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Total knee endoprosthesis

Structure of the knee joint

The knee joint connects the two longest bones of the human body, the femur and the tibia bone. There is an enormous leverage on it. The stability of the knee is ensured by a complex ligament apparatus. This is fairly vulnerable. Due to numerous injuries and significant functional loads, we often find signs of degenerative discomfort on the knee joint. The ideal knee joint load is in the mechanical axis of the limb, that is, the straight line of the femoral head, the center of the knee joint and the center of the ankle joint.

It is a degenerative, non-inflammatory affection of hyaline knee cartilage due to its reduction, the formation of joint osteophytes, bone sclerosis and changes in soft tissues. Clinically, it is manifested by pain in movement, change of the limb axis, stiffness of the joints. Typical is starting pain at the beginning of movement and in the morning.

Primary coxarthrosis - arises from a metabolic disorder of cartilage 
Secondary coxarthrosis - the cause of arthrosis is not primarily on the metabolic background.

Mechanical axis
Lower limbs
The cause may be:

  • Various injuries (cartilage, ligament apparatus)
  • Arthritis (conditions after joint inflammation)
  • Congenital and developmental defects
  • Axial deformity

On X-ray imaging, gonarthrosis is manifested by gradual tapering of the joint, increased peripheral osteophytes, subchondral sclerosis, sometimes through the formation of subchondral cysts with the possibility of bone necrosis. Arthrosis is divided into four stages according to the X-ray finding.

Operational treatment

Debridement of arthritic knee

In earlier stages of knee arthrosis, arthroscopic joint revision is appropriate, where degenerative meniscus cracks can be treated, tumors degenerative, removing loose bodies, or revitalizing local cartilage defects.

Correction osteotomy

If the cartilage abrasion occurs due to abrasion of the cartilage to change the axis of the lower limb, it is advisable to compensate, in the indicated cases, for the distribution of the load on the articular surface, thereby relieving the damaged cartilage areas. We use corrective osteotomy to do this.

Aloplasty - artificial joint

Aloplasty of the knee joint is a replacement of the damaged joint with an implant, replacing the sliding part of the femur and the tibia.

  • Femoral component - mostly metal (CrMoCo steel), fixed with bone cement
  • Tibial component - usually of titanium, fixed with bone cement
  • Tibial plateau - a polyethylene sliding surface between the femoral and tibial component

Preoperative preparation

The patient should be thoroughly preoperatively examined before knee joint alloplasty. On the way to our Grand Class ambulance, we perform standard preoperative examinations (ECG, laboratory examinations, heart and lung x-rays), dental examinations, gynecological and urological examinations. In the preoperative period, it is necessary to modify the medication that affects blood clotting. The patient is provided with underarm crutches and medications to prevent thromboembolic disease.

Operation

The time spent by the patient in the operating room is about 120 minutes. The entire patient is accompanied by an anesthesiologist with an anesthesiologist. In most cases, knee joint alloplasty is appropriate in spinal anesthesia, ie in the patient's condition during conscious operation. Only the operated limb is unresponsive. In order to stimulate a pleasant atmosphere, patients are given calming drugs. The actual surgery takes about 90 minutes. We use recuperation to compensate for blood loss. Blood drawn from the wound is returned to the bloodstream after treatment. There is often no need for foreign blood transfers or for self-transfusion. The implantation of the knee joint TEP can be done at the PMI  using the Visionaire method Our workplace is one of three centers in the Czech Republic.

Performance parameters

Duration of hip surgery: cca 60 minutes
Duration of anesthesia: 90 minutes
Length of hospital stay: 8 days
Duration of knee surgery: cca 80 minutes
Duration of anesthesia: 100 minutes
Length of hospital stay: 8 days

 

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