Knee Replacement in Iran

What is the purpose of knee replacement surgery?

Injury caused by osteoarthritis to the knee is one of the most common reasons for knee replacement surgery, and doctors recommend surgery when other invasive treatments have not been successful.

How do I know if we are a good candidate for knee replacement surgery?

Several factors are involved in determining whether or not you qualify for knee replacement surgery. These factors include:

• If the knee is deformed or the so-called sudden knee weakness.
• Knee pain increases during mobility and daily activities, especially walking and climbing stairs.
• Overall body health
• Your age

The most crucial reason for knee replacement surgery is to relieve the severe pain caused by osteoarthritis. People who cannot walk, sit and get up from chairs, walk upstairs, or suffer from knee pain even while sitting need a knee replacement. Knee replacement surgery is a standard treatment method for which most patients over 55 are suitable candidates.

But younger people can also improve their activities with an artificial joint. The specialist doctor evaluates the condition of all patients who are candidates for surgery in different ways to make the right choice. For your doctor to determine if a knee replacement is suitable for you, it will examine the stability and strength of the knee and the range of motion of the patient. Your doctor can prescribe a variety of alternative prostheses according to your age, activity level, size, and shape of the knee.

How is knee replacement surgery performed?

During knee replacement surgery, which lasts about one to two hours, a long incision is made above the knee by pulling the skin and muscle. The prosthesis is then placed on the femur and tibia, the prominent bone of the lower leg. This is done with surgical screws and hard cement-like materials. The wound is sutured at the end of the work, and the bandage is screwed on.

What are your expectations for knee replacement surgery?

One of the essential things you need to know before your surgery is your expectations of surgery. After Knee Replacement, many preoperative restrictions on the knee joint are eliminated. Usually, 90% of knee pain will be relieved after surgery, and there will be no problem performing many of the daily activities.

But keep in mind that activities such as mountaineering, skiing, tennis, jogging, and lifting 25kg are not suitable for artificial joints. Activities such as running, jumping, and jogging are hazardous for your new knee.

Techniques for knee joint prosthesis implant

• cemented method: In this method, artificial joints are implanted into bones with special bone cement.
• Cementless method: In this case, the artificial joints are carefully implanted between the bones. In some parts, the prosthetic joint is tightened with screws at the bone graft to keep the joint stable.
• Hybrid Method: A combination of the two methods above

Types of Knee Replacement

• Total Knee Arthroplasty (TKA): Total Knee Arthroplasty involves the replacement of the femur (superficial femoral joint) and the external joint of the tibia (tibia) which can include patella-kneecap replacement with a smooth plastic prosthesis. The strengths and ligaments are restored when the new joint is in place.

At the end of this 2-hour surgery under complete or local anesthesia, your skin is sutured and closed. In Total knee arthroplasty (TKA), the surgeon first creates a rupture in the knee, removing the muscles and ligaments from the joint and removing the damaged bones to fit in the new joint. Many physicians try to maintain the normal patella of the knee as far as possible. People who have had this surgery for up to 25 years can walk more efficiently and have less pain.

Sometimes your doctor may decide to have both of your knees at the same time undergoing Total knee arthroplasty. In this case, you will need to stay in the hospital longer and need longer therapy sessions and physiotherapy.

But what are the components of this synthetic organ? The main features of the knee prosthetic joint are made of particular medical metal and plastic. Your doctor will choose a gender-specific knee joint depending on the apparent difference between the male and female knees.

• Partial Knee Arthroplasty (PKA): In some cases, your entire knee is not damaged, and you do not need to have the whole knee removed. In such cases, only the part of the knee that is injured is removed, and partial surgery is performed for the inner part of the knee. This surgery will result in faster recovery and better performance than total knee replacement because it has not changed the entire knee. Partial joint replacement has no age limit and can be done anytime.
• Patellofemoral Arthroplasty: involves the replacement of the underlying Patella-Kneecap and trochlea because the only areas affected by arthritis are the Kneecap and knee trochlea, also called patellofemoral replacement or patellofemoral joint Arthroplasty.
• Knee revision surgery: Knee revision surgery is performed when your knee needs two or three more replacements or you have severe knee arthritis. Some people may require a more complex type of knee replacement. Common reasons for this include:
  • Primary bone loss due to arthritis or bone fractures
  • Knee malformation
  • Weaken main knee ligaments

Preparing for Knee Surgery Before Surgery

Before the surgery and during the consultation sessions, your doctor will examine you for general health and anesthesia complications. After the physical examination, you should provide your doctor with a complete medical history, including a description of previous surgeries you have had and your medical condition.

Take any medications, including over-the-counter medicines and herbal supplements. It would be best to talk to your doctor because you may need to stop taking some of them before surgery. You will then perform several tests, such as blood tests and imaging tests, and show them to your doctor. If you have an allergic reaction to anesthesia, consult your doctor because they can choose the anesthesia method that suits your circumstances.

• Lose Weight
• Follow the physiotherapy sessions with your physician
• Exercise
• Also, try medication treatments
• Consider surgery as the last resort

Before starting the description of knee joint surgery, we want to familiarize you with the internal structure and function of the knee. You need to know the body organ you decide to have surgery on.

