Total Knee Arthroplasty - Term Paper Example

Total knee Arthroplasty (Author’s name) (Institutional Affiliation) Table of Contents Table of Contents 2 Abstract 3 Introduction 3 Case study. 4 Knee arthroplasty 4 Preoperative Preparation 5 A Summary of the Operative Technique on Therese. 6 Post Operative Rehabilitation 7 Future Mobility 8 Conclusion 9 References. 10 Abstract Osteoarthritis is a common form of chronic arthritis. This condition is similarly known as osteoarthrosis or degenerative joint disease. It is a complicated condition that affects the cartilage and other elements of the structure of the joint. This condition is associated with pain and disability in the joint (McAlindon Formica, Schmid and Fletcher, 2007). The prevalence of osteoarthritis increase as a person grows older. This condition affects an estimated 1.5 million Australian which translates to about 7.5 percent of the population (March, and Bagga, 2004). Experts have stated that the exact point of onset of osteoarthritis cannot be detected (Knox, Harrison, Britt and Henderson, 2008). Therese has opted for a total knee arthroplasty to stop the pain and suffering she has endured following the osteoarthritis. Introduction Osteoarthritis is a disease of the joint that usually affects the cartilage. The cartilage is the slippery tissue which covers the ends of bones in a joint. Cartilage that is still healthy allows the bones to glide over each other. Such cartilage is also important because it helps to absorb shock movements. In cases of osteoarthritis, the upper layer of the cartilage wears away and breaks down. When this happens, those bones under the cartilage rub against one another causing acute pain, loss of motion of that particular joint and swelling. With time, this joint may lose its normal shape. It is possible for bone spurs to grow on the edges of such a joint. It is also possible for cartilage or bits of bone to break off and float inside the space of the joint leading to further damage and pain (Scott, 2006). Persons who have osteoarthritis experience pain in the joint and have reduced motion. Osteoarthritis is arthritis that affects only the joints. It does not affect the internal organs. Osteoarthritis is common among older people. Young people can also get osteoarthritis especially when they get joint injuries. Osteoarthritis occurs gradually with time and common risk factors include old age, joint injury, being overweight, joints not properly formed, genetic defect in joint cartilage and stress on the joints from playing sports among other factors (Messier, Gutekunst, Davis and DeVita, 2005). The operative procedure total knee replacement or total knee arthroplasty is a surgical process or procedure that replaces the weight enduring and bearing surfaces of the joint of the knee. It is performed to alleviate and relieve the pain and disability caused by osteoarthritis. This paper will discuss the operative procedure that Therese has had (total knee arthroplasty) in relation to her osteoarthritis and future mobility. Case study. Knee arthroplasty Arthritis may be treated through conservative management but in the event, it does not succeed, surgery is the next option (Kim, Axelrod, Howard, Buratovich and Waters, 2006). Total knee replacement surgery abbreviated as TKR is also known as total knee arthroplasty. According to studies carried out, it is among the most successful elective surgeries that are performed today. This surgery involves the replacing of cartilage tissue that has been severely damaged. The cartilage tissue is replaced with a prosthesis that is made of plastic and metal. This prosthesis duplicates the function of the joint of the knee joint. A successful total knee arthroplasty helps to relieve the patient of the excruciating pain and restores the function in knee joints that were severely damaged. During the surgery, the surgeon cuts out any damaged cartilage and bone from a patient’s thighbone, kneecap and shinbone and then replace it with the prosthesis, which is the artificial joint made of high-grade polymers and plastic and alloys of metal (Scott, 2006). Total knee arthroplasty improves problems of the knees that are associated with osteoarthritis. It can also help improve problems associated with psoriatic arthritis, rheumatoid arthritis and other situations that are degenerative such as osteonecrosis which is a condition that arises when blood flow is obstructed and the bone tissue dies causing the degenerative condition (Scott, 2006). Preoperative Preparation A thorough and complete preoperative preparation is essential to ensure the ultimate success of a total knee arthroplasty. Therese requires a preoperative preparation shortly after surgical consultation. Every patient who is to undergo a total knee arthroplasty must have a careful general medical evaluation which also includes laboratory tests. Therese had to perform a range of motion exercises as well as, knee, hip and ankle strengthening exercises. The purpose of the medical evaluation is to assure to the greatest extent possible that the potential patient has the medical capacity to undergo a total knee procedure (Busch, et al. 2006). The medical examination on Therese should be performed one to four weeks before the proposed day of surgery. In older patients for instance, a coronary artery stress test maybe necessary once the first medical evaluation has been performed. Patients with a history or symptoms and signs of peripheral vascular diseases or coronary artery require vascular studies of a special nature. The preoperative tests that are usually done include electrolytes, a total blood count, APTT and PT to evaluate clotting of blood. Other tests that are carried out include chest X-rays, ECG and cross matching of blood for possible transfusion. It is also important for Therese’s orthopaedic surgeon to obtain the appropriate preoperative musculoskeletal radiographic study (Busch, et al. 2006). A custom primary total knee arthroplasty ordinarily requires a full length standing X-Ray of the two lower extremities, a lateral view of the knee that is to be operated upon and a sky line view of the pair patellae. The full length standing of both radiographs is important because it reveals the extent of bone loss and angular deformity that is present. It will permit the surgeon to anticipate Therese’s prosthetic and bone graft needs accurately. The lateral