Site de chirurgie orthopédique du Dr Erwan Simon

Chirurgie Orthopédique
Conventionnement : Secteur 2
Carte Vitale Acceptée

Clinique de la Baie de Morlaix


Secrétariat de chirurgie, Rond point de La Vierge Noire ,
29600 Morlaix, France

Contacts

  • Fixe : 02.98.61.48.18
  • Fax : 0298620146
  • Fixe : 02.98.61.48.18
  • Fax : 0298620146
Plus d'informations (Accès, Horaire...)

Bienvenue sur le site de chirurgie orthopédique du Dr Erwan Simon

Vous y trouverez les informations pratiques concernant mon activité, ainsi qu'un certain nombre d'informations relatives à la chirurgie orthopédique et traumatologique.

Réunions scientifiques avec les partenaires santé

  • Vendredi 6 avril 2012: Topo sur la chirurgie mini invasive et percutanée du pied et de la cheville avec les podologues du Finistère.

  • Mardi 22 mai 2012 : Topo sur l'entorse grave du genou et la plastie du ligament croisé antérieur sous arthroscopie avec les médecins du secteur de Lanmeur dans le cadre de de la Formation Médicale Continue.

  • Vendredi 22 juin 2012: Topo sur la chirurgie mini invasive et percutanée du pied et de la cheville avec les podologues des Côtes d'Armor.

  • Vendredi 28 septembre 2012: Réunion avec médecins généralistes sur l'état des lieux concernant la prothèse totale de hanche et l'arthrose du genou en 2012.

  • Vendredi 16 novembre 2012: Réunion avec médecins généralistes sur l'état des lieux concernant la prothèse totale de hanche et l'arthrose du genou en 2012.

  • Jeudi 20 février 2014 : Réunion avec les FMC de Morlaix et Lanmeur Sous l'égide du CHEM (Collège des Hautes Etudes en Médecine) entrant dans le cadre du DPC: Etat des lieux dans la prise en charge de l'hallux valgus.


  • Vendredi 10 octobre 2014: Réunion avec les kinésithérapeutes de la région brestoise au CHEM organisme DPC sur le sujet: Focus sur la chirurgie et la rééducation du ligament croiséantérieur.

  • Vendredi 7 novembre 2014: Réunion avec les kinésithérapeutes de la région 29 est et 22 ouest dans la cadre du CHEM organisme DPC sur le sujet: Focus sur la chirurgie et la rééducation du ligament croisé antérieur.

  • Mercredi 1 juillet 2015 : Réunion avec généralistes du Finistère Nord: Récupération rapide après prothèses de hanche et de genou/Ligamentoplastie du croisée antérieur en ambulatoire.

  • Jeudi 24 septembre 2015 :Réunion avec les kinésithérapeutes des Côtes d'Armor à Saint Brieuc dans le cadre du CHEM: Focus sur la chirurgie et la rééducation du croisé antérieur.


    Jeudi 20 octobre 2016: Réunion médecins et kinés du 29 dans le cadre du CHEM: Quoi de neuf sur la gonarthrose en 2016.


    Jeudi 27 avril 2017: Réunion avec les médecins généralistes du 29 dans cadre du CHEM: Le pied dans tous ses états avec les Drs Valls Bellec et Ferrand rhumatologues sur Brest et Rennes.


Congrès

  • Cours du DESCQ Inter région Ouest(Pr Langlais)

  • Cours de traitement des fractures du Collège de Chirurgie Orthopédique CHU Tours(Pr Burdin)

  • SOO(Société d’Orthopédie de l’Ouest) Saint Malo 2005 (Dr Le Cerf)

  • SOO Brest 2006 (Pr Le Nen)

  • SOFCOT(SOciété Française de Chirurgie Orthopédique et Traumatologique) Paris Novembre 2008

  • Cours des voies d’abord de la hanche Brest (2 sessions) (Pr Lefèvre)

  • Cours des lambeaux CHU Tours (Pr Masquelet)

  • Journées d’enclouage centromédullaire Brest (2 sessions) (Pr Lefèvre)

  • Congrès Prothèse Totale de Genou Ile de Berder Morbihan (Prs Dubrana, Massin, Neyret)

  • Cours de voies d’abord du poignet CHU Tours (Dr Laulan) 2006

  • Cours d’arthroplastie du genou Gainesville Floride (Dr Burnstein) 2007

  • Congrès de Micro Chirurgie GAM Saint Malo 2009

  • Journées AFCP(Association Française de Chirurgie du Pied) Brest (Dr Toullec)2009

  • Journées Congrès Jeunes Orthopédistes Chamonix 2008

  • Journées du GRECMIP(Groupe de Recherche En Chirurgie Mini Invasive du Pied) Bordeaux 2009 (Drs Lafenêtre/De La Vigne)

  • Congrès de chirurgie de la main GEM Paris 2010

  • Session Arthroscopie Epaule de la SFA 2010 IRCAD CHU Strasbourg (Dr Courage)

  • SOO 2010 La Rochelle (Dr Raimbeau)