The knee is the junction of the femur to the large shin bone (the tibia). This hinge joint allows you to bend and straighten your legs. The three sections are the tibia, the femur, and the patella-kneecap, which are connected at the end of each of the three knees and form the human knee, which contains a soft fluid that enables the bones to move easily. In addition to this fluid, the synovial membrane also produces a fluid that covers the entire surface of the knee and prevents bones from overlapping.

Preoperative Care

• Exercise: Start with gentle exercise before surgery. Exercising before surgery will significantly help speed up your recovery. Start with activities that require little movement and do not put too much pressure on your knees. Exercises like walking in the water, swimming, soft exercising, strengthening your arm and shoulder muscles (you need strong hands and arms after surgery), balance exercises (helpful in preventing you from falling into surgery).
• Proper nutrition: Start a healthy but nourishing diet. This healthy diet accelerates your recovery after surgery and reduces the risk of infection. Some protein-containing foods such as meat and its products accelerate post-surgical healing. Also, do not forget to take multivitamins before surgery. Multivitamins also reduce post-surgical inflammation. Again, if you want to mention the ingredients needed before the surgery, we should say the fruits. Calcium helps rebuild and strengthen bones, which is precisely what you need after surgery. So get your body ready.
• Weight Loss, again: Any extra pounds in the body will put 3 to 6 pounds more pressure on your knees, making it harder for you after surgery. Before surgery, try to lose one pound each week./ Knee Replacement in Iran

Is Knee Surgery Possible for Everyone?

Unfortunately, the answer is no. Sometimes though you have gone through all the above steps still have severe knee pain, you may not be able to do your daily routine, but for the following reasons, your doctor may not be able to perform knee surgery for you:

• If your thigh muscles are too weak, they may not support the new knee joint.
• High risk of infection in cases where you have long open sores under the knee skin.

Who is a candidate for knee replacement surgery?

• People over 60.
• People with severe knee pain and stiffness in their knees, which this pain prevents them from doing their daily activities like walking and walking without pain.
• People who also have knee pain during rest.
• People with knee deformities.
• People with knee inflammation and swelling.
• People with different treatment modalities such as physiotherapy, drug therapy, and weight loss did not affect their recovery.

What diseases cause Knee Replacement?

Arthritis: Arthritis, associated with losing a knee joint, usually begins over 50 years. As a result of knee joint loss, the bones become stitched together, eventually requiring surgery. Rheumatoid arthritis: Increased synovial membrane volume that covers the joint’s inner surface increases synovial membrane volume, causing inflammation in the knee tissue. This inflammation will result in injury to the knee and limit foot movements. Knee Blown: Severe knee injury, which is also associated with fractures, will gradually damage the knee cartilage and cause movement restriction if the bones of the knee un-union or the knee ligaments are injured.

Life after knee replacement surgery

About three to six weeks after surgery, you can resume most daily activities such as shopping and housekeeping. After this time, you can even drive as long as you can bend your knee without restriction and sit in the car. Of course, take gas and brakes easily and do not use analgesics. You can drive after about three weeks if you have all the above conditions.

After you feel recovered, you can play walking, swimming, cycling, and golf. But avoid heavy and dangerous activities such as running and jumping sports. A full recovery can take four months to a year, and most people do not need help walking after a full recovery. After leaving the hospital, some people have to stay in the rehabilitation center to learn how to do everyday activities.

Recovery and Rehabilitation process after knee replacement surgery

Prosthetic knees do not function similarly to normal knees, and you should measure knee function due to everyday activities such as climbing stairs and driving. After surgery, you can help reduce pain, increase balance and strength, improve gait, and prevent excessive accumulation of scar tissue through orthopedic physiotherapy sessions.

After surgery, you can help reduce pain, increase balance and strength, improve walking and prevent excessive accumulation of scar tissue through orthopedic physiotherapy sessions. The method of recovery depends on several factors, including:

• Pain level
• The time it takes time for wounds to heal
• Your level of mobility and ability to bend and stretch your knees

Possible complications of knee replacement surgery

Knee replacement surgery, like any other surgery, has common complications such as bleeding, blood clots, and infection, which is a worrying complication for people undergoing joint replacement surgery. The disease can flow through the blood and infect the prosthetic knee. If you have a common infection, your doctor may have to remove part or whole joint before knee surgery again.

In general, complications of this surgery include:

• The prosthetic joint wears out over time
• Respiratory problems caused by anesthesia
• Blood clots in the feet and lungs
• Knee stiffness
• Heart attack
• Nerve damage in the knee
• Stroke

There are other factors associated with surgical complications that you should contact your doctor immediately if you notice any. These include:

• Discharge coming out of the wound.
• Fever over 100°F or 37°C.
• Increased pain, swelling, redness, and knee sensitivity

Postoperative care After knee surgery

Like all surgeries, how successful your operation will depend entirely on your Postoperative care. After surgery in the shin, you will feel stiffness and pain, managed by analgesic injection. You should also take medication to prevent blood clots. Most people can start physiotherapy sessions one day after surgery because it helps circulate blood flow in tissues around the new joint.

