A total knee replacement or total knee arthroplasty is a surgical procedure that resurfaces a damaged knee with metal and plastic components called prostheses. We utilize this procedure for patients who suffer from pain and loss of function of the knee usually as a result of some loss or damage to the articular cartilage whether it is from a condition such as arthritis or possibly a severe fracture involving the knee joint.
The ends of our femur and tibia are lined with specialized tissue called articular cartilage. It is this articular cartilage which allows the joints to move in a near frictionless fashion providing a smooth travel of the surfaces without causing any reactions such as formation of heat or the sensation of pain with weight bearing. This articular cartilage is made of tissue called hyaline cartilage. Unfortunately we as adults are unable to regenerate or grow hyaline cartilage if our own cartilage gets injured. Under some circumstances we are able to move good hyaline cartilage from an area of non-weight bearing to an area of weight bearing such as with an OATs transfer. However when the amount of articular cartilage that is damaged is a significantly large amount then our best option of treatment is to resurface the area. The total knee replacement is a method of resurfacing the joint to make up for the damaged hyaline (articular) cartilage. The premise is very straightforward. We make an incision in the front of the knee and retract the quadriceps tendon and patella laterally. We then remove the articular cartilage covering the end of the femur, patella, and the tibia. We save the medial and lateral collateral ligament and the posterior cruciate ligament if at all possible. When we resurface the knee with the total knee components we make up the difference between the cartilage and bone that was removed and the metal and plastic which is replaced. By saving the ligaments and matching the bone resection, we can provide a stable smooth joint resurfacing to allow return to normal activities with only a few restrictions.
The total knee procedure has been done for more than 50 years with improvements not only in the instruments to perform the procedure, but also with the materials that the joints are made of. New minimally invasive surgical techniques including quadriceps sparing approaches along with better pain relief techniques has greatly improved the speed of recovery and limited the pain involved.
Utilizing minimally invasive techniques and quadriceps sparing approaches, I have seen the recovery and return to function greatly enhanced.