What is a Total Knee Replacement

0:00 · Introduction

Hi, I'm Dr Chien-Wen Liew from Orthopaedics 360.. I'm a hip and knee replacement surgeon. And here today to talk to you a little bit about what a total knee replacement is now. Many of you will have either already seen me or about to, and I'd like to just go over what I perform. But also a little bit in general, about a total knee replacement.

0:29 · When is a Total Knee Replacement Performed

Now, a total knee replacement is an operation performed usually, and for most people, when they have severe osteoarthritis of the knee osteoarthritis. Accounts were probably about 90 of all cases, with many other potential cases and causes to warrant a knee replacement. However, today we're really just talking about a normal total knee replacement.

0:52 · What is a modern Knee Replacement

A knee replacement in our current and modern times is more like a resurfacing of the knee. And all that involves is taking a few millimeters off the surface of the bone and then positioning the new implant to mat. There are many ways to perform a knee replacement, and today we're not going to go into all of them in too much detail, I perform all of my knee replacements using patient-specific technology with a kinematic alignment.

Now, they are just words to describe the technology and philosophy that I use, and another video will go into those in a bit more detail.

1:26 · Components of a Knee Replacement

A knee replacement that is composed of four components is composed of the femur, the tibia, the plastic that goes in between the two. And then a poly button that may or may not sit on the back of the kneecap. We never remove the whole kneecap during surgery, as the kneecap is attached to very important ligaments and tendons that enable the need to actually straighten and bend now, if we were to remove the kneecap, which many of my patients are worried about, then the knee would never straighten or bend.

And I can assure you that in modern knee replacements, that is not the case now. A knee replacement is something that should alleviate all of the pain in the knee. Improve range of movement and allow functional outcomes to be significantly improved.

2:13 · Types of Knee Replacements

There are many different types of knee replacements, and in the past, it used to be dominated by two main types of knee replacements. Ones that were called cruciate retaining and the others that were called posterior sacrificing, all that meant was whether or not we maintained or lost the posterior cruciate ligament. In current technology, there has been the addition of one more, more prevalent type, and that's called the medial pivot articulation.

2:38 · Medial Pivot Knee Replacements

What that means is that a knee is replicating the normal motion of the knee. It is tighter on the inner aspect of the knee and looser on the outer aspect of the knee. And that mimics what a normal knee will function, and the expectation is that it makes the knee feel a lot more natural.

3:01 · Limitations after TKR

That's what I perform for all of my total knee replacements, as with all joint replacement surgery for the hip and knee. There are limitations, and one of those limitations is long distance road running. We don't allow my patients to run long distance or perform high level impact activities. However, you are more than welcome to play tennis, run around with kids at the beach, play some soccer with the kids and similar activities. But running the city debate or running a marathon, it certainly should not be on the agenda for the future.

3:32 · Type of anaesthetic used

We perform our knee replacements under a spinal anaesthetic most of the time, and, if possible, that is the anaesthetic of choice for our knee replacements. As it reduces the risk of bleeding and blood clots after the surgery. To learn a little bit more about the techniques that I perform, please stay tuned to other videos on this channel or follow us on Facebook.

Thanks for your time and I look forward to seeing you next time.

Transcript edited lightly for readability.