Although the procedure is called knee replacement, it would be more accurate to call it knee resurfacing. This is because the surfaces of the thigh and shin bones are skimmed to remove all the damaged cartilage and to create an even surface upon which the prosthesis can then be placed.
It is a surgical procedure which requires a very high degree of precision. Very accurate ‘balancing’ of the joint is aimed for thus creating an even gap between the bones, allowing even pressure to be transmitted. The total knee replacement is often referred to as a ‘soft tissue procedure’ as a lot of attention is paid to the ligaments while ‘balancing’ the joint. Once the surgeon is happy with the bony cuts and tension of the ligaments, metal components are used to cap the ends of the thigh and shin bones, fixing them with bone cement. A high density plastic (HDPE) is placed between the two, allowing the joint to move smoothly.
There are two types of knee replacements:
- Fixed bearing – performed by the vast majority of orthopaedic surgeons
- Mobile bearing – which allows the knee to rotate, which is my personal choice
The total knee replacement is a very successful operation. Its results tend to be predictable. The chances of the joint lasting ten years are in excess of 95%.
Mr Prakash’s approach: I have chosen to perform ‘mobile bearing’ knee replacements as the prosthesis allows the joint to rotate and find its position of least constraint. As a result, it is expected that these joints will last much longer than the fixed bearing knee replacements. However, this will have to be checked over a period of time.
While performing this surgery, I ensure that the joint is ‘fully balanced’, both in flexion and extension, using a very highly sophisticated soft tissue distracter. This allows me to check the tension of the ligaments and at the same time I can check the gap between the bones very accurately.
For further information, please use this link.Read more