The surgeon and physiotherapy team design the best program to suit your condition. Your doctor may recommend using specific devices to control foot movement continuously. This device has a brace that helps your knee move with a gentle bending motion. Based on the condition and the surgery results, your doctor will order your discharge from the hospital. The most critical care after surgery is:

• Change the patient’s dressing regularly. Replace the sauce as directed by your doctor. After the first few days of surgery, your patient’s wound will have a hydrous, evident leak that will soak the dressing. In this case, it is necessary to change the dressing regularly as instructed. After stopping the leakage, you do not need to change the bandages regularly, but cover the wound with a bandage until the sutures are removed. The sutures are usually removed after two weeks and do not allow the damage to come into contact with water until then.
• In the first few months after surgery, having a slight swelling in the surgical area is quite normal, but tell your doctor if you notice increased swelling over time.
• Anorexia after surgery is normal. Foods high in iron, fruit, and water can be used during this time and prevented from eating foods that contain high amounts of vitamin K, such as green beans, broccoli, spinach, lentils, and onions so that after a few months, the patient would return to normal and be able to start eating the main foods.
• Complete cessation of alcohol consumption
• Availability of necessary patient supplies for several months
• After a while, the patient should be able to sit comfortably on the chair and get up
• The patient should gradually begin their daily activities
• The patient should walk home with the advice of their physician regularly daily. And of course, the time and distance of walking are getting more every day.
• The patient should not use the stairs for several months
• The patient should perform the exercises that the physiotherapist has taught them regularly, and these exercises will continue for at least two months after surgery.

Knee joint surgery postoperative instructions

Within a few weeks of surgery, you should use a walker or crutch to move, so prepare them before surgery. Get help from someone for everyday tasks because you can’t do things like shopping, cooking, and bathing after surgery. Before surgery, you need to secure the house and some places not to get injured again when you recover.

1. Secure the stairwell using a sturdy railing.
2. Live in a space where you do not need to climb stairs for a few weeks.
3. Install a protective rod or railing for the shower.
4. Use a fixed and firm pillow to raise your feet.
5. Use the toilet with care.
6. Collect carpets and rugs that cause you to fall.

The most important thing you need to know is what to do after surgery

• How to care for wounds and surgical incisions.
• Use assistive devices such as crutches and walkers.
• You can move from the bed to the sofa or chair.
• Follow a home exercise program.
• Use passive motion devices continuously.

Therapies to improve knee joint function after surgery

A wide range of treatments can help improve the part of the knee joint after surgery, such as exercise, assisted devices, and techniques that the patient is taught to regain mobility. Depending on the methods your therapist chooses, these methods fall into two categories:

• Inactive procedures (the therapist will give you a cure)
• Active procedures (you perform a therapeutic movement)

In the following treatments performed by orthopedic physiotherapy, we will explain some of the treatments served by physiotherapy.

• Therapeutic Exercises

 According to a workout program from your therapist, you do strengthening, mobility, and balancing exercises. First, you should be familiar with how the therapist performs the activities, and then you are encouraged to do these exercises regularly at home.

• Electrical stimulation device

There is evidence that an electrical stimulation device reduces pain by having the therapist place the device on injured areas of the body, such as the knee joint.

• Stretching exercises

Stretching exercises can relieve pressure on damaged joints. This procedure is performed both by the device and by the therapist.

• Hydrotherapy

Your therapist may consider hydrotherapy as part of rehabilitation therapy. Hydrotherapy can be done in the pool. This type of treatment improves joint problems and injuries because water can create mild resistance.

• Manual muscle massage

Manual muscle massage is one of the practical muscles that help improve muscle function. This method is recommended as a way to reduce muscle pain.

• Laser or light therapy

Laser or light therapy is a fair treatment to strengthen muscle function, reduce muscle fatigue, and repair damaged muscles.

Orthopedic treatments help diagnose and treat skeletal injuries, bones, ligaments, tendons, and connective tissues. Depending on your circumstances, your therapist will use treatment methods to restore your mobility, such as aids, manual therapy, or other forms.

Benefits and Disadvantages of Knee Replacement

According to the researchers, out of every five people who did Knee Arthroplasty, 4 were satisfied with the results. Those dissatisfied complained of continued knee pain, which could not be attributed to surgery. But the other benefits:

• Pain relief
• Improved ability to move
• Improving the quality of life

But, on the other hand, knee replacement can have some side effects and consequences:

• You will never have your normal knee. Having an artificial knee will at best give you three-quarters of a sense of normalcy.
• Although you can kneel to a limited extent, it is usually painful to put your weight on artificial knees.
• An articulated joint will wear out or lose after many years. Most knee joints, however, live up to 20 years.

The Result of Knee Replacement Surgery

As mentioned earlier, knee replacement will help relieve pain and improve mobility, and the prosthesis is expected to last more than 15 years. In some cases, they last up to 20 years and then need to be replaced, but in most cases, the results of the second operation are not as good as the first surgery.

Try not to have knee joint surgery at a young age and try other methods under the supervision of a specialist for recovery. You should be checked regularly after surgery to ensure your prosthetic joint is in good condition.