Scientific American Health Alerts Guide to Knee Replacement

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Minimally Invasive Knee Replacement Surgery

Surgeons continually seek ways to make joint replacements and repairs easier, safer and less arduous for the patient. A number of new techniques are currently under development.

Some surgeons have started performing knee replacement surgery through very small incisions, a procedure called minimally invasive joint replacement. However, minimally invasive procedures are more difficult to perform than standard joint replacements, and researchers don’t yet know whether the long-term results will be as good. In addition, not everyone is a candidate, including individuals who are obese.

Is minimally invasive surgery for a total knee replacement as safe and effective as conventional surgery? Studies conducted to date on minimally invasive knee replacement surgery have had conflicting results, and not many have been completed with randomization and control groups. Recently, however, surgeons in Europe conducted a randomized multicenter study to compare the safety and effectiveness of the two procedures. They enrolled 134 people, average age 70 years; 66 had a minimally invasive procedure, and the rest had conventional surgery. The minimally invasive procedure took nearly an hour longer to perform because it is a more technically demanding procedure. However, it was associated with less blood loss.

At the four- to six-week postoperative visit, people who had minimally invasive surgery were in less pain and were dealing better with their daily activities than patients who had standard surgery, but this advantage was short-lived. At one year, there were no significant differences between the two groups.

You and your doctor should carefully and realistically weigh the short- and the long-term advantages of minimally invasive surgery before making a decision on which technique will be used.

More on Knee Replacement Surgery

What Happens During Knee Replacement

Joint replacement is called arthroplasty, and the most common type of arthroplasty is total joint replacement. In this procedure, the entire diseased or damaged knee joint is removed and replaced with an artificial one (a prosthesis) to relieve pain and restore function.

Weighing the Pros and Cons of Knee Replacement Surgery

Knee replacement surgery is not a quick fix, and it is not without risks. Serious complications, such as blood clots and infections, can occur—but precautions can be taken to prevent or control them. In addition, the road to recovery can be difficult and time consuming, particularly with joint replacement surgery.

Is Age an Obstacle to Knee Replacement Surgery?

Some people may worry that they are too old too benefit from having a total knee replacement. But even osteoarthritis patients 75 and older appear to benefit greatly from joint replacement surgery, as a study in the Archives of Internal Medicine has indicated. Researchers followed 174 elderly patients with severe knee or hip osteoarthritis—average age 75—for 12 months, assessing them at six weeks, six months, and one year.

Female Knee Replacements

Designed specifically to fit a woman’s knee, female knee replacements have been available only in recent years. Prior to 2006, when the Gender Solutions knee was approved by the U.S. Food and Drug Administration (FDA), knee replacements were unisex—designed to fit both men and women.

After Knee Replacement Surgery: Rehab and Recovery

Successful knee replacement requires a considerable investment of time and energy in rehabilitation following the surgery. Rehabilitation begins in the hospital, usually the day after surgery. During this period, a strict timetable of exercise, rest, and medication is crucial to the success of the surgery.

Resuming Physical Activities After Your Knee Replacement

If you are facing a knee replacement or have had one, you should talk to your physician about the risks of physical activity, such as a loosening or dislocation of the replacement and the possible need for a repeat surgery. Chances are, though, that a knee replacement won’t halt your golf game or drive you from the bowling lanes.


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