  • Congrès « Hip arthroplasty and reconstruction » Florence 2010

  • SOFCOT Paris Novembre 2010

  • Cours avancé CARLAG Ligamentoplastie du genou Laboratoire Anatomie CHU Tours 2011(Pr Plawesky)

  • Congrès “Knee Arthroplasty Depuy”Docteur Schiffrin Annecy 2011

  • Journée Hôpital privé Jean Mermoz Lyon (Dr Ait Si Selmi) 2011

  • Congrès "State of the art in hip and knee arthroplasty" Wright Barcelone 2012

  • Arthrolab Arthrex "Arthroscopie du poignet et chirurgie de la main sur sujet anatomique" Mars 2013 Munich

  • Journée finistérienne d'orthopédie Mai 2013 Sainte Marine: Prothèse de hanche de première intention

  • Congrès de la Société Française d'Arthroscopie Bordeaux 5,6,7 décembre 2013

  • Journées IMK Institut Marcel Kerboull Paris le 25 janvier 2014

  • Congrès de l'AFCP Association Française de Chirurgie du Pied Bordeaux les 10.11.12 avril 2014

  • Journée finistérienne d'orthopédie Juin 2014:Le point sur la chirurgie de l'épaule, du pied et de la cheville.

  • SOFCOT Paris Novembre 2014

  • STAFF DES CHIRURGIENS DU PIED ET DE LA CHEVILLE DE L'OUEST avec Pr Brilhault de Tours et Crosnier d'Angers Clinique Saint Grégoire Rennes le 10/04/2015

  • Journée au bloc opératoire avec le Dr Xavier Cassard Chirurgien du genou Clinique des Cèdres Toulouse. Echanges de pratiques sur la Réhabilitation Rapide Après Chirurgie RRAC

    Congrès 2017 de Réhabilitation Rapide après Chirurgie Université Pierre et Marie Curie Paris le 2 juin 2017

Actualités

  • PROTOCOLE FAST TRACK OU Réhabilitation Rapide Après PROTHESE DE HANCHE et PROTHESE DE GENOU

    Publié le 11/06/2013

    Depuis la fin d'année 2012, le protocole FAST TRACK est proposé à la Clinique de la Baie de Morlaix pour les patients éligibles, lors de la réalisation de prothèse totale de hanche ou de genou, ou de prothèse unicompartimentale du genou, fémoro tibiale ou fémoro patellaire.

    Ce protocole de récupération rapide a déjà montré dans la littérature scientifique que l'autonomie du patient réapparaissait nettement plus vite sans augmenter le risque de complications, au contraire.( Acta Orthop.2008 Apr;79(2):168-73.Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Husted H, Holm G, Jacobsen S.)

     

    Vous trouverez ci-dessous le protocole FAST TRACK de la clinique de la Baie de Morlaix avec sa prise en charge multi disciplinaire.

    Protocole FAST TRACK
     parcours rapide en chirurgie orthopédique après prothèse totale de hanche et prothèse de genou

     

    Par le Docteur Erwan Simon<

  • ETUDE CLINIQUE PROTHESE DE GENOU EN COLLABORATION AVEC LE CHRU DE BREST

    Publié le 18/12/2014

    A partir de mars 2015, une étude clinique va être débutée en collaboration avec le service de Médecine Nucléaire du CHRU de Brest. Les patients inclus seront les patients présentant une arthrose du genou unicompartimentale. L'objectif est de vérifier qu'il n'y a pas de souffrance d'un autre compartiment du genou qui contre indiquerait alors la mise en place d'une prothèse unicompartimentale et nécessiterait plutôt une prothèse totale de genou. Les patients participant à l'étude s'ils sont d'accord seront mes patients et ceux du Professeur Dubrana Chef de Service de Chirurgie Orthopédique au CHU de Brest.

    La seule contrainte de l'étude sera la réalisation d'une scintigraphie préopératoire gratuite dans le service de Médecine Nucléaire du CHRU de Brest soit sur l'hôpital Morvan soit sur la Cavale Blanche.

  • CREATION DU MUG: Morlaix Urgences Genou

    Publié le 15/02/2015

    Depuis le début d'année 2015, une consultation dédiée aux traumatismes sportifs du genouintitulée le MUG MORLAIX URGENCE GENOU est organisée. Les traumatismes sportifs du genou se déroulant souvent le week-end lors des compétitions, le MUG se déroule les lundi soirs à mon cabinet de la Clinique de la baie de Morlaix à partir de 18 heures.

    Il suffit pour le patient, le kinésithérapeute ou le médecin traitant d'envoyer un mail à ortho.es@free.fr ou d'appeler le 02.98.61.48.18 afin d'organiser les examens complémentaires lors de la consultation en particulier en radiologie.

     

    L'objectif de cette consultation spécialisée est d'obtenir un diagnostic rapide, de programmer si besoin un bilan IRM rapide, d'immobiliser si besoin le genou,  de débuter systématiquement une rééducation adaptée, et enfin d'éviter que des ruptures ligamentaires du ligament croisé antérieur ne soit éventuellement pas diagnostiquée suffisamment tôt.

