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Being able to walk in the forest without difficulty

Total knee replacement (TKP) or half knee replacement

Anatomy

The knee joint is a hinge joint. It is formed by two bone ends: these are the bottom of the femur and the top of the tibia. At the front is the kneecap. The ends of this are covered with a layer of cartilage so that the knee moves smoothly. On the inside and outside of the knee is the meniscus: a kind of pad. In the middle of the knee joint are the anterior and posterior cruciate ligaments. These prevent the lower leg from sliding forward or backward during walking and twisting movements.

Wear

As we age, the quality of cartilage diminishes. Usually this is normal wear and tear in old age, called osteoarthritis. Furthermore, cartilage and metabolic diseases can also be causes of wear. Wear can also occur due to a bone fracture or rheumatism or after removal of a meniscus. Because the joint surfaces can no longer glide smoothly along each other, movement becomes increasingly difficult and painful.

A damaged or worn knee can cause a variety of symptoms:

  • Pain when walking (stairs);
  • Pain if you stand for a long time;
  • Stiffness when getting up if you have been sitting (starting pain);
  • pain during the night;
  • exacerbation of symptoms in humid or cold weather.

Prosthetics

There are two types of prostheses: half and total knee replacement. Sometimes there is only the wear on the inside or outside of the joint. In those cases, a half knee replacement may suffice.

The most common is the total knee replacement, which replaces all the cartilage of the femur and tibia. In this operation, the orthopedist makes a vertical incision at the front of the knee. He then removes the worn ends of the femur and tibia and replaces them with metal prosthetic parts. In between is a plastic disc, which allows the metal prosthetic parts to move smoothly.

Post-treatment

You can load the knee replacement the same day. You will be supervised in this by the physical therapist. The first 6 weeks you will learn to bend the knee to more than 90 degrees. After 6 weeks you will have completely worn out both crutches for short distances (max 500m). For longer distances, 1 crutch is then regularly needed for a few weeks. Total rehabilitation takes 4-6 months.

Treatment

At first, medication and physiotherapy are started. However, if the symptoms restrict your mobility too much and the pain becomes too severe, you will be considered for a half or total knee replacement.

Complications

The chance of a wound infection after surgery is about 0.5%. Should the wound become red or continue to leak after 10-14 days, cleaning surgery followed by antibiotics will be required.

The knee replacement may not last your entire life. The prosthesis may then become loose. The knee replacement may then need to be replaced. After ten years, more than 95% of placed knee replacements still meet set conditions (after fifteen years, 85%).Post-bleeding: in the first two weeks after surgery, a leaking blood vessel may cause blood to accumulate in the knee. Sometimes blood comes out through the wound. The joint becomes red, very thick and painful.

Thrombosis: to prevent a blood vessel from suddenly closing, you will need to take blood-thinning medication (injections) for the first 4 weeks after surgery. Thrombosis occurs when an (unwanted) clot forms in a blood vessel, usually in the calf vein. The lower leg is painful, swells and becomes slightly red and shiny.

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