As we discussed in our last blog about total hip replacement, there are several factors that influence the outcome of knee replacement. These include surgical technique, fixation of implants, avoidance of wear of the bearing surface, and with regard to motion, the amount of motion that is present prior to knee replacement. Arthritis of the knee is associated with loss of range of motion and when it is significant this loss of motion can impair normal daily walking, getting out of a chair, going up and down stairs, and most recreational activities. Over the last two years, there has been quite a bit of discussion around “high-flex knees”. These are knee replacements designed to allow greater range of motion. In laboratory testing, these types of knees do allow more motion when placed in ideal situations and in patients who have a good range of motion prior to surgery. What is unclear is how significant the difference in range of motion of current total knee replacements and “high-flex knees” are under less than ideal situations or in large groups of patients. In addition to the implant, important surgical factors influence range of motion, including alignment of the limb, placement of the components in proper orientation with regard to rotation and position and the diligence of the patient with their postoperative rehabilitation. All influence range of motion. Talk to your orthopedic surgeon about the various options for treatment of arthritis in the knee.
William P. Barrett, M.D.
WPB/ceb
I am a 41 year old active female with approximately forty pounds of extra weight. I previously had an allograft for a large (~4cm) articular cartilege lesion. The recovery was long, at three to four years. Well I recenly noted a locking of my other knee, and required arthroscopy to evaluate. A significant lesion (~3cm) flap had lifted away from the medial codyle. This lesion was debrided down to bone, and now I am now faced with a hurried decision. Do I want to proceed with another allogaft OATS of the entire medial chondial/tibial plateau? Or do I want to proceed with an artificial total knee?
Part of me wonders if buying some time with an OATs may allow medical device companies to come up with some breakthroughs. But I hate to have the extended recovery.
If I move towards the artificial knee, do you have any specific advice noting my unique situation. Is it worth collecting a second opinion regarding options at Mayo noting my age and the various options available at this time. Etc, etc, etc….
Dear Tricia,
In general it is always best to preserve your own knee. An Allograft is a large procedure but if your other knee is doing well then it may be appropriate. There are no breakthroughs in the near future re: Total Knee Replacement. A second opinion is always a good idea.
William Barrett
I was told by UWMC that I need a total knee replacement
for both knees. They estimated that the cost is $30000/knee and my insurance only pay 80%. Is there
finanical help I can get to pay for the surgery?
How much does Valley Joint charge?
Dear Susan,
You can contact the billing department at Valley Medical Center to check on payment options. Phone # 425-228-3450
Regards,
William Barrett
Dr. Barrett,
I had an injury in 1996, since then have gained weight and lost mobility due to pain, arthritis and a significant decrease in activity. I am currently 39 and was recently hit by a car as a pedestrian that has increased all above. Due to my age I have been told that total knee is not suggested, but I am only gaining more weight and losing more mobility as the arthritis and damage progresses. What do you consider to be the youngest age a total knee can be done and how long would one typically last? What then? Since I already have lost mobility, what are my chances of getting a “high flex” knee?
Thanks,
Denise
Dear Denise,
The indication for a total knee in a young person is severe arthritis which is refractory to conservative treatment options. Post op range of motion is related to pre op range of motion. High flex knees may increase range of motion in patients with good rang of motion pre op.
Regards,
Bill Barrett
RE: Previous discussions on popping sounds after hip replacement. Any feed back on what the problems were and the solutions. It has been a year since my husband’s surgery and the popping has gotten louder. The orthropedist is reseraching it but I’m getting impatient. Thanks, Bonnie
Dear Bonnie,
The most common popping sounds after hip replacement are due to:
1. Separation of ball from the socket during gait.
2. Squeaking due to Ceramic on Ceramic components.
Neither are painful and usually surgeons do not re-operate unless the noise is very loud.
William Barrett
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