Total Knee Arthroplasty
January 1, 2021
Dr. Shaw has been performing total knee arthroplasty (TKA) since 2000 when he started practicing. Six hundred thousand TKA’s are performed a year in the United States with 90% experiencing a significant reduction in knee pain. The surgery and technology related to TKA has advanced over the years. Smaller incisions, limited muscle cutting, advances in pain management and robotic navigation are all improvements that Dr. Shaw implements into his surgery.
TKA is one of the most common and most successful surgeries performed in the U.S. every year. Patient satisfaction continues to improve as newer pain management techniques are implemented and same-day knee replacement surgeries have become the norm. Results for knee replacement in large population studies have shown 95% survival of the implant at 15 years.
The first question patients ask is how do I know if I need a total knee? When pain is consistently at a high level and interrupting daily life or recreational activities, they should see a surgeon like Dr. Shaw. Once x-rays confirm the diagnosis of arthritis, options for treatment are discussed. Typically, patients try activity modifications, oral NSAIDs like ibuprofen, steroid or viscosupplementation injections as nonsurgical treatment. If the nonsurgical management is not effective, then it is time to discuss surgery.
A preoperative visit with the medical doctor to ensure safety through the surgery will occur. Dr. Shaw will review the details of surgery and prepare the patient for surgery through education about the rehabilitative course and order the medications used after surgery. The risks of surgery are discussed in detail. These include infection, blood clotting and implant failure. He uses a multimodal pain medication approach so that pain is reduced effectively and the need for strong narcotics are minimized.
On the day of surgery, the patient meets the anesthesia doctor, and a nerve block is placed to reduce or eliminate pain for the first day. This allows almost all patients to leave the surgical center the day of surgery.
Once in surgery, the incision is made over the front of the knee and the arthritic ends of the bones are trimmed. Careful alignment of the knee is done with guides or the ROSA navigation robot (see below). The knee implants are cemented in placed. After surgery, the patient is seen by the physical therapist to get the patient walking before they leave. At Beacon Orthopaedics, we typically do a pre-op one-time therapy visit to educate and train the patient on what they can expect on the day of surgery.
There are two major versions of knee replacement. Depending on the location and severity of the arthritis, the patient will learn what is best on an individual basis. Partial knee, also known as medial unicondylar knee replacement, replaces the medial half of the knee when most or all of the arthritis is located at the medial (inner) side of the knee. Partial knee replacements are a little faster to heal and usually less painful because there is less bone cutting. More commonly, patients have more widespread arthritis affecting the patella, medial, and lateral compartments of the knee. This amount of knee arthritis will require a total knee (TKA).
Please see the link at Zimmer Biomet for more information.
When a patient has a significant deformity of the knee as a result of severe arthritis, Dr. Shaw will elect to use the Zimmer Biomet ROSA system to make accurate bone cuts to align the knee anatomically. The robotically assisted technique uses GPS technology to navigate in real time to allow precise placement of the knee implants. The surgeon still does the surgery, but the ROSA robot places the cutting blocks in the perfect position.
Please see the Zimmer Biomet link for more detailed information.