Knee Replacement Surgery, A Simple Guide To The Procedure And Related Conditions
By Kenneth Kee
()
About this ebook
Knee replacement is a surgical intervention that reduces pain and enhances the quality of life in many patients with serious arthritis of the knees.
Normally patients go through this surgery after non-operative treatments (such as activity modification medicines, knee injections or walking with a cane) have been unsuccessful to provide relief of arthritic symptoms.
Surgeons have done knee replacements for over three decades normally with good results.
Most documented cases have ten-year success rates past 90 percent.
Generally speaking there are two forms of knee replacements:
1. Total knee replacements and
2. Partial (or unicompartmental) knee replacements.
Both have long track records and good medical results in USA and in Europe.
Conventional total knee replacement requires a 7-8” incision over the knee, a hospital stay of 3-5 days and a recuperation period (during which the patient walks with a walker or cane) lasting from one to six months.
A large group of patients report substantial or total relief of their arthritic symptoms once they have healed from a total knee replacement.
Partial (unicompartmental) knee replacements have been present for decades and present excellent medical results just like total knee replacements.
But in the last year or two surgeons and patients have become very excited about a thrilling new method to this well-established procedure.
Minimally-invasive partial knee replacement (or mini knee) is a surgical method that permits a partial knee replacement to be placed through a small (3-3.5”) incision with minimal injury to the muscles and tendons around the knee.
Knee arthroscopy is minimum invasive surgery that utilizes a tiny camera to look inside the knee.
Small incisions are made to put in the camera and small surgical tools into the knee for the intervention.
Arthroscopy may be advised for these knee disorders:
1. Torn meniscus
Surgery is performed to restore or get rid of it.
2. Torn or injured anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)
3. Inflamed (swollen) or injured lining of the joint.
4. Kneecap (patella) that is dislocated.
5. Small debris of broken cartilage in the knee joint
6. Excision of Baker's cyst
Osteotomy requires cutting and relocation of one of the bones around the knee joint.
This treatment is suitable only if the arthritis is restricted to one compartment of the knee.
Knee fusion (also called arthrodesis) eternally joins the femur (thigh bone) with the tibia (shin bone) producing one long bone from the hip to the ankle.
It eliminates all movement from the knee ending in a stiff-legged gait.
Finally Total knee replacement surgery procedure is described.
TABLE OF CONTENT
Introduction
Chapter 1 Knee Replacement Surgery
Chapter 2 The Knee
Chapter 3 Types of Knee Surgeries
Chapter 4 Partial Knee Arthroplasty
Chapter 5 Total Knee Arthroplasty
Chapter 6 TKA Procedure
Chapter 7 OsteoArthritis
Chapter 8 Rheumatoid Arthritis
Epilogue
Kenneth Kee
Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"
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Knee Replacement Surgery, A Simple Guide To The Procedure And Related Conditions - Kenneth Kee
Knee Replacement
Surgery,
A
Simple
Guide
To
The
Procedure
And
Related Conditions
By
Dr Kenneth Kee
M.B.,B.S. (Singapore)
Ph.D (Healthcare Administration)
Copyright Kenneth Kee 2016 Smashwords Edition
Published by Kenneth Kee at Smashwords.com
Dedication
This book is dedicated
To my wife Dorothy
And my children
Carolyn, Grace
And Kelvin
This book describes the Knee Replacement Surgery, Procedures and Treatment and Related Diseases which are seen in some patients in my Family Clinic.
This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.
If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.
Thank you for respecting the hard work of this author.
Introduction
I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Conditions) for the benefit of my patients since 2007.
My purpose in writing these simple guides was for the health education of my patients.
Health Education was also my dissertation for my Ph.D (Healthcare Administration).
I then wrote an autobiolographical account of his journey as a medical student to family doctor on this other blog http://afamilydoctorstale.blogspot.com.
This autobiolographical account A Family Doctor’s Tale
was combined with my early A Simple Guide to Medical Conditions
into a new Wordpress Blog A Family Doctor’s Tale
on http://ken-med.com.
From which many free articles from the blog was taken and put together into 600 amazon kindle books and some into Smashwords.com eBooks.
Some people have complained that the simple guides are too simple.
For their information they are made simple in order to educate the patients.