view will help reveal to the surgeon the degree of posterior tibia and femoral osteophyte formation. Therese will have to stop medications such as aspirin and warfarin days before the surgery so as to reduce her amount of bleeding (Lassen, Ageno, Borris et al. 2008). Therese may be admitted on the surgery day or the eve of the surgery. Admission on the surgery day depends on whether the pre-op work has been done and completed in a pre-anaesthetic clinic (Busch, et al. 2006). A Summary of the Operative Technique on Therese. The total knee arthroplasty on Therese involves the exposure of the front part of her knee with disconnection of the quadriceps muscle parts from the patella. The patella is moved to one side of the joint whereby it will allow the exposure of the femur’s distal end and the tibia’s proximal end. The ends of these bones are later precisely cut into shapes using cutting guides that are oriented to the long axis of the bones. The next process is to remove the cartilages, as well as the anterior cruciate ligaments. The surgeon may also remove the posterior cruciate ligament while preserving the collateral ligaments (Scuderi, 2006). After this process, metal components are impacted onto the bone. The surgeon may opt to fix the components using poly-methylmethacrylate cement abbreviated as PMMA. An implant that is round ended is used as the femur which imitates the natural bone shape. The component is flat on the tibia. Usually the component will have a stem which will go inside the bone for auxiliary stability. The surgeon will then insert a flattened or slightly high polythene surface onto the tibial component so that the weight will be transferred from the metal to the plastic and, not from one metal to the other. During the total knee arthroplasty, any existing deformities must be rectified and, the ligaments balanced so that Therese’s knee will have a good range of movement which is stable. In certain surgeries, the patella’s articular surface is separated and substituted with a polythene button which is cemented to the patella’s posterior surface (Hanssen and Scott, 2009). It is worth mentioning that there are numerous manufacturers of implants. The different kinds require a technique and instrumentation that is slightly different from the other. There are numerous debates about the knee replacement design that is suitable. Common variations exist between components that are either to be cemented or un-cemented (Hutchinson, Parish and Cross, 2006) and, between operations that will spare the posterior cruciate ligament and that which will resurface the patella or that which will not resurface it (Busch, et al. 2006). Post Operative Rehabilitation Following Therese’s successful operation, it is important for the weight to be protected with walkers or crutches until her quadriceps muscles are healed and have recovered their strength (Forster, Bauze, Bailie, Falworth and Oakeshott, 2011). Therese will be on a continuous passive motion following the operation. Therese’s hospitalization will depend in the status of her health and the available support that will be accorded to her after discharge from the hospital (Naylor, Harmer, Fransen, Crosbie and Innes, 2006). The surgeon estimate that Therese will recover within a period of two weeks. Approximately six weeks after her surgery Therese will have progressed to full weight bearing with the help of a walking cane. A complete recovery from an operation involves the return of normal function after three months. Some patients may record improvement that is gradual which may take a longer period than the estimated three months (Naylor, Harmer, Fransen, Crosbie and Innes, 2006). Future Mobility There are certain complications and risks that may arise after Therese’s operation that may affect her motion. Therese has to be conscious of the risks that are likely to arise. Following the total knee arthroplasty, the knee at times may fail to recover the normal range of motion. This is however, dependent on pre-operative functions. Many patients may achieve a high degree of motion but, they may suffer from stiffness of the joint (Miner, Lingard, Wright, et al. 2003). In certain instances patients have had their knees manipulated under anesthetic in order to improve post operative stiffness (Naylor, Harmer, Fransen, Crosbie and Innes, 2006). After Therese’s successful total knee arthroplasty she has to exercise regularly in order to restore her knee’s mobility and strength. She has to engage in exercises gradually so that she can progressively return to everyday activities that are crucial to her full recovery. Therese has to maintain a healthy weight (Calder, 2006). Conclusion Osteoarthritis is a disease of the joint that usually affects the cartilage. A total knee replacement (TKR) or total knee arthroplasty is a surgical treatment that is performed following an advanced case of osteoarthritis of the knee joint. Total knee arthroplasty improves problems of the knees that are associated with osteoarthritis. During this surgery, the surgeon replaced Therese’s knee join with an artificial material. Therese’s knee joint was made up of the femur which is also the thigh bone, a shin bone or the tibia, the knee cap or patella and the cartilage. When Therese suffered from osteoarthritis, her cartilage was worn out causing the excruciating pain that she was going through. During the surgery, the surgeon removed the end of Therese’s femur and replaced it with a metal surface. The surgeon then removed the top of Therese’s tibia and replaced with a piece made of plastic that has a metal stem. Since her knee cap had degenerated as well, the surgeon added a plastic piece to the back surface in order to create a smooth surface in the joint. Therese’s total knee arthroplasty was successful and thus, the surgeon advised her to engage in regular exercises so that she can restore the future mobility of her knee. References. Busch, A.C et al. (2006) Efficacy of periarticular Multimodal Drug Injection in Total Knee Arthroplasty. A Randomized Trial. The Journal of Bone and Joint Surgery, 88, 959-963. Calder, P. (2006). n-3 polyunsaturated fatty acids, inflammation and inflammatory disease. American Journal of Clinical Nutrition, 86 (6 Suppl), 1505s-1519s. Forster, M. C., Bauze, A. J., Bailie, A. G., Falworth, M. S., and Oakeshott, R. D. (2011). 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