Endoprosthetics of the knee joint

With certain diseases of the knee joint, the limbs can be returned to function only by applying surgical methods of treatment. Depending on the disease that caused impaired motor activity, arthrotomy, arthroscopy and knee endoprosthetics are used.

Operative methods of treatment are used when conservative therapy has not yielded positive results, and the disease continues to progress.

The following clinical manifestations indicate that pathology becomes irreversible:

• the presence of severe long-term pain that occurs during the night or daytime and is not stopped by pain medication (pain can be continuous);
• The process of destruction is proceeding at a rapid pace;
• There are significant in the volume of destruction of the contact surfaces entering the joint of bones.

Indications and contraindications to the appointment of surgical methods of treatment

The main indications for surgical treatment

The main diseases that cause joint damage, in which surgical methods of treatment are prescribed, are:

1. Deforming arthrosis (gonarthrosis) is a dystrophic-degenerative disease that leads to to the calcification and death of the cartilaginous tissue, followed by the proliferation of bone structures entering the joint.
2. Rheumatoid arthritis is a chronic systemic inflammatory disease that has a rather complex autoimmune developmental mechanism. In this disease, erosive-destructive lesions of the joints (including the knee) are mainly developed.
3. Aseptic or avascular necrosis of the knee joint - necrosis and decay of cartilage and bone tissue, which develops as a result of disturbance of normal blood circulation and trophism (nutrition).
4. Benign and malignant neoplasms of bone and cartilaginous tissue, disrupting normal functioning.
5. Intraarticular fractures of the tibia or femur. Various posttraumatic dysfunction of the joint.
6. Diseases associated with metabolic disorders (gout, diabetes mellitus), capable of causing damage to individual structural elements or the entire knee joint.
7. Damage to the ligamentous apparatus and meniscus due to trauma or various diseases.
8. Presence of habitual dislocation of the patella.
9. Inflammatory process, localized in the synovial membrane. The indication for surgical treatment in this case is the unclear etiology of the process, frequent repetition and the absence of a positive result after conservative therapy.
10. Purulent bursitis and the presence of free bodies within the joint are indications for carrying out arthrotomy.

Contraindications to the appointment of surgical methods for the treatment of knee diseases

There are relative and absolute contraindications to the surgical intervention in diseases of the knee joint.

Absolute contraindications:

• dysplasia (immaturity) of cartilaginous and bone tissue, including in childhood;
• chronic diseases of the respiratory and cardiovascular system, leading to disruption of their activity;
• infectious diseases of the knee in an acute period;
• presence of foci of bacterial infection in various organs and systems of the patient;
• thromboembolism or thrombophlebitis in the acute stage.

Relative contraindications and risk factors for complications:

• mental disorders and mental illness;
• presence of oncological diseases of other organs and systems;
• neurological disorders (Parkinson's disease, tremor and muscle weakness);
• a decrease in the activity of the functioning of the immune system, which may lead to the attachment of a secondary infection in the rehabilitation period;
• obesity of the third degree;
• a person's psychological unpreparedness for prompt intervention.

Pros and cons of endoprosthetics

Like any surgery, endoprosthetics has its advantages and disadvantages, which should be taken into account when prescribing this method of treatment.

Pros of endoprosthetics

The advantages of replacing a damaged knee joint with an artificial analogue include:

• virtually complete elimination of pain syndrome or a significant decrease in the intensity of painful attacks;
• relief of motor function. The goal of the rehabilitation period is to return the full volume of movements in the knee joint;
• significant improvement in the patient's quality of life;
• operation returned. The volume of movements after endoprosthetics reaches 120%, which in time allows not only to walk freely, but also to subject the joint to insignificant physical loads.

The main disadvantages are:

• the need to replace the joint with time if the operation was performed at a young or middle age (about once every 15-20 years);
• possible presence of residual pain or restriction of motor activity;
• the development of complications such as prosthesis bias, deep vein thrombosis, secondary infection.

Types of surgical intervention and methods of their conduct

With various pathologies, arthrotomy, arthroscopy and endoprosthetics are used.

Arthrosis

Arthrosis (a resection of the knee) is called a surgical intervention, in which structural elements are exposed knee joint and remove all free intra-articular inclusions (blood clots, purulent exudate, foreign body).If necessary, old and habitual dislocations of the patella are fixed during arthrotomy.

Resection is performed under general or spinal anesthesia. If there is no significant infection of the articular bag, then after the introduction of antibiotics into the joint cavity on the synovial membrane, sutures are applied.

Arthroscopy

Operative intervention, which is carried out under the control of an arthroscope, with the help of special tools. For its implementation, two small punctures are required, which do not require suturing, and heal independently in the postoperative period.

Endoprosthetics

Endoprosthetics is the replacement of an artificial analogue.Primary endoprosthetics and revision surgery (performed to replace a knocked-down prosthesis or treatment of complications) can be performed.

Depending on the volume of surgical intervention, they are:

• single-pole endoprosthetics- partial replacement of the knee joint;
• total endoprosthetics- is performed when extensive irreversible lesions are diagnosed on the surfaces of bones entering the joint.

Types of knee endoprostheses

The knee endoprosthesis includes a tibial, femoral and patella.Thanks to modern technologies, the following types of prostheses have been developed:

• one-muscle - to replace the external or internal condyles;
• prosthesis with a movable platform - a standard two-sided model;
• bound - used for significant damage to the joint, touching the ligament apparatus;
• special - individually manufactured prosthesis model;
• Interposition is a cartilage prosthesis, used for minor injuries for maximum preservation of bone tissue.

Rehabilitation period

On the first day after the operation, the patient is already allowed to sit in bed, and on the second day you can get up and even try to walk. It must be remembered that at the first attempt to get up there should be a LFK instructor or a doctor.

After discharge from the hospital for quick recovery, several rules must be observed:

• carefully follow all the doctor's recommendations;
• maintain the cleanliness and dryness of the wound;
• Do not play sports for 8-9 weeks after surgery;
• Exercise from the complex of therapeutic gymnastics;
• It is also forbidden to kneel and lift heavy things.

Prolong the life of the prosthesis can refrain from physical activities associated with sports or professional activities, regular massage sessions, normalization of body weight.