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All you need to know about arthrosis and knee replacement surgery

This brochure will help you gain some basic knowledge on your knee joint, on arthrosis (a worn-out joint) and on knee replacement surgery. We would like to point out that this brochure is only meant for educational purposes. It should not be seen as substitution for your orthopaedic surgeon’s medical advice. Worn-out joints can hinder your daily activities significantly. People usually ignore the very first signs of arthrosis, but when their condition becomes too painful, activities, such as running, riding a bicycle and standing, become strenuous, painful and very difficult. Knee replacement surgery was performed for the first time more than 30 years ago. Since then millions of people have had total knee replacement surgery. Knee replacement surgery is, in general, an exceptionally successful surgical procedure. The term ‘replacement’ makes people believe that their whole knee joint will be removed. But in reality your orthopaedic surgeon will only replace the damaged cartilage at the ends of the bones in your joint. That is why this procedure had better be called ‘knee cartilage replacement’. The Knee The knee joint roughly looks like a hinge. In the knee joint two bones come together: the upper part of the shinbone and the lower part of the thighbone. The ends of these bone in the joint are covered with cartilage, which is a thin layer of smooth tissue that makes it possible for you to move your joint freely, without friction, and that acts as a shock absorber. This cartilage can be damaged by everyday wear and tear. This is what we call arthrosis. This continuous wear and tear of the cartilage can cause pain, stiffness and swelling, especially when getting out of bed or getting up from a chair, getting in a car and going up or down the stairs. The joint feels warm to the touch and moving it becomes ever more painful and difficult. These complaints can occur more and more often. They can last longer and become more severe. The position of the knee can change visibly. The lower leg will stand crooked in comparison with the lower leg, as in knock-knees or bow legs. These complaints can actually differ immensely from person to person. Your orthopaedic surgeon will discuss your specific complaints with you and will advise you the treatment that will be most successful. Pain medication, the use of a walking stick, physiotherapy or weight loss, these things can help alleviate your complaints of arthrosis. But when the pain becomes simply unbearable, total knee replacement surgery is a good solution. A healthy knee A worn-out knee Thighbone Cartilage Shinbone Total Knee Replacement During total knee replacement surgery all the worn-out cartilage will be removed and the surface will be replaced by an implant. During this procedure the orthopaedic surgeon will surgically open up the knee joint to get access to it. The diseased bone ends will be provided with a purpose-made implant, designed to replace the ends of the bones. The knee implant is made of body-friendly materials. The knee prosthesis consists of a round metal coating for the lower part of the upper leg and a metal coating for the upper part of the lower leg. In between a plastic layer (polyethylene) will be applied to make sure that the metal parts can glide against each other freely. In principle these metal parts will be anchored in the bone using a special kind of cement. (a cemented prosthesis) Total knee replacement surgery lasts about an hour and a half and is performed while you are under general anaesthesia. There are two kinds of anaesthesia: general anaesthesia (narcosis) and local anaesthesia (a spinal jab) The operation usually takes place under spinal anaesthesia. Your orthopaedic surgeon will explain this to you before the operation. Of course, you can also put your questions to the anesthesiologist. During surgery you will always lose some blood. Medicines, but also techniques to salvage the blood lost during surgery and to give it back to you, will prevent you from needing a blood transfusion during or after the operation. Being prepared for surgery and waking up afterwards in the recovery room, this can add 2 to 3 hours to the duration of the operation. When you are back on your nursing ward, you will be given some medication to reduce the risk for complications as much as possible. Pictures: An X-ray of the knee An X-ray of a knee implant A knee implant Complications Although it is uncommon, complications can occur during and after surgery. Possible complications are an infection, thrombosis, a pulmonary embolism and a broken implant. Your orthopaedic surgeon will do his utmost to minimize the risk for complications. You will get antibiotics against infections, anticoagulants and medicines to prevent thrombosis, pulmonary embolisms and ossification around the knee. Before your operation the orthopaedic surgeon can ask you to consult another specialist, usually an internist or cardiologist, for further examination, to minimize the risk for complications. You can also be asked to have your teeth looked after in case of dental or mouth infections. If you suffer from overweight, you will be asked to lose some weight. There can also be delayed complications. Some can even show up many years after the procedure. Joint replacement surgery is highly successful in most cases. Nevertheless, some patients will experience pain and stiffness afterwards. No implants last forever. Such factors like high body weight and strenuous physical activities can