     

    Docteur Erwan Simon

    Chirurgien orthopédiste

    Membre de la Société Française d'Arthroscopie

  • Clinique de la Baie de Morlaix: PREMIER CENTRE DE CHIRURGIE ORTHOPEDIQUE DU FINISTERE POUR L'HALLUX VALGUS SELON LA REVUE TOP SANTE

    Publié le 28/04/2015

    La revue Top Santé d'avril 2015 a édité un classement national des établissements privés et publics de la chirurgie de l'hallux valgus en partenariat avec SwissLife, en se basant sur les données de la Caisse Nationale d'Assurance Maladie.

    Le service de chirurgie orthopédique de la Clinique de la Baie se classe en première position pour le département du Finistère, en cinquième rang régional et approche le top 100 (105) au niveau national.

  • CHIRURGIE DU PIED: 52ème National sur 605 au Classement Hôpitaux et Cliniques Novembre 2015/2016 de L'Express

    Publié le 13/01/2016

    Avec une note de 17,2/20, la Clinique de la Baie de Morlaix se classe au 52 ème rang National en chirurgie du Pied sur plus de 600 établissements classés.

Horaires de consultation

  • Consultation libre
  • Consultation sur RDV
  • Visite à domicile
  • Autre
Informations complémentaires

jeudi 13h30-19h00 : BLOC OPERATOIRE
vendredi 8h00-18h00 : BLOC OPERATOIRE
samedi 9h00-12h00 : UN SAMEDI PAR MOIS CONSULTATIONS DE PREMIERES FOIS PRIORITAIREMENT
lundi 18h00-19h00 : MUG:MORLAIX URGENCE GENOU
lundi 8h30-18h00 : CONSULTATIONS PREMIERES FOIS PRIORITAIREMENT
mercredi 8H00-19h00 : BLOC OPERATOIRE

À la une

Total Hip Replacement

Dr Erwan Simon

Orthopedic Surgeon

Clinique de la Baie de Morlaix

La Vierge Noire

29600 Morlaix France

Whether you have just begun exploring treatment options or have already decided to undergo hip replacement surgery, this information will help you understand the benefits and limitations of total hip replacement. This article describes how a normal hip works, the causes of hip pain, what to expect from hip replacement surgery, and what exercises and activities will help restore your mobility and strength, and enable you to return to everyday activities.

If your hip has been damaged by arthritis, a fracture, or other conditions, common activities such as walking or getting in and out of a chair may be painful and difficult. Your hip may be stiff, and it may be hard to put on your shoes and socks. You may even feel uncomfortable while resting.

If medications, changes in your everyday activities, and the use of walking supports do not adequately help your symptoms, you may consider hip replacement surgery. Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.

First performed in 1960, hip replacement surgery is one of the most successful operations in all of medicine. Since 1960, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of total hip replacement. According to the Agency for Healthcare Research and Quality, more than 300,000 total hip replacements are performed each year in the United States.

Anatomy

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement.

Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

Normal hip anatomy.

Common Causes of Hip Pain

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

  • Osteoarthritis. This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
  • Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed "inflammatory arthritis."
  • Post-traumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
  • Avascular necrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called avascular necrosis (also commonly referred to as "osteonecrosis"). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause avascular necrosis.
  • Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later on in life. This happens because the hip may not grow normally, and the joint surfaces are affected.
  • A hip with osteoarthritis.

    Osteoarthritis of the Hip

    <div><h1>Une erreur s&#39;est produite.</h1><

    Description

    In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

  • The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.
  • A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
  • The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
  • A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
  • (Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.

    Total Hip Replacement

    Is Hip Replacement Surgery for You?

    The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation.

    Candidates for Surgery

    There are no absolute age or weight restrictions for total hip replacements.

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

    When Surgery Is Recommended

    There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

  • Hip pain that limits everyday activities, such as walking or bending
  • Hip pain that continues while resting, either day or night
  • Stiffness in a hip that limits the ability to move or lift the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports
  • The Orthopaedic Evaluation

    An evaluation with an orthopaedic surgeon consists of several components.

  • Medical history. Your orthopaedic surgeon will gather information about your general health and ask questions about the extent of your hip pain and how it affects your ability to perform everyday activities.
  • Physical examination. This will assess hip mobility, strength, and alignment.
  • X-rays. These images help to determine the extent of damage or deformity in your hip.
  • Other tests. Occasionally other tests, such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your hip.
  • (Left) In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space.

    This x-ray shows a large bone spur that has developed on the ball of an arthritic hip.

    Deciding to Have Hip Replacement Surgery

    Talk With Your Doctor

    Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.

    In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.

    Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

    Realistic Expectations

    An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.

    With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.

    Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.

    With appropriate activity modification, hip replacements can last for many years.

    Preparing for Surgery

    Medical Evaluation

    If you decide to have hip replacement surgery, your orthopaedic surgeon may ask you to have a complete physical examination by your primary care doctor before your surgical procedure. 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 a cardiologist, before the surgery.

    Tests

    Several tests, such as blood and urine samples, an electrocardiogram (EKG), and chest x-rays, may be needed to help plan your surgery.

