee arthroplasty is a safe operation with few complications and high success rates (over 95%), which is performed daily on our island as well. Patients report high rates of permanent pain relief, return to normal levels of functioning and improvement in their quality of life.

Manolis Spyrantis is an Orthopedic surgeon, partner of Creta InterClinic. He undertakes total knee arthroplasty operations either with the classic technique or with the digital navigation technique. By applying Fast Track protocols and modern minimally invasive techniques, it aims to effectively treat pain, allow the patient to walk immediately and quickly return to their activities. More information www.spyrantis.gr

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