The later books go into more details of medical conditions.
The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.
Since 2013, I have tried to improve my spelling and writing.
As I tried to bring you the latest information about a condition or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.
Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.
I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.
I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.
I apologize if these repetitions are irritating to some readers.
Chapter 1
Knee Replacement Surgery
I have many patients over the past forty years who had knee pain mostly due to wear and tear from climbing stairs or carrying heavy things.
I used to give them intra-articular injections of steroid or lubricant with some improvement.
In the early 1980 the surgery for the knee was quite rudimentary mostly arthodesis (fusing of the two bones from the joint) so there is no movement in order to relieve pain.
My office cleaner had the left knee arthritis and was given this form of surgery at a public hospital to relieve her knee pain.
Her right joint was operated on and fused at an angle so that her leg is not sticking out straight but is slightly angulated.
Because her joint was fused there is no movement of the bones in the joint and therefore no pain but she still had a limp because her leg cannot be straightened.
It was the cheapest form of knee surgery at that time.
However there was also knee replacement surgery for those who could not walk properly without pain and those with severe knee pain.
This early form of knee replacement surgery was in the form of 2 artificial metallic or plastic implants for the femur and tibia sides of the knee.
Because many of this prosthesis were imported from Europe or USA they were not so fitting in the Asian knee.
Sufficient bone is removed so that the prosthesis reproduces the level of the joint line in order for the prosthesis to be implanted into the bones by cement or screws.
Some of the patients who did not have general anesthesia complain of the sawing of their bones and the knocking of the cemented implants.
I had a few patients who underwent this form of surgery and still complain of pain after the operation.
Another woman patient had the implants coming loose after 5 years.
She had to return back to her private orthopedic surgeon for re-cementing of her implants and a screw plate to ensure it did not slip out again.
Some operations were not successful because the sizes were too large and did not fit well.
Subsequently the national hospital of Singapore began to produce the hospital’s own prostheses based on the image obtained from an x-ray of the damaged knee.
There were some improvements as a result of this.
Still there were many complaints of residual pain or poor recovery of the knee.
Some patients developed painful backs because the legs were not the same length others had pain in the other knee because over usage of un-operated knee.
The recovery time was also very long at least 6 months to one year before recovery of the operated knee although the patient was advised to walk one or two days after surgery.
There was another old woman who refused to walk after the operation because of the pain.
She preferred to go around in a wheelchair instead and gradually lost the use of her legs because of muscle wasting.
A doctor of mine also had a bad knee as he became older.
Because he heard horror stories from his patients, he also did not go for knee surgery and took his own painkillers.
He is still taking his medicine and limping along.
Because of these frequent complaints of knee surgery, I was not very keen to advise it for my sister in law who had a bad knee and was complaining of pain and limping for the past 1 year.
The painkiller that she was taking however had however caused a gastric ulcer with occult blood in the stools.
Her blood creatinine was also increasing because of the mild damage to the kidney from the painkillers side effect.
New methods and new implants came with improvement in successful surgery.
She eventually took my advice and went for knee surgery because I told her about the newer technology and the new form of implants.
Even then it took at least 6 months before she was able to walk without a limp.
Painkillers were not needed after the first 2 weeks.
The newest method is a metal prosthesis covering the femur side of the knee joint.
It has a grove to articulate with the tibial prosthesis of the knee.
No bone cuts were necessary except to remove excess overlapping edges and bone debris.
This method was found to be the best presently available.
Unilateral partial prosthesis for the knee joint is also available.
Computer-assisted surgery (CAS) has shown to improve the positioning of implant placement and more properly arrange in a line the lower limb mechanical axis based on the desired plan
There are several advantages of the CAS:
1. Dynamic evaluation of deformity at any angle of flexion with patella in situ as opposed to conventional TKR where tensioning devices can be used in zero and 90° only.
2. Calculation of soft tissue tension to give a perfectly balanced knee
3. Accurate restoration of mechanical limb axis
4. Reduced blood loss
5. Decrease in incidence of fat embolism due to extramedullary instrumentation.
6. Precision of data on soft tissue tensions even in 1mm and 1cm.
Surgeon is given control, ability to correct errors, feedback, and reports needed by CAS.
But there are some disadvantages:
1. Prolonged operative time
2. Definite learning