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Total Knee Replacement


Nearly all routine activities, such as walking, running, shoveling snow, and playing sports involve the use of the knee. Because of the strain the knee joint commonly receives, knee pain is one of the most common complaints of Americans today. Sources of knee pain include degenerative conditions, such as osteoarthritis, traumatic injuries, like ligament and meniscal tears and strains, as well as chronic overuse.

Knee Replacement Surgery for Osteoarthritis – New York City

Innovations in medicine provide orthopaedic surgeons and patients with a multitude of treatment options to reduce the limitations and symptoms associated with musculoskeletal knee conditions. One of the most effective, safe and commonly performed procedures to treat excessive knee pain is total knee replacement.

Total knee replacement has been performed for decades in the US, providing hundreds of thousands of patients with the ability to walk and move more freely. Most commonly performed to treat severe onset of osteoarthritis, total knee replacement can also treat rheumatoid arthritis and traumatic conditions affecting the knee joint, such as a result of a sports injury. If a patient’s chronic knee pain cannot be alleviated through noninvasive, conservative methods and other surgical procedures, then total knee replacement surgery may be indicated.

Anatomy of the Knee

The knee is the largest joint in the body, and is comprised of the femur (thighbone), the tibia (shinbone), and the patella (kneecap). The femur attaches and pivots on top of the tibia, which forms a joint that is covered by the patella for protection. Ligaments provide stability to the knee joint, and attach the femur to the tibia. Articular cartilage lines the surfaces of the bone to cushion the joint and aid in movement. Additionally, a tissue known as the synovial membrane provides lubrication to the knee to reduce friction and aid in healthy motion. Another type of cartilage, called a meniscus also is present, acting like a shock absorber between the bones.  If any of the components within the knee fail or degenerate due to overuse, intense pain can arise and cause further damage to the joint.

Total Knee Replacement Surgery

Total knee replacement is a procedure commonly performed to treat symptoms associated with severe osteoarthritis, a degenerative condition that plagues millions of Americans. Total knee replacement involves surgically removing the affected damaged cartilage and a thin amount of bone, and then resurfacing it with a prosthesis that takes its place.  The procedure is much like placing a cap on a tooth.

During a total knee replacement procedure, the orthopaedic surgeon first makes precise cuts to the top of the tibia and the bottom of the femur to remove the worn-out joint. Next, the surgeon implants a prosthesis that mimics the feel and motion of a natural knee. The kind of implant inserted depends on the unique needs of the patient. Types of knee replacement implants include custom-fit knees, gender-specific male and female knees, as well as high tech bearing and fixation surfaces.

Gender Specific Knee Replacement

The American Academy of Orthopaedic Surgeons estimates that two-thirds of total knee replacement patients are women; however, despite the anatomical differences between men and women and the prevalence of female knee replacement patients, most artificial knee joint implants are not tailored to accommodate the differences between the sexes. Gender specific knee replacement procedures allow surgeons to customize knee implants to meet the needs of female patients.

Gender specific knee replacement procedures are tailored to the unique physiological profile of both male and female patients. A custom-designed artificial implant, calibrated to the specific dimensions of average sized adult women and men, is used rather than a traditional implant. Gender specific implants conform closely to the patient’s bone profile, increasing the implant’s durability and lifespan. With the ability to choose from gender specific implants of varying sizes and shapes, surgeons are more likely to find the perfect fit for each patient instead of relying on “one size fits all” implants.

Dr. Harwin, a design team member of the Triathlon Total Knee , has published the first peer-reviewed scientific paper on the results of a gender-specific high performance knee replacement (see the article published by Dr. Harwin and his colleagues in Surgical Technology International, 2007.)

After Total Knee Replacement

To the Physical Therapist: Please direct most of your efforts to increasing the range of motion. Dr. Harwin encourages return to normal activities as soon as possible.

  • Try to resume a normal walking pattern as soon as you can.
  • You may put as much weight on the leg as you feel possible.
  • Switch to a cane as soon as you are comfortable and secure.
  • You may go outside and resume normal activities as soon as you can.

For the first six weeks after surgery, follow these instructions:

  • The most important part of physical therapy is to…
    • Achieve extension of 0° (the knee must straighten fully)
    • Get more than 90° of flexion (to bend more than a right angle)
  • Never put a pillow under the knee; put a rolled towel under the ankle. The knee should be as straight as possible, but you should also be bending the knee further than a right angle several times a day.
  • Do not begin exercises with weights until told to do so by Dr. Harwin.
  • Physical Therapist: Call Dr. Harwin if motion is not achieved

The ”Best“ Knee Replacement Surgery in New York City

Dr. Harwin is a board-certified orthopaedic surgeon renowned for his experience, skill, and accomplishments in joint replacement, reconstruction, and arthroscopic surgery. Dr. Harwin has been named ”New York Super Doctor,“ ”Best Doctor,“ as well las ”Top Doctor in the Metro Area.“ For a comprehensive evaluation with Dr. Harwin regarding your knee pain, schedule an appointment at his offices in Manhattan and The Bronx.

By Dr. Steven Harwin