    Preparing Your Skin

    Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for treatment to improve your skin before surgery.

    Blood Donations

    You may be advised to donate your own blood prior to surgery. It will be stored in the event you need blood after surgery.

    Medications

    Tell your orthopaedic surgeon about the medications you are taking. He or she or your primary care doctor will advise you which medications you should stop taking and which you can continue to take before surgery.

    Weight Loss

    If you are overweight, your doctor may ask you to lose some weight before surgery to minimize the stress on your new hip and possibly decrease the risks of surgery.

    Dental Evaluation

    Although infections after hip replacement are not common, an infection can occur if bacteria enter your bloodstream. Because bacteria can enter the bloodstream during dental procedures, major dental procedures (such as tooth extractions and periodontal work) should be completed before your hip replacement surgery. Routine cleaning of your teeth should be delayed for several weeks after surgery.

    Urinary Evaluation

    Individuals 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 having surgery.

    Social Planning

    Although you will be able to walk with crutches or a walker soon after surgery, you will need some help for several weeks with such tasks as cooking, shopping, bathing, and laundry.

    If you live alone, your orthopaedic surgeon's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home. A short stay in an extended care facility during your recovery after surgery also may be arranged.

    Home Planning

    Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Securely fastened safety bars or handrails in your shower or bath
  • Secure handrails along all stairways
  • A stable chair for your early recovery with a firm seat cushion (that allows your knees to remain lower than your hips), a firm back, and two arms
  • A raised toilet seat
  • A stable shower bench or chair for bathing
  • A long-handled sponge and shower hose
  • A dressing stick, a sock aid, and a long-handled shoe horn for putting on and taking off shoes and socks without excessively bending your new hip
  • A reacher that will allow you to grab objects without excessive bending of your hips
  • Firm pillows for your chairs, sofas, and car that enable you to sit with your knees lower than your hips
  • Removal of all loose carpets and electrical cords from the areas where you walk in your home
  • Set up a "recovery center" where you will spend most of your time. Things like the phone, television remote control, reading materials, and medications should all be within reach.

    Your Surgery

    You will most likely be admitted to the hospital on the day of your surgery.

    Anesthesia

    After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

    Implant Components

    Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell).

    The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.

    Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.

    (Left) A standard non-cemented femoral component. (Center) A close-up of this component showing the porous surface for bone ingrowth. (Right) The femoral component and the acetabular component working together.

    (Left) The acetabular component shows the plastic (polyethylene) liner inside the metal shell. (Right) The porous surface of this acetabular component allows for bone ingrowth. The holes around the cup are used if screws are needed to hold the cup in place.

    Procedure

    The surgical procedure takes a few hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position new metal, plastic, or ceramic implants to restore the alignment and function of your hip.

    X-rays before and after total hip replacement. In this case, non-cemented components were used.

    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.

    Your Stay in the Hospital

    You will most likely stay in the hospital for a few days. To protect your hip during early recovery, a positioning splint, such as a foam pillow placed between your legs, may be used.

    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.

    Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

    Physical Therapy

    Walking and light activity are important to your recovery. Most patients who undergo total hip replacement begin standing and walking with the help of a walking support and a physical therapist the day after surgery. In some cases, patients begin standing and walking on the actual day of surgery. The physical therapist will teach you specific exercises to strengthen your hip and restore movement for walking and other normal daily activities.

    Preventing Pneumonia

    It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed "atelectasis") which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.

    Recovery

    The success of your surgery will depend in large measure on how well you follow your orthopaedic surgeon's instructions regarding home care during the first few weeks after surgery.

    Wound Care

    You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.

    Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

    Diet

    Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids.

    Activity

    Thinkstock © 2011

    Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity and at night is common for several weeks.

    Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside
  • Resuming other normal household activities, such as sitting, standing, and climbing stairs
  • Specific exercises several times a day to restore movement and strengthen your hip. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery
  • Possible Complications of Surgery

    The complication rate following hip replacement surgery is low. Serious complications, such as joint infection, occur in less than 2% of patients. Major medical complications, such as heart attack or stroke, occur even less frequently. However, chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur they can prolong or limit full recovery.

    Infection

    Infection may occur superficially in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later.

    Minor infections of the wound are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

    Blood Clots

    Blood clots may form in the leg veins or pelvis.

    Blood clots in the leg veins or pelvis are one of the most common complications of hip replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program which may include blood thinning medications, support hose, inflatable leg coverings, ankle pump exercises, and early mobilization.

    Leg-length Inequality

    Sometimes after a hip replacement, one leg may feel longer or shorter than the other. Your orthopaedic surgeon will make every effort to make your leg lengths even, but may lengthen or shorten your leg slightly in order to maximize the stability and biomechanics of the hip. Some patients may feel more comfortable with a shoe lift after surgery.

    Dislocation

    This occurs when the ball comes out of the socket. The risk for dislocation is greatest in the first few months after surgery while the tissues are healing. Dislocation is uncommon. If the ball does come out of the socket, a closed reduction usually can put it back into place without the need for more surgery. In situations in which the hip continues to dislocate, further surgery may be necessary.

