Arthritis & Total Joint Replacements
Part 1 – Total Knee Arthroplasty
Last month, I talked about osteoarthritis and how it affects over 20 million Americans and this number is expected to rise to 40 million by the year 2020. The total knee replacement or arthroplasty is usually the long term surgical procedure that is performed to allow a person the opportunity to regain function in the knee and return to an active lifestyle. In the United States, over 267,000 total knee replacements are performed each year. Candidates for total knee replacement have experienced painful arthritis in the knee that overtime causes pain and stiffness that may become constant. Walking and going up and down stairs becomes difficult. With knee joint replacement, there are a few options that may be available to the person suffering from osteoarthritis. Most recently, surgeons in the United States are now performing a less invasive surgery with the use of a Unispacer. The Unispacer is a small, lightweight, C-shaped cup that acts as a cushion between the tibia and femur to fill the space where the cartilage has worn away. When performed on patients that are the correct candidates, this surgery may postpone the need for a total knee replacement for up to ten years. Another option in replacement surgery is the unicompartmental replacements, where the resurfacing in the knee is done on the tibia and femur but only on one side of the joint. This procedure has the advantage of acting more like one’s own knee than a total knee replacement. Again, the patient must fit certain criteria to be a surgical candidate for this surgery. The total knee replacement has been the standard surgery since the 1970’s for patients that exhibited a significant arthritic knee condition and has evolved to become a very successful surgery. In this procedure, the surface of the knee joint is replaced by metallic components with a plastic insert between the new joint surfaces. Recovery time for this surgery usually is 2-3 months and patients are able to return to a more functional and pain-free lifestyle. There is a new approach to total knee replacement that is being performed by Dr. Richard Berger, an orthopedic surgeon at Rush University Medical Center. Dr. Berger is on of the pioneers of the first minimally invasive total knee arthroplasty as an outpatient procedure. This procedure, developed in conjunction with Zimmer, a manufacturer of orthopedic reconstructive devices, avoids cutting muscles and tendons during the surgery as it replaces the damaged knee through a 3-4 inch incision, rather than the standard 8-12 inch incision. This procedure has the potential benefits of dramatically reducing pain and allowing increased range of motion sooner after surgery for a faster recovery time and shorter hospital stays as 92% of patients leave the hospital the same day. This procedure may allow for a quicker return to work and daily activities as there is usually a shorter recovery time of 2-4 weeks. An active person may resume activities following a total knee replacement that does not place undue stress on the new joint. Recommended activities following total knee arthroplasty include stationary bicycling, golf, dancing, walking, swimming, and low-impact aerobics. If the patient has experience in the following activities; tennis, hiking, weight machines, road bicycling, canoeing, stationary skiing, and cross-country skiing, they may be allowed. With all of these procedures, physical therapy is a vital part of the recovery process to help the patient restore normal range of motion, strength, and stability in the knee joint, allowing return to daily activities.