Three main sections (medial, lateral, and patellofemoral) make up the knee joint, and are joined by a complex system of ligaments, tendons, and muscles. While these connective tissues secure the joint and provide support, the bone surfaces are coated by a thin synovial membrane, which provides valuable friction-reducing lubrication. Within a healthy knee, abrasive contact is almost non-existent, allowing for movements to be pain-free and uninhibited.
Knee and cartilage damage may result from a traumatic injury, called post-traumatic arthritis, or emerge as the result of long-term wear and deterioration as in osteoarthritis or as the result of an inflammatory process such as rheumatoid arthritis. These have all been associated with the occurrence of progressive knee damage, and are associated with the need for both partial or total joint replacement.
Any or all of the three main joint sections may become damaged due to either wear-and-tear or injury. Common symptoms will include the development of progressive discomfort and restricted knee movement. If significant damage is present within all three sections, a total knee replacement most likely will be recommended; however, if only one requires intervention, a partial knee replacement may be considered. Determination of whether or not more than one compartment is involved will most often require careful examination and special testing, such as special X-rays and MRI examination.
For younger patients, and some older patients, the partial replacement procedure may be recommended, since only part of the joint may be damaged. Patients who undergo a partial knee replacement must understand that due to progressive damage in other compartments they will likely have to have another operation to convert the partial to a total knee replacement.
In cases of severe knee injury or advanced damage, a total knee replacement will be recommended for both the recovery of function and relief of pain. This procedure replaces only the surface of the three compartments, much like a cap on a tooth. It removes any damaged cartilage and therefore removes the arthritis.
While some patients of partial replacement operations may report shorter recovery times and a more “natural” feeling to the knee, this has not been definitively proven. On the other hand, individuals undergoing total replacement surgeries often exhibit more pain relief since all damaged parts of the knee are removed.
In cases of both partial and total knee replacement, patients benefit from the reduction of debilitative joint pain, as well as the restoration of the strength and stability needed for many everyday physical activities.
Dr. Harwin has extensive experience with both procedures, having performed over 10,000 joint replacements.
Based on symptom history and severity, Dr. Harwin will determine whether a partial or total knee replacement will be recommended. Common signs that replacement surgery is in order are:
Dr. Harwin will lead the patient through a several tests in order to assess your specific condition, including a thorough history of your problem, a physical examination and X-rays and possibly MRI testing.
The operation is done under a regional (preferred) or general anesthesia. It takes Dr. Harwin about 45 minutes to insert the implant. No significant amount of blood is lost and rarely is a transfusion needed (if a patient will accept it). Dr. Harwin is skilled in Bloodless Surgery and operates on many Jehovah’s Witnesses. He is Director of the Beth Israel Medical Center Total Hip and Total Knee Replacement Bloodless Surgery Program. During the operation, Dr. Harwin will remove any damaged cartilage or like joint components, applying a specially individualized prosthesis for you to assure optimal fit and function. Bone cement may be used to hold the implant in place in certain circumstances, but in most cases Dr. Harwin can avoid the use of cement by using “cementless” technology in which the implant bonds directly to your bone, providing the potential for a longer lasting implant.
Dr. Harwin and his specialized Pain Management team have devised specific protocols that minimize the pain after joint replacement surgery.
Based on the type and nature of the procedure completed, a hospital stay of 2 days will likely be required. Upon release, a comprehensive program of rehabilitative (physical) therapy will be prescribed. Dr. Harwin will prescribe a combination of anti-inflammatory and pain medications for use in conjunction with at-home and formal physical therapy efforts.
Throughout the healing process, Dr. Harwin will monitor you recovery progress, adjusting the prescribed recovery program accordingly.
By Dr. Steven Harwin