    Hip implant dislocation.

    Loosening and Implant Wear

    Over years, the hip prosthesis may wear out or loosen. This is most often due to everyday activity. It can also result from a biologic thinning of the bone called osteolysis. If loosening is painful, a second surgery called a revision may be necessary.

    Other Complications

    Nerve and blood vessel injury, bleeding, fracture, and stiffness can occur. In a small number of patients, some pain can continue or new pain can occur after surgery.

    Top of page

    Avoiding Problems After Surgery

    Recognizing the Signs of a Blood Clot

    Follow your orthopaedic surgeon's instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

    Warning signs of blood clots. The warning signs of possible blood clot in your leg include:

  • Pain in your calf and leg that is unrelated to your incision
  • Tenderness or redness of your calf
  • New or increasing swelling of your thigh, calf, ankle, or foot
  • Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:
  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing
  • Preventing Infection

    A common cause of infection following hip replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections.

    Following surgery, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter your bloodstream. Your orthopaedic surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.

    Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible hip replacement infection:

  • Persistent fever (higher than 100°F orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the hip wound
  • Drainage from the hip wound
  • Increasing hip pain with both activity and rest
  • Avoiding Falls

    A fall during the first few weeks after surgery can damage your new hip and may result in a need for more surgery. Stairs are a particular hazard until your hip is strong and mobile. You should use a cane, crutches, a walker, or handrails or have someone help you until you improve your balance, flexibility, and strength.

    Your orthopaedic surgeon and physical therapist will help you decide which assistive aides will be required following surgery, and when those aides can safely be discontinued.

    Other Precautions

    To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.

    Prior to discharge from the hospital, your surgeon and physical therapist will provide you with any specific precautions you should follow.

    Outcomes

    How Your New Hip Is Different

    You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.

    Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. You may ask your orthopaedic surgeon for a card confirming that you have an artificial hip.

    Protecting Your Hip Replacement

    There are many things you can do to protect your hip replacement and extend the life of your hip implant.

  • Participate in a regular light exercise program to maintain proper strength and mobility of your new hip.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Make sure your dentist knows that you have a hip replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
  • See your orthopaedic surgeon periodically for routine follow-up examinations and x-rays, even if your hip replacement seems to be doing fine.
  • Total Knee Replacement TKR

    Dr Erwan Simon

    Orthopedic Surgeon

    Clinique de la Baie de Morlaix

    La Vierge Noire

    29600 Morlaix France

    Anatomy

    Normal knee 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.

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

    Osteoarthritis of the Knee

    Description

    A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are actually replaced.

    There are four basic steps to a knee replacement 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.

    Total Knee Replacement

    Is Total Knee Replacement for You?

    The decision to have total knee replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopaedic surgeon. Your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you might benefit from this surgery.

    When Surgery Is Recommended

    There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement 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 replacement surgery.

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

    Orthopaedic Evaluation

    An evaluation with an orthopaedic surgeon 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.
  • (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).

    Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether total knee replacement 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, your orthopaedic surgeon will explain the potential risks and complications of total knee replacement, including those related to the surgery itself and those that can occur over time after your surgery.

    Deciding to Have Knee Replacement Surgery

    Realistic Expectations

    An important factor in deciding whether to have total knee replacement surgery is understanding what the procedure can and cannot do.

    More than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. But total knee replacement will not allow you to do more than you could before you developed arthritis.

    With normal use and activity, every knee replacement implant begins to wear in its plastic spacer. Excessive activity or weight may speed up this normal wear and may cause the knee replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports for the rest of your life after surgery.

    Realistic activities following total knee replacement include unlimited walking, swimming, golf, driving, light hiking, biking, ballroom dancing, and other low-impact sports.

    With appropriate activity modification, knee replacements can last for many years.

    Possible Complications of Surgery

    The complication rate following total knee replacement is low. Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. Major medical complications such as heart attack or stroke occur even less frequently. Chronic illnesses may increase the potential for complications. Although uncommon, when these complications occur, they can prolong or limit full recovery.

    Discuss your concerns thoroughly with your orthopaedic surgeon prior to surgery.

    Blood clots may develop in leg veins.

    Infection. Infection may occur in the wound or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

    Blood clots. Blood clots in the leg veins are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they break free and travel to your lungs. Your orthopaedic surgeon will outline a prevention program, which may include periodic elevation of your legs, lower leg exercises to increase circulation, support stockings, and medication to thin your blood.

    Implant problems. Although implant designs and materials, as well as surgical techniques, continue to advance, implant surfaces may wear down and the components may loosen. Additionally, although an average of 115° of motion is generally anticipated after surgery, scarring of the knee can occasionally occur, and motion may be more limited, particularly in patients with limited motion before surgery.

    Continued pain. A small number of patients continue to have pain after a knee replacement. This complication is rare, however, and the vast majority of patients experience excellent pain relief following knee replacement.

    Neurovascular injury. While rare, injury to the nerves or blood vessels around the knee can occur during surgery.

