Total knee arthroplasty (TKA) is an orthopedic surgical procedure that involves removing damaged bone and cartilage and replacing them with artificial joint components to restore joint function. It is primarily used for patients with severe degenerative osteoarthritis, traumatic arthritis, or joint deformities, significantly improving walking ability and quality of life. Successful surgery can alleviate chronic pain and extend the lifespan of the joint.
This treatment is typically indicated for patients unresponsive to conservative therapies such as medication and physical therapy. The main types of surgery include total knee replacement and partial knee replacement. Postoperative rehabilitation is necessary to restore joint mobility and muscle strength.
Total knee replacement involves replacing the entire knee joint structure, including the femoral condyles, tibial plateau, and patellar components. Artificial joints are commonly made from cobalt-chromium alloys and high-density polyethylene, mimicking the normal sliding and weight-bearing functions of a healthy joint. Partial knee replacement targets only the damaged compartment, preserving healthy tissue to shorten recovery time.
The mechanism involves removing osteophytes and worn tissues, then reconstructing the anatomy with metal and plastic materials. The new joint reduces friction and restores proper load distribution. Postoperative rehabilitation aims to re-establish proprioception and muscle coordination around the joint.
Main indications include:
Doctors evaluate suitability based on the degree of joint space loss seen on X-rays and pain scores. When pain significantly affects sleep, stair climbing, or long walks, and medication is ineffective, surgery is considered the standard treatment option.
The procedure is performed under general or spinal anesthesia, lasting approximately 2-3 hours. The steps include:
Patients typically stay in hospital for 5-7 days, with initial drainage to remove tissue exudate. Anesthesia dosage and surgical precision are adjusted based on patient weight, bone density, and degree of joint deformity, with personalized surgical plans devised by orthopedic specialists.
Key outcomes include:
Compared to conservative treatments, surgery markedly improves patients' daily functioning. Studies show a 35% average increase in quality of life index (SF-36) one year post-surgery. New surface treatment technologies enhance implant-bone integration and reduce loosening risks.
Potential complications include:
Emergent complications include pulmonary embolism and severe infections, requiring immediate medical attention. Some patients may experience permanent joint stiffness or foreign body sensation, which can be improved with physical therapy.
Contraindications include:
Postoperative care requires strict adherence to instructions, including:
Preoperative physical therapy for 6 weeks is recommended to strengthen muscles and may include corticosteroid injections for temporary pain relief. Postoperative pain is often managed with NSAIDs, but gastrointestinal side effects should be monitored. Compared to cemented fixation, biologic fixation implants require avoiding early weight-bearing and adjusting activity levels as per physician instructions. Diabetic patients should control blood glucose levels below HbA1c 8% to reduce infection risk.
According to the American Academy of Orthopaedic Surgeons, 95% of patients can resume mild activities one year after surgery, with a 10-year implant survival rate exceeding 90%. Randomized controlled trials show that total knee replacement provides superior pain relief compared to partial knee replacement in patients with severe joint degeneration.
Long-term follow-up studies indicate that patients with moderate activity levels can enjoy implant longevity over 20 years. 3D printing of customized prostheses further improves surgical success rates in complex cases.
Non-surgical options include:
Drug therapies include NSAIDs and weak opioids, but long-term use may cause gastrointestinal mucosal damage and liver/kidney dysfunction. Alternative options should be chosen based on the extent of joint damage and overall health status.
Doctors usually recommend controlling weight, improving blood sugar or blood pressure, and strengthening periarticular muscles through physical therapy. Blood tests, X-rays, and cardiopulmonary assessments are necessary to ensure safety. Quitting smoking and adjusting anticoagulant medications are also important preparations.
How should I manage swelling and pain after surgery?In the early postoperative period, ice packs can reduce swelling, and pain medications should be taken as prescribed. Physical therapists will design personalized rehabilitation plans including muscle strengthening and joint mobility exercises to alleviate pain and restore function. If pain worsens or fever develops, seek medical attention immediately.
What is the lifespan of an artificial joint and how should it be maintained?Modern artificial knees typically last 15 to 20 years, depending on patient weight, activity level, and surgical technique. Avoid high-impact activities such as running or basketball, maintain a normal weight, and have regular follow-ups to prolong the implant's lifespan.
Can I walk or climb stairs normally during rehabilitation?Assistive devices like walkers or crutches are usually needed in the first few weeks. Most patients can regain independent walking and stair climbing abilities within 6 to 8 weeks, with physical therapy adjusting the training intensity based on recovery. Avoid premature weight-bearing or sudden turning movements.
Is long-term anticoagulation necessary after surgery?Short-term use of low-dose anticoagulants (2-4 weeks) is common to prevent thrombosis. Patients with a history of heart disease or stroke may require longer anticoagulation, which should be carefully monitored and adjusted by the physician to balance bleeding risks.
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