Types of Knee Surgeries - Indications, Procedure, and Complications

Introduction:

The knee joint connects the thigh to the leg and constitutes two different joints; the tibiofemoral joint (which connects the femur to the tibia) and the patellofemoral joint (which connects the femur to the patella). The knee joint is prone to mechanical wear and tear like any other body part depending on how it is used or abused, especially in sports, athletics, aging, arthritis, and other medical conditions.

What Are the Constituents of the Knee Joint?

The knee joint primarily comprises the following parts:

• Three bony compartments (the medial and lateral femoral-tibial compartment and the patellotibial compartment).

• Network of ligaments (band of tissues that holds bones and joints in their respective place).

• Cartilages.

• Blood and nerve supply.

• Muscle.

The knee joint components are further explained as follows:

Bony Components:

• The thigh bone or femur.

• The shin bone or tibia.

• The kneecap or patella.

Ligaments:

• The ligament located in the middle of the knee, known as the anterior cruciate ligament, regulates the tibia's rotation and forward motion (shin bone).

• The ligament in the back of the knee, known as the posterior cruciate ligament, regulates the tibia's rearward motion (shin bone).

• The ligament that stabilizes the inside knee is known as the medial collateral ligament.

• The ligament that stabilizes the outside of the knee is known as the lateral collateral ligament.

Cartilages:

• Medial Meniscus Cartilage: It is the crescent-shaped band of tissues between the medial tibia and medial femur bone. It is responsible for reducing stress on the knee joint.

• Lateral Meniscus Cartilage: It is the crescent-shaped band of tissues present on the outer side of the knee joint.

When Did Knee Surgeries Originate?

Knee replacement surgeries or knee surgeries were initially performed in 1968. However, knee surgeries started being practiced regularly in the 1970s. The technique of the procedure has been polished, perfected, and modernized to match the current medical practices to provide minimally invasive dissections and sustainable implants. These practices, on the whole, help in providing a better quality of life to the patient.

What Are the Various Types of Knee Surgeries?

Surgical techniques to treat patellofemoral pain syndrome may include the following;

• Knee replacement surgeries.

• Knee reconstruction surgeries.

What Is a Knee Replacement Surgery?

Knee arthroplasty, another name for a knee replacement, is a better description because only the surface of the bone needs to be replaced.

The steps involved in knee replacement surgery are listed below:

• Bone Preparation: The femur’s and tibia’s damaged cartilage surfaces are removed.

• Placing Metal Implants: The joint surface is reproduced by replacing the bone and cartilage with metal parts that may or may not be cemented.

• Resurfacing the Patella: A plastic button is used to resurface the area below the kneecap. However, this is not always necessary.

What Conditions Might Prompt a Knee Replacement Surgery?

The friction between the bones can result in knee pain and stiffness. Age-related "wear and tear" arthritis, known as osteoarthritis, is most common in individuals over 50 years of age. Over time, the articular cartilage that cushions the bones deteriorates and weakens. The friction between the bones brings on knee pain and stiffness.

Rheumatoid arthritis, often known as "inflammatory arthritis," is when the synovial membrane around the joint becomes inflamed. This can harm the cartilage and eventually result in cartilage loss, discomfort, and stiffness.

Post-traumatic arthritis following a severe knee injury over time, articular cartilage degradation from knee ligament rips, or fractures of the knee's encircling bones can result in discomfort and decreased knee function.

What Is a Knee Reconstruction Surgery?

• A knee reconstruction surgery is generally done under general or spinal anesthesia.

• Initially, an incision is made on the surface of the affected joint. Next, the part of the bone or cartilage that is damaged is removed. In addition, grooves are made for the necessary implants.

• The implants are then stabilized using either cement or screw plates. A plastic liner insert is placed between the two sides of the articulating bones that serve as the cartilage.

• For ligament reconstruction surgeries, the hamstring tendon is used as a graft. This is then joined by drilling holes in the required places on the surface of the knee joint and then pulling through these holes.

• Once stability has been achieved, the cartilage is sutured and allowed to heal using screws or plates.

How Is Rehabilitation Done Postoperatively?

Rehabilitation starts immediately after the surgery. A physical therapist is hired to instruct the patient in the proper exercises to strengthen the joint to a degree similar to its original capacity and restore proper knee motion. For a while, until the joint regain its functionality, prosthetic equipment like a walker, cane, or crutches may be recommended. While the patient is unwinding, a continuous passive motion machine could passively move the joint. Additionally, a home workout regimen is advised to maintain joint functionality.

What Are the Postoperative Complications of Knee Surgery?

The postoperative complications of knee surgery are:

1. Infection at the site of operation.

2. Stiffness in the knee.

3. Deep vein thrombosis or blood clotting.

4. Nerves and blood vessels are damaged.

5. Loosening of the implant.

6. Plastic liners can wear out.

7. Dislocation of the kneecap.

8. Ligament injuries.

9. Addiction to pain relief medications.

What to Do at Home After a Knee Surgery?

No matter how precise the surgery is, the patient needs proper home care, both during and after recovery. The measures taken at home include:

• Create a one-floor limited living area.

• Wherever they are required, such as in showers and stairways, install guard rails and handles.

• Elevating the joint with a stable chair with a cushion and footrest.

• If the toilet height is low, arrange a toilet seat riser with handles.

• Loose rugs and cords should be removed.

What Is the Success Rate of Knee Surgery?

For the majority of patients, knee operations result in pain alleviation and better quality of life for more than 10 to 15 years, assuming there are no severe postoperative complications. Three to four weeks of bed rest may also make it easier to perform simple chores like driving or climbing an incline. Moreover, running, jogging, and other sports activities that involve repetitive strain should be avoided.

Conclusion:

The knee joint, one of the most frequently used body parts, gets subjected to years of wear and tear and high stress. Various issues can cause knee pain due to the quality of the bone and the kind of exertions that put the bone under substantial stress. However, patients typically report a significant decrease in knee discomfort and an improvement in their ability to carry out daily tasks after knee surgery.