    Preparing for Surgery

    Medical Evaluation

    If you decide to have total knee replacement surgery, your orthopaedic surgeon may 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 urine samples, and an electrocardiogram, may be needed to help your orthopaedic surgeon plan your surgery.

    Medications

    Tell your orthopaedic surgeon about the medications you are taking. He or she 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 replacement 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 crutches or a walker soon after surgery, you will need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.

    If you live alone, your orthopaedic surgeon's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home. They also can help you arrange for a short stay in an extended care facility during your recovery, if this option works best for you.

    Home Planning

    Several modifications can make your home easier to navigate during your recovery. The following items may help with daily activities:

  • Safety bars or a secure handrail in your shower or bath
  • Secure handrails along your stairways
  • A stable chair for your early recovery with a firm seat cushion (and a height of 18 to 20 inches), a firm back, two arms, and a footstool for intermittent leg elevation
  • A toilet seat riser with arms, if you have a low toilet
  • A stable shower bench or chair for bathing
  • Removing all loose carpets and cords
  • A temporary living space on the same floor because walking up or down stairs will be more difficult during your early recovery
  • Your Surgery

    You will most likely be admitted to the hospital on the day of your surgery.

    Anesthesia

    After admission, you will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

    Procedure

    The procedure itself takes approximately 1 to 2 hours. Your orthopaedic surgeon 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.

    Different types of knee implants are used to meet each patient's individual needs.

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

    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.

    Your Hospital Stay

    You will most likely stay in the hospital for several 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.

    Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

    Blood Clot Prevention

    Your orthopaedic surgeon may 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.

    Physical Therapy

    A continuous passive motion (CPM) machine.

    Most patients begin exercising their knee the day after surgery. In some cases, patients begin moving their knee on the actual day of surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement to allow walking and other normal daily activities soon after your surgery.

    To restore movement in your knee and leg, your surgeon may use a knee support that slowly moves your knee while you are in bed. The device is called a continuous passive motion (CPM) exercise machine. Some surgeons believe that a CPM machine decreases leg swelling by elevating your leg and improves your blood circulation by moving the muscles of your leg.

    Preventing Pneumonia

    It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed "atelectasis") which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths. Your nurse may provide a simple breathing apparatus called a spirometer to encourage you to take deep breaths.

    Your Recovery at Home

    The success of your surgery will depend largely on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery.

    Wound Care

    You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.

    Avoid soaking the wound in water until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.

    Diet

    Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to help your wound heal and to restore muscle strength.

    Activity

    Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.

    Your activity program should include:

  • A graduated walking program to slowly increase your mobility, initially in your home and later outside
  • Resuming other normal household activities, such as sitting, standing, and climbing stairs
  • Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.
  • Thinkstock © 2011

    You will most likely be able to resume driving when your knee bends enough that you can enter and sit comfortably in your car, and when your muscle control provides adequate reaction time for braking and acceleration. Most people resume driving approximately 4 to 6 weeks after surgery.

    Avoiding Problems After Surgery

    Blood Clot Prevention

    Follow your orthopaedic surgeon's instructions carefully to reduce the risk of blood clots developing during the first several weeks of your recovery. He or she may recommend that you continue taking the blood thinning medication you started in the hospital. Notify your doctor immediately if you develop any of the following warning signs.

    Warning signs of blood clots. The warning signs of possible blood clots in your leg include:

  • Increasing pain in your calf
  • Tenderness or redness above or below your knee
  • New or increasing swelling in your calf, ankle, and foot
  • Warning signs of pulmonary embolism. The warning signs that a blood clot has traveled to your lung include:

  • Sudden shortness of breath
  • Sudden onset of chest pain
  • Localized chest pain with coughing
  • Preventing Infection

    A common cause of infection following total knee replacement surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. These bacteria can lodge around your knee replacement and cause an infection.

    After knee replacement, patients with certain risk factors may need to take antibiotics prior to dental work, including dental cleanings, or before any surgical procedure that could allow bacteria to enter the bloodstream. Your orthopaedic surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your situation.

    Warning signs of infection. Notify your doctor immediately if you develop any of the following signs of a possible knee replacement infection:

  • Persistent fever (higher than 100°F orally)
  • Shaking chills
  • Increasing redness, tenderness, or swelling of the knee wound
  • Drainage from the knee wound
  • Increasing knee pain with both activity and rest
  • Avoiding Falls

    A fall during the first few weeks after surgery can damage your new knee and may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, a walker, hand rails, or have someone to help you until you have improved your balance, flexibility, and strength.

    Your surgeon and physical therapist will help you decide what assistive aides will be required following surgery and when those aides can safely be discontinued.

    Outcomes

    How Your New Knee Is Different

    Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery can be predicted by the range of motion you have in your knee before surgery. Most patients can expect to be able to almost fully straighten the replaced knee and to bend the knee sufficiently to climb stairs and get in and out of a car. Kneeling is sometimes uncomfortable, but it is not harmful.

    Most people feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities.

