Knee arthroplasty in Kyiv

Knee arthroplasty is a surgery of joint surfaces (friction pair) replacement with artificial implants. It is performed in case of joint affections and dystrophic diseases which can’t be cured in non-surgical way. Arthrosis is one of main diseases, in which endoprosthetics is required. Gonarthrosis is a pathology accompanied by destruction of the knee joint cartilage resulting in movements limitation, deformation and pain syndrome development. Violated blood supply of cartilage and subchondral zone is basic mechanism of arthrosis development. Dependently on the kind of pathological changes there are 4 stages of the arthrosis. Artificial joints are produced from different materials such as titanium, tantalum, cobalt, chrome, ceramics, polyethylene or stainless steel. Main requirements for prosthesis components are biocompatibility, strength and replaceability. Special medical cement is used for fixation. In case of instability or wear replacement of the whole prosthesis or its components is possible. This intervention is called revision endoprosthetics.

Total prostheses of the knee may be divided in three main types:
 - untied (are not used almost nowadays);
 - semitied (when PCL is preserved);
 - tied-and-swivel (make it possible to replace the joint with affected ligaments or extensive apparatus)

Separate type is unicompartmental (single-pole) endoprosthetics, which is indicated in isolated affection of one condilum. Three-pole knee endoprosthetics is total replacement of the patella. Basic indication for total endoprostetics is pain syndrome: the patient decides it by himself when to fulfill replacement intervention. It is not recommended to wait until development of movements limitation in the affected joint and remarkable deformations as far as it makes further surgery more complicated for both the doctor and the patient. With the development of modern devices and minimally invasive technologies joint replacement surgery is not anymore severe and blood-consuming. The patient starts walking on the same evening or next day after intervention. Mid time of staying at in-patient department makes 2 – 3 days. Hip joint prosthesis price lies between 1000 and 10000 USD dependently on its model and manufacturer. The most expensive are swivel prostheses of the knee, so there is no sense to bring the affected joint condition to severe deformities formation and motility insufficiency.

Recommendations to patient before knee athroplasty:

First of all visit your family doctor. Previously you can fulfill clinical blood count, blood glucose, proteinogram, urineanalysis and ECG. Additive diagnostics will be prescribed if needed by therapeutist or orthopedist in hospitalization. It is important before surgery not to skip taking drugs prescribed by doctors of other specialities. Anticoagulants should be used if recommended by a doctor only. It is also needed that you discuss the necessity of using crutches or orthoses as well as taking some drugs with orthopedist on the stage of planning the date of surgical intervention. On the day of operation you need to come to a clinic fasting, which means that you should not take any food in the morning. In case there is long interval between diagnostics and operation, please, discuss the possibility to take some foods and beverages with your anesthesiologist. You may shave your ankle and hip 1 - 2 days before operation. It is allowed for patients to take phone, notebook, personal hygiene items, including toothbrush, toothpaste and shower gele to the ward. Clinic is providing each patient with hygienic items, towels, gowns, bed linen, one time slippers and 3-times meals. Each ward is equipped with a toilet room, TV-set, functional bed, WiFi-net. Patient's relatives may visit him adhering to sanitary and hygienic requirements; in case of quarantine visting patients is limited. Minimal period of staying in the clinic after the operation makes 2 days.

Recommendations to patient after arthroplasty of the knee joint 

(This is general information and may be not objective enough in each individual case and therefore should be obligatory agreed with doctor)

Basic principles: Gradualeness of loads. Implants stability is provided by not only axes of loads but also tendons, muscles and joint's capsule. Stitched during operation tissues and scars around implants need to grow together and strengthen. These processes take approximately 3 - 4 weeks. Remember: absence of loads leads in atrophy, however, harsh overloads may cause affection of tissues; gradual load promotes strengthening of soft tissues and bones.

Thromboembolism prevention. After the operation there is risk of vessels occlusion with blood clots caused by sedentary regimen and vascular pathology. Therefore it is necessary to intake anticoagulants (blood diluting drugs) during 1 - 3 weeks up to complete restoration of motile regimen. The course of these drugs and their dosages should be prescribed by doctor individually. It is of great importance to provide thorough self control of fulfillment of all prescriptions both in the hospital and at home. It is also recommended to use elastic bandages and compression stockings to prevent thromboembolism. Avoid blood pressure rise and palpitations while doing exercises and/or walking.

Maitenance. Getting up from the bed first time should be done with a help of either relatives or social workers in order they could support you or soften your falling down in case if you lose the balance. It is recommended to sit during 3 - 5 minutes in the bed before standing up on the legs. Don't forget to roll your legs with elastic bandage or put on compression stockings.

Body weight control. Gaining the weight decreases capacity of implants' working components and harms the organism by overloading the heart and violating blood supply. Thus it is stricktly recommended to move regularly and correct dietary habits by taking healthy quantitatively and qualitatively balanced diet. Before starting the diet it is preferable to consult your family physician or dietologist.

Infections prophylaxis. There is a risk of implant contamination after endoprosthetic operation. Infection may permeate from outside or develop inside the organism. When visiting doctors, dentists, physiotheraputists always inform them about you have implants. Any bacterial infection of any localization in the organism should be obligatory treated as far as it is diagnosed.

It is impossible to underevaluate importance of adhering to healthy lifestyle: it is known that smoking and alcohol abuse poison one's organism, worsen its immunological responce and blood circulation.

Connection with doctor. Never be shy to call your doctor in case if you have some doubts or if you forgot to ask something. It may resque your life and prevent complications. Pay special attention on worsening of pain, increasing of edema, soaking of bandage, postoperative wound reddening, local or general body temperature increase, shortening or deformation of the extremity, acute reduction of movements volume, sensitivity loss, retrosternal aches, dyspnoea, complicated defecation or/and urination, etc.

After knee joint replacement it is necessary to remember that knee joint is easily cooled which may cause development of tissues inflammation. In case of using bandages and tutors follow them not to compress soft tissues as far as it may lead in ischemia and venous congestion in the extremities leading in thrombs formation. Compression stockings and elastic bandages should compress minimally and evenly. UHF-therapy, ultrasound and shockwave therapy, electroprocedures, magnetic and harsh heat procedures are condtraindicated to patients after knee joint replacement.