shorten an implant’s life. Be sure to discuss these and other risks with your orthopaedic surgeon. When your knee prosthesis is worn-out, a so-called revisionary operation will have to be performed. Your old prosthesis will then be removed wholly or partially and a new prosthesis will be inserted. Such operations are more extensive than the first (or primary) knee operation. Thanks to the current prostheses and surgery techniques your prosthesis will function ten to fifteen years, if used normally. After surgery After surgery you will start your physiotherapy. It is important that you start exercising as soon as possible after surgery for the healing process to be able to begin. You will most likely be out of bed within 24 hours after surgery. And you will be walking your first metres with your new knee, using crutches or a walking frame. What type of rehabilitation can I expect after surgery ? Exercising is necessary for a speedy recovery. Your physiotherapy will begin in hospital. And you will receive some instructions and advice to start exercising yourself at home. In the days after surgery you will learn how to go up and down the stairs in a safe manner, how to sit down and get up and how to take care of your knee once you are at home. It is a good idea to call in the help of your family and friends, especially the first few days after being discharged from hospital. Before you leave the hospital, the physiotherapist will teach you a number of exercises meant to regain mobility and strength in your knee. You need to do these exercises on your own. Of course, it is particulary important to keep on doing these exercises at home. Within a week after surgery you will be ready to go home. However, some people will go to a rehabilitation centre for a short while. This is a possibility your orthopaedic surgeon will discuss with you before surgery, if needed. Most people go straight home. Which activities can I expect after this surgical procedure ? Physiotherapy in the first few days after surgery, the right nutrition and the willingness to follow your orthopaedic surgeon’s recommendations, these things will contribute to a successful recovery from your operation. Six weeks after surgery most patients will be able to walk again without aid. You can usually resume activities such as driving, playing golf, playing tennis or swimming, but not until your orthopaedic surgeon has given you the green light. Always follow your orthopaedic surgeon’s recommendations because the recovery period is different for everyone. It is usually not allowed to take part in labour or in activities that are too strenuous for the hip or to practise a contact sport. This kind of activities will put extreme pressure on the new joint, which may lead to complications. Ask your orthopaedic surgeon which activities you need to avoid after surgery. Tips for when you are back home - If you have to go see the dentist, please inform him or her that you have had a knee prosthesis fitted. If you need to undergo an operation on your jaws and/or teeth because of an infection, you will run the risk of an infection on your new knee prosthesis. The dentist can prescribe you some antibiotics to prevent this from happening. - Check if you have a long shoehorn at home. A long shoehorn can help you putting on your shoes. - Thanks to elastic shoelaces you will not have to bend to lace up your shoes or to take them off. By the way, it is advisable to wear some sturdy, low heel loafers. - Check if you have enough supplies at home to last a week after your discharge from hospital. You could, for instance, freeze some meals in advance or buy products that will keep for a long time. - A helping-hand, or a long pair of tongs, can spare you the trouble of bending when you have dropped something. - Antiskid mats can prevent you from slipping in your bathroom, for example. - Get rid of any free-lying wires and cables and temporarily remove any rugs from your home, so that you do not risk tripping over them. This way you reduce the risk of falling and getting a fracture around your knee prosthesis. - You can get more information on the helping-hand, elastic shoelaces and toilet seat raisers at a homecare shop. - If you have pets that need to be taken care of intensively, please talk to someone about it before being hospitalized. This way you can continue this care during your hospital stay and in the first few days after. Should I go see my orthopaedic surgeon after surgery ? Your orthopaedic surgeon will lay out a scheme for the first year after surgery to check your knee prosthesis and to discuss your progress. After that you will need to come back every year or every two years to have your new joint checked. It is particularly important that you keep going to your specialist for check-ups because your knee prosthesis can wear out without you even noticing it. And a revisionary operation is less drastic at an early stage. If you notice any changes in between consults, it is of the utmost importance that you contact your orthopaedic surgeon. Conclusion We know that the decision to undergo an operation is not an easy one. We hope that this brochure has helped you gain some basic knowledge on total knee replacement surgery so that you can take the best decision for you, together with your orthopaedic surgeon. Millions of others have already taken this decision, which helped them lead an active life again! Is not that what you want, too ? This brochure is not meant to replace your orthopaedic surgeon’s advice. Please contact your orthopaedic surgeon, should you have any more questions.

