Monday Medical: What’s new about knee replacements
Total knee replacements aren’t what they used to be; they’re much better.
“If you knew somebody who had a knee replacement 10 to 15 years ago, it was probably a completely different experience than what happens now,” said Dr. Bryan Bomberg, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center.
Below, Bomberg describes how knee replacements have changed for the better through the years.
They last longer
In a knee replacement, the surgeon removes damaged cartilage and bone, coats the ends of the thigh and calf bones with metal and inserts a plastic spacer to help the joint move.
The new knee joint can last upwards of 20 years.
“A few decades ago, we weren’t sure how long a new knee would last, and might say about 10 years,” Bomberg said. “Now, we know there’s an 80-percent chance the knee replacement will last 20 years.”
An improved design and the ability to precisely position implants have both contributed to the longer lifespan of replacement knees. And by monitoring the joint, it may also be possible to replace the plastic as it wears out while leaving the embedded metal alone.
“We definitely have seen an improvement in design, particularly to the weight-bearing surface,” Bomberg said. “In most situations, there’s every reason to think your knee replacement will last you the rest of your life.”
Surgery is smoother
A decade ago, a knee replacement may have resulted in significant blood loss and intense pain directly after the surgery.
Now, blood transfusions are rarely needed, and long-acting numbing medications are placed inside the knee, helping to better control pain for the first few days after surgery.
The knee is sealed up with absorbable stitches and skin glue, and since the dressing is watertight, patients can often shower the day after surgery.
Typically, patients stay a night or two in the hospital after a surgery, instead of the four or five that were previously the norm.
“It’s easier for patients to get out of bed the day of surgery,” Bomberg said. “There is much greater functionality occurring the day after.”
New medications aid in the process
A newer medication called tranexamic acid is used to successfully stabilize blood clots and reduce blood loss, and studies have now shown that aspirin is effective at preventing post-operative clots for patients who have a normal clotting risk, which means many patients don’t have to take other blood thinners that may require regular blood tests. Pain medications have also advanced, helping to better manage pain.
It’s easier to return to activity
After surgery, the focus is on helping patients get back to their regular activities.
“The experience is much more geared towards a person who wants to restore function,” Bomberg said. “If you’ve been a skier, we expect you can go back and ski.”
Keep in mind that the first four to six weeks post-surgery should be focused on gradually restoring basic activities while it takes four to six months for higher levels of athletic pursuits.
“Have a realistic sense of the recovery, and know that it takes some work,” Bomberg said.
While a number of things have changed, one has stayed the same. Orthopedic surgeons enjoy helping patients restore motion and find relief from pain.
“Before a knee replacement, a patient may have tried exercises, a brace, anti-inflammatory medications, steroid injections, physical therapy, and still been in so much pain that the knee was dictating their lives, saying what they could or couldn’t do,” Bomberg said. “It’s a real joy to get somebody back to the things that they love.”
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