    Most people also feel or hear some clicking of the metal and plastic with knee bending or walking. This is a normal. These differences often diminish with time and most patients find them to be tolerable when compared with the pain and limited function they experienced prior to surgery.

    Your new knee may activate metal detectors required for security in airports and some buildings. Tell the security agent about your knee replacement if the alarm is activated.

    Protecting Your Knee Replacement

    After surgery, make sure you also do the following:

  • Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
  • Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
  • Make sure your dentist knows that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
  • See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays, usually once a year.
  • Extending the Life of Your Knee Implant

    Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon's instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.

    .

    Unicompartmental Knee Replacement

    Dr Erwan Simon

    Orthopedic Surgeon

    Clinique de la Baie de Morlaix

    La Vierge Noire

    29600 Morlaix France

    During knee replacement surgery, damaged bone and cartilage is resurfaced with metal and plastic components. In unicompartmental knee replacement (also called "partial" knee replacement) only a portion of the knee is resurfaced. This procedure is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee.

    Because a partial knee replacement is done through a smaller incision, patients usually spend less time in the hospital and return to normal activities sooner than total knee replacement patients.

    There are a range of treatments for knee osteoarthritis and your doctor will discuss with you the options that will best relieve your individual osteoarthritis symptoms.

    In unicompartmental knee replacement, only one area of the knee is resurfaced.

    Description

    In knee osteoarthritis, the cartilage protecting the bones of the knee slowly wears away. This can occur throughout the knee joint or just in a single area of the knee.

    Your knee is divided into three major compartments:

  • Medial compartment (the inside part of the knee)
  • Lateral compartment (the outside part)
  • Patellofemoral compartment (the front of the knee between the kneecap and thighbone)
  • Advanced osteoarthritis that is limited to a single compartment may be treated with a unicompartmental knee replacement. During this procedure, the damaged compartment is replaced with metal and plastic. The healthy cartilage and bone, as well as all of the ligaments are preserved.

    (Left) Osteoarthritis that is limited to the medial compartment. (Right) This x-ray shows severe osteoarthritis with "bone-on-bone" degeneration in the medial compartment (arrow).

    Advantages of Partial Knee Replacement

    Multiple studies show that a majority of patients who are appropriate candidates for the procedure have good results with unicompartmental knee replacement.

    The advantages of partial knee replacement over total knee replacement include:

  • Quicker recovery
  • Less pain after surgery
  • Less blood loss
  • Also, because the bone, cartilage, and ligaments in the healthy parts of the knee are kept, many patients report that a unicompartmental knee replacement feels more natural than a total knee replacement. A unicompartmental knee may also bend better.

    Disadvantages of Partial Knee Replacement

    The disadvantages of partial knee replacement compared with total knee replacement include:

  • Slightly less predictable pain relief
  • Potential need for more surgery. For example, a total knee replacement may be necessary in the future if arthritis develops in the parts of the knee that have not been replaced.
  • An advantage of partial knee replacement over total knee replacement is that healthy parts of the knee are preserved, which helps to maintain more "natural" function of the knee.

    Candidates for Surgery

    If your osteoarthritis has advanced and nonsurgical treatment options are no longer relieving your symptoms, your doctor may recommend knee replacement surgery.

    In order to be a candidate for unicompartmental knee replacement, your arthritis must be limited to one compartment of your knee. In addition, if you have any of the following characteristics, you may not be eligible for the procedure:

  • Inflammatory arthritis
  • Significant knee stiffness
  • Ligament damage
  • With proper patient selection, modern unicompartmental knee replacements have demonstrated excellent medium- and long-term results in both younger and older patients.

    Orthopaedic Evaluation

    A thorough evaluation with an orthopaedic surgeon will determine whether you are a good candidate for a partial knee replacement.

    Medical History

    Your doctor will ask you several questions about your general health, your knee pain, and your ability to function.

    Location of pain. He or she will be specifically concerned with the location of your pain. If your pain is located almost entirely on either the inside portion or outside portion of your knee, then you may be a candidate for a partial knee replacement. If you have pain throughout your entire knee or pain in the front of your knee (under your kneecap) you may be better qualified for a total knee replacement.

    Physical Examination

    Your doctor will closely examine your knee. He or she will try to determine the location of your pain.

    Your doctor will also test your knee for range of motion and ligament quality. If your knee is too stiff, or if the ligaments in your knee feel weak or torn, then your doctor will probably not recommend unicompartmental knee replacement (although you still may be a great candidate for total knee replacement).

    Imaging Tests

  • X-rays. These images help to determine the extent of damage and deformity in your knee. Your doctor will order several x-rays of your knee to see the pattern of arthritis.
  • Magnetic resonance imaging (MRI) scans. Some surgeons may also order an MRI scan to better evaluate the cartilage.
  • X-rays of a good candidate for partial knee replacement. (Left) Severe osteoarthritis limited to the medial compartment. (Right) The same knee after partial knee replacement.

    Your Surgery

    Before Surgery

    You will likely be admitted to the hospital on the day of surgery.