Genesis II ™ Knee System

Het Genesis II ™ Knie Systeem is een uitgebreid en gebruiksvriendelijk systeem dat opties biedt voor alle indicaties in primaire en revisie chirurgie, en dit met een grote intra- operatieve flexibiliteit.

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Meniscus hechting en transplantatie

Arthrose knie

Meniscectomie, het verwijderen van een gescheurde meniscus, kan op lange termijn aanleiding geven tot pijn en functieverlies door het ontstaan van arthrose in de knie.

De meniscus heeft immers een belangrijke functie als schokdemper in de knie. In de nieuwe behandelingen van meniscusletsels wordt dan ook zoveel mogelijk meniscusweefsel gespaard. Bij scheuren van de mensicus moet het beschadigde weefsel meestal verwijderd worden, omdat dit niet kan genezen. Dit gebeurt met een kijkoperatie waarbij enkel het niet functionele weefsel wordt weggeknipt.

Bepaalde types van meniscusscheuren die zich helemaal aan de rand bevinden, kunnen wel terug aan elkaar groeien. Voor dit type scheuren kan met een kijkoperatie een meniscushechting worden uitgevoerd.

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Oxford Knee - Unicondylar knee prosthesis

 

In some cases of knee arthrosis we can see that the arthrosis is limited to just one part of the knee while the cartilage in other parts of the knee has been preserved well. For these patients there is a knee prosthesis that only replaces the inside of the knee joint. This is the so-called Oxford Knee.

Oxford knie  Oxford knie

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Tips voor thuis na een knieprothese

10 tips voor revalidatie thuis na een knie prothese

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Totale knieprothese (TKP)

De gezonde knieKnie prothese

In een gezond kniegewricht zijn de gewrichtsoppervlakken glad zodat ze gemakkelijk over elkaar kunnen glijden. Dit wordt mogelijk gemaakt door het kraakbeen. De knie wordt beschermd door spieren en gewrichtsbanden. Door deze constructie kan men vrij bewegen.

De zieke knie

In de zieke knie worden de botoppervlakken ruw. Ze veroorzaken pijn wanneer ze over elkaar schuren. Het kraakbeen brokkelt af en geeft aanleiding tot ontstekingsreactie (inflammatie). Hierdoor gaat de knie zwellen. Het resultaat is pijn en stijfheid in de knie.

Knie prothese

Wat is een Totale Knie Prothese?Genesis II ™ Knee System

Op dit ogenblik is er nog geen wondermedicament dat voor kraakbeen regeneratie zorgt. Door de grote vooruitgang in de moderne technieken, is het nu mogelijk om het slechte kniegewricht te vervangen door een kunstknie. De Totale Knie Prothese is een moeilijke maar veilige operatietechniek die U zal toelaten vele van uw dagelijkse activiteiten te hernemen en de pijn duidelijk zal doen afnemen. Zoals een normale knie zal de kunstknie zorgen voor een glad gewrichtsoppervlak. Afhankelijk van uw leeftijd, activiteiten en verwachtingen moet er worden gekozen uit een heel gamma van prothesen.

Op het einde van de operatie wordt een klein buisje aangebracht om het resterende bloed te laten wegvloeien (dit wordt na enkele dagen verwijderd zonder extra verdoving). Dit bloed kan eventueel na zuivering terug gegeven worden. Dan wordt de wonde zeer zorgvuldig gesloten en wordt een drukverband aangebracht. Een radiografie (foto van de knie) wordt onmiddellijk genomen.

 

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Video knieprothese

 

Voorste kruisband reconstructie

Kijkoperatie kruisband

Functie van de voorste kruisbandVoorste kruisband reconstructie

  • anterieure translatie van het onderbeen beperken(tibia)
  • mediale en laterale stabiliteit
  • endorotatie
  • flexie-extensie
  • proprioceptie

Functie van de meniscusVoorste kruisband reconstructie

  • transmissie van de krachten
  • stabiliteit
  • absorptie van de schokken
  • voeding en glijding van het gewricht

Letsel van de kruisbandVoorste kruisband reconstructie

  • sport
  • verhoogde activiteiten
  • betere diagnose en behandelingstechnieken
  • vluggere revalidatie
  • hogere verwachtingen

De voorste kruisband is een stevige band in het centrum van de knie waarvan het ene uiteinde aan het bovenbeen en het andere uiteinde aan het onderbeen vastzit. De naam zegt het al, de voorste kruisband loopt niet recht naar beneden maar gekruist. De voorste kruisband voorkomt dat het onderbeen ten opzichte van het bovenbeen naar voren verschuift. Door een ongeval (vaak een rotatie van de knie) kan de kruisbanden doorscheuren. Men spreekt dan van een voorste kruisbandruptuur of voorste kruisbandinstabiliteit (gescheurde kruisband).

Een kapotte voorste kruisband is meestal het gevolg van een sportletsel. Dit kan bijvoorbeeld optreden tijdens voetbal wanneer een schotpoging met de binnenzijde van de voet wordt geblokkeerd door de tegenstander of tijdens skiën wanneer bij het vallen de binding niet loskomt. Naast beschadiging van de voorste kruisband kan ook beschadiging van de mediale band en van de laterale (mediale) meniscus optreden.

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