Orthopedic Procedures

Total Knee Resurfacing

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee resurfacing surgery. This is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Total knee resurfacing is one of the most successful procedures in all of medicine. According to the Agency for Healthcare Research and Quality, more than 600,000 knee replacements are performed each year in the United States.

Normal knee anatomy.

Anatomy

The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities.

The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.

The menisci are located between the femur and tibia. These C-shaped wedges act as "shock absorbers" that cushion the joint.

Large ligaments hold the femur and tibia together and provide stability. The long thigh muscles give the knee strength.

All remaining surfaces of the knee are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction to nearly zero in a healthy knee.

Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Osteoarthritis often results in bone rubbing on bone. Bone spurs are a common feature of this form of arthritis.

Cause

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

  • Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
  • Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."
  • Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
About the Procedure

There are four basic steps to a knee resurfacing procedure.

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

(Left) Severe osteoarthritis. (Right) The arthritic cartilage and underlying bone has been removed and resurfaced with metal implants on the femur and tibia. A plastic spacer has been placed in between the implants. The patellar component is not shown for clarity.

Photo of the Total Knee Resurfacing appliance.

Is Total Knee Resurfacing Right for You?

The decision to have total knee resurfacing surgery should be a cooperative one between you, your family, your family physician, and Dr. Hayter.

When Surgery is Recommended

People who benefit from total knee resurfacing often have:

  • Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
  • Moderate or severe knee pain while resting, either day or night.
  • Chronic knee inflammation and swelling that does not improve with rest or medications.
  • Knee deformity — a bowing in or out of your knee.
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries.
Candidates for Surgery

There are no absolute age or weight restrictions for total knee resurfacing surgery.

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee resurfacing are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total knee resurfacing surgery has been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Orthopedic Evaluation

An evaluation with Dr. Hayter consists of several components:

  • A medical history. Your orthopaedic surgeon will gather information about your general health and ask you about the extent of your knee pain and your ability to function.
  • A physical examination. This will assess knee motion, stability, strength, and overall leg alignment.
  • X-rays. These images help to determine the extent of damage and deformity in your knee.
  • Other tests. Occasionally blood tests, or advanced imaging such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your knee.

Dr. Hayter will review the results of your evaluation with you and discuss whether total knee resurfacing is the best method to relieve your pain and improve your function. Other treatment options — including medications, injections, physical therapy, or other types of surgery — will also be considered and discussed.

In addition, Dr. Hayter will explain the potential risks and complications of total knee resurfacing, including those related to the surgery itself and those that can occur over time after your surgery.

(Left) In this x-ray of a normal knee, the space between the bones indicates healthy cartilage (arrows). (Right) This x-ray of a knee that has become bowed from arthritis shows severe loss of joint space (arrows).

Preparing for Surgery
Medical Evaluation

If you decide to have total knee resurfacing surgery, Dr. Hayter will ask you to schedule a complete physical examination with your family physician several weeks before the operation. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such as a cardiologist, before the surgery.

Tests

Several tests, such as blood and an electrocardiogram, may be needed to help plan your surgery.

Medications

Tell Dr. Hayter about the medications you are taking. He will tell you which medications you should stop taking and which you should continue to take before surgery.

Dental Evaluation

Although the incidence of infection after knee replacement is very low, an infection can occur if bacteria enter your bloodstream. To reduce the risk of infection, major dental procedures (such as tooth extractions and periodontal work) should be completed before your total knee resurfacing surgery.

Urinary Evaluations

People with a history of recent or frequent urinary infections should have a urological evaluation before surgery. Older men with prostate disease should consider completing required treatment before undertaking knee replacement surgery.

Social Planning

Although you will be able to walk on a walker soon after surgery, you will need help for a few weeks with such tasks as cooking, shopping, bathing, and doing laundry.

Your Surgery
Anesthesia

After admission, you will be evaluated by a member of the anesthesia team. The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

Procedure

The procedure itself takes approximately 1 hour. Dr. Hayter will remove the damaged cartilage and bone, and then position the new metal and plastic implants to restore the alignment and function of your knee.

After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.

(Left) An x-ray of a severely arthritic knee. (Right) The x-ray appearance of a total knee resurfacing. Note that the plastic spacer inserted between the components does not show up in an x-ray.

Your Hospital Stay

You will most likely stay in the hospital for 1-3 days.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Blood Clot Prevention

Several tests, such as blood and an electrocardiogram, may be needed to help plan your surgery.

Medications

Dr. Hayter will prescribe one or more measures to prevent blood clots and decrease leg swelling. These may include special support hose, inflatable leg coverings (compression boots), and blood thinners.

Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots.

Post op Exercises and wound care

You will be instructed by the staff on the post operative exercises that you should begin while in the hospital and throughout your recovery period at home. You will also be instructed on wound care, dressing change and activity prior to your discharge to home.

Please contact the office or our Nurse Coordinator, Jamie Flores, R.N. at 727-515-5546 if you have any questions or concerns.