• Knee Replacement

    Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. It is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis

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    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses Knee Replacement Surgical Options.
    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses Knee Replacement Surgical Options.
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    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses What to Expect From Knee Replacement Surgery Outcomes.
    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses What to Expect From Knee Replacement Surgery Outcomes.
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    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses What to Expect From Knee Replacement Surgery Outcomes.
    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses What to Expect From Knee Replacement Surgery Outcomes.
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    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses Movement and Sports After Knee Replacement Surgery.
    Dr. Bassam Masri, MD, FRCSC, Orthopedic Surgeon, discusses Movement and Sports After Knee Replacement Surgery.
  • Knee Replacement Surgical Options

    So once you and your physician have decided that everything else is no longer working and surgery is required for osteoarthritis of the knee, there are a variety of options.

                                     

    The most common option, by far, is a knee replacement. In very young patients, and typically patients in their 20s who have localized arthritis to one part of the joint, typically on the inside of the joint with a bowlegged deformity, occasionally you can break the leg bone – the tibia – and do what’s called an osteotomy and realign the leg. But that’s only an option for very young patients.A local chiropractor may work with your local massage therapist and your local physiotherapist to create the best health or rehabilitation plan for your situation. 

    Another option is a partial knee replacement. And that is a reasonable option if the arthritis is localized to one of the three compartments of the knee joint. And the knee joint can be thought of as having three compartments. The inside of the knee is one compartment, the outside of the knee is a second compartment, and the third compartment is the kneecap area.

    So if there’s arthritis located either to the inside or the outside, then a partial knee replacement can be considered. If the arthritis is localized to the kneecap area, and this is not just patients with pain in the kneecap, but bona fide arthritis one can see on an x-ray of the knee, then a partial replacement of the kneecap area can be an option.

    And the final – and really, the most common surgical option for osteoarthritis of the knee – is a knee replacement. And that is usually offered to patients who have pain either all over the knee, or even if they have localized arthritis in one compartment but the pain is global in the knee, then we generally offer a full knee replacement.

    Or, if technically a partial knee replacement is not possible, or if the patient and their surgeon decide that a full knee replacement is the best option, then that is what is offered.

    Generally, the long term outcome of a full knee replacement is better than that of a partial knee replacement in that the revision rate at 10 years for a partial knee replacement is two to three times as high as that of a full knee replacement.

    And this is why a lot of patients and surgeons choose to do a full knee replacement as opposed to a partial knee replacement. So the question I guess asked is why would you even consider a partial knee replacement if the failure rate at 10 years is higher?

    So if the patient is younger and they wish to have another option as they get older, to be converted to a full knee replacement, then that is also another option, but that is a personal decision that the patient and the surgeon have to discuss and agree that it is the best option for a particular patient.

    There really is no right or wrong answer in this regard, as long as everybody knows what the facts are and then they make an informed decision. So if you think that you need a knee replacement or have any further questions, consult with your physician.

    Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

    Now Health Network Local Practitioners: Orthopaedic Surgeon

  • What to Expect From Knee Replacement Surgery Outcomes

    So a knee replacement for arthritis of the knee is a highly beneficial operation. The good or excellent results are 80 to 90 percent after surgery.

    So patients are told that 80 percent are extremely happy or ecstatic with the outcome, 10 percent are happy, but not ecstatic, and 10 percent are not happy at all. So right off the bat, one has to accept that there is at least a 10 percent risk of lack of satisfaction, and a 10 to 20 percent risk of ongoing pain after a knee replacement. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option. Getting a referral to a rheumatologist or your local pharmacist is also important in dealing with Arthritic conditions.  

    One should not expect to have immediate pain relief after a knee replacement. A knee replacement tends to be a fairly painful operation. The pain is fairly intense for the first little while, however it is treated effectively in the hospital with local anesthetic infiltrations, sometimes with blocks, with medications, so that the patient is reasonably comfortable.

    However, after surgery the pain tends to continue for a relatively prolonged period of time. When I say pain I mean relatively minor pain. For example, pain at the end of the day, or pain in the evening just before one goes to bed, and that is easily controlled with a painkiller. Just a Tylenol or Advil before one goes to bed, and that gives reasonable comfort.

    And that tends to continue for anywhere from six to nine months. And the maximal benefit from a knee replacement isn’t really achieved until anywhere from nine to eighteen months after surgery. So one should not expect to be extremely happy at two weeks or four weeks. Having said that, most patients tend to use a walker or crutches for a short period of time, basically until they get home from the hospital, which is approximately two to three days. Then they switch over to a cane.

    By anywhere from three to six weeks they can get rid of the cane. A lot of patients can start golfing at six weeks. They can resume driving - as long as they’re not taking narcotic analgesics or painkillers - at three weeks. They can return to swimming at six weeks. They can return to fairly vigorous walking at anywhere from four to six weeks.

    While they may have a little bit of pain this will get better. The knee will be swollen and warm to the touch for up to a year or two after surgery, and that is not a concern. The knee will be bruised, as will the leg, from the hip potentially all the way down to the ankle for the first few days to a couple of weeks after surgery, and that is also completely normal and not a cause for concern.

    There is significant swelling, particularly after a patient goes home, because now they’re walking more, the leg is more dependent, and that is also not a huge cause for concern, because it is a normal feature after a knee replacement.

    So the final thing that one needs to know about a knee replacement is that the outside of the knee will be numb after surgery. This is not a complication, this is a normal feature of a knee replacement. It is not painful, it is not bothersome, it is simply numb, and patients always ask about this and it is a normal feature.

    If you think you have any more questions, or if you’d like to know more about a knee replacement, consult with your physician. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health. Presenter: Dr. Bassam Masri, Orthopaedic Surgeon, Vancouver, BC

    Local Practitioners: Orthopaedic Surgeon

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