    Before your procedure, a doctor from the anesthesia department will discuss anesthesia choices with you. You should also have discussed anesthesia choices with your surgeon during your preoperative clinic visits. Anesthesia options include:

  • General anesthesia (you are put to sleep)
  • Spinal (you are awake but your body is numb from the waist down)
  • Your surgeon will also see you before surgery and sign your knee to verify the surgical site.

    Surgical Procedure

    A partial knee replacement operation typically lasts between 1 and 2 hours.

    Inspection of the joint. Your surgeon will make an incision at the front of your knee. He or she will then explore the three compartments of your knee to verify that the cartilage damage is, in fact, limited to one compartment and that your ligaments are intact.

    If your surgeon feels that your knee is unsuitable for a partial knee replacement, he or she may instead perform a total knee replacement. This contingency plan will have been discussed with you before your operation to make sure that you agree with this strategy.

    A partial knee replacement implant.

    Partial knee replacement. There are three basic steps in the procedure:

  • Prepare the bone. Your surgeon will use special saws to remove the cartilage from the damaged compartment of your knee.
  • Position the metal implants. The removed cartilage and bone is replaced with metal coverings that recreate the surface of the joint. These metal parts are typically held to the bone with cement.
  • Insert a spacer. A plastic insert is placed between the two metal components to create a smooth gliding surface.
  • Recovery room. After the surgery you will be taken to the recovery room, where you will be closely monitored by nurses as you recover from the anesthesia. You will then be taken to your hospital room.

    Complications

    As with any surgical procedure, there are risks involved with partial knee replacement. Your surgeon will discuss each of the risks with you and will take specific measures to help avoid potential complications.

    Although rare, the most common risks include:

  • Blood clots. Blood clots in the leg veins are a common complication of knee replacement surgery. Blood clots can form in the deep veins of the legs or pelvis after surgery. Blood thinners such as warfarin (Coumadin), low-molecular-weight heparin, and aspirin can help prevent this problem. Newer blood thinners, such as apixaban (Eliquis) and rivaroxaban (Xarelto), may also be prescribed by your doctor, depending upon your needs.
  • Infection. After surgery an infection may occur in the skin over the wound or deep in the wound. An infection may happen while you are in the hospital or after you go home. You will be given antibiotics before the start of your surgery and these will be continued for about 24 hours afterward to prevent infection.
  • Injury to nerves or vessels. Although it rarely happens, nerves or blood vessels may be injured or stretched during the procedure.
  • Continued pain
  • Risks of anesthesia
  • Need for additional surgery
  • Recovery

    Hospital discharge. Partial knee replacement patients usually experience less postoperative pain, less swelling, and have easier rehabilitation than patients undergoing total knee replacement. In most cases, patients go home 1 to 3 days after the operation. Some patients go home the day of the surgery.

    Pain management. After surgery, you will feel some pain, but your surgeon and nurses will make every effort to help you feel as comfortable as possible.

    Many types of medicines are available to help control pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Treating pain with medication can help you feel more comfortable, which will help your body heal and recover from surgery faster.

    Opioids can provide excellent pain relief, however, they are a narcotic and can be addictive. It is important to use opioids only as directed by your doctor. You should stop taking these medications as soon as your pain starts to improve.

    Weightbearing. You will begin putting weight on your knee immediately after surgery. You may need a walker, cane, or crutches for the first several days or weeks until you become comfortable enough to walk without assistance.

    Rehabilitation exercise. A physical therapist will give you exercises to help maintain your range of motion and restore your strength.

    Doctor visits. You will continue to see your orthopaedic surgeon for follow-up visits in his or her clinic at regular intervals.

    You will most likely resume all of your regular activities of daily living by 6 weeks after surgery.

    Cursus

    Ancien Interne et  Ancien Assistant au CHU de Brest

    Ancien Interne inter CHU des hôpitaux de Bordeaux

    Ancien Chef de Clinique à la Faculté

    DESCQ de Chirurgie Orthopédique et Traumatologique

    DIU de Chirurgie de la Main et du Membre Supérieur

    DIU de Chirurgie Arthroscopique

    Membre associé à la SOFCOT (Société Française de Chirurgie Orthopédique et Traumatologique)

    Membre associé à la SFA (Société Française d'Arthroscopie)

    Membre du GRECMIP (Groupe de Recherche En Chirurgie Mini Invasive du Pied)

    Chirurgien accrédité par l'HAS (Haute Autorité de Santé)

    En savoir plus

    Honoraires


    Consultation première fois: de 46 à 58 euros (base de remboursement Sécurité Sociale 46 euros)

    Consultation de suivi: de 23 à 35 euros (base de remboursement sécurité sociale 23 euros)

    En savoir plus
    • P1030578.JPG

      P1030578.JPG

    • P1030582.JPG

      P1030582.JPG

    • P1030579.JPG

      P1030579.JPG

    Numéro RPPS et Numéro d'inscription au Conseil de l'Ordre des Médecins


    N°RPPS:10100076180

     

    N°d'inscription au Conseil de l'Ordre: 29/6117

    Actualités

    Ce site n'a pas pour vocation de remplacer une consultation médicale