Knee Osteoarthritis

WHAT IS KNEE OSTEOARTHRITIS?
Osteoarthritis of the knee joint is caused by the destruction of cartilage structures covering the knee joint. These cartilage structures deteriorate due to pain and swelling in the joint. In addition, the sound from the joint and deformity may occur over time. this deformity causes movement limitation.
WHAT ARE THE FINDINGS OF KNEE OSTEOARTHRITIS
Knee pain, which is mild in the early stages, starts to increase in the future and become permanent. Night pain may not let slept. After activity, swelling is observed in the knees and then it can be seen even at rest. Bad feelings about knee become apparent day by day. Over time, the degree of bending in the knees decreases, and patients are unable to open their knees. Disfigurement of the legs is usually seen as leg bending described as "O". Patients who cannot bend sufficiently, who have difficulty in moving because of pain, complain that they cannot do their work alike in the past. For example, they struggle to squat and wear socks, and they do not want to go outside the house because their walking distance is restricted.
WHAT CAUSES KNEE OSTEOARTHRITIS
Age progression to joint osteoarthritis may be caused by genetic predisposition, excess weight, excessive strain of joints, falls, accidents, rheumatic diseases, joint inflammations, diseases that impair blood supply to the bone, bone cysts and tumors and recurrent surgical interventions.
HOW IS KNEE OSTEOARTHRITIS TREATED?
While knee osteoarthritis is in the initial phase, the joint damage can be delayed by non-surgical methods such as weight reduction, pain medication, physical therapy, needles (joint fluid, PRP injections). Bone surgeries that correct the leg shape and closed knee surgeries can prevent joint disruption. However, in advanced osteoarthritis , the cartilage is completely damaged and the patient's life comfort decreases significantly. In this case, the only solution to restore the quality of life is the process of covering the damaged joint surfaces named total knee replacement ( TKR) .

Robotic Total Knee Replacement

WHAT IS ROBOTIC TKR?
Computer assisted surgical systems, which are referred to as CAS (computer assisted surgery) and started to be produced in 1990 are a general definition and are divided into active and passive systems. In active systems, the surgeon is operated by a robotic arm. In passive systems, the navigation system helps the surgeon.
HOW DOES THE NAVIGATION SYSTEM WORK?
This method works like road navigation in vehicles. The signals emitted from our vehicle are received by satellites. Marks the position of the satellite vehicle instantly to the system. The computer that combines instant shared information on the map with the map guides you to the correct address on the screen. In the robotic knee arthroplasty, the three-dimensional reflectors placed on the thigh and the leg and the joint markers and the shape of the knee, the position of the hip and the ankle in space are loaded into the computer through the cameras. The size of the prosthesis, the amount of bone incision, and string placement angles are calculated. It is done on computer model. During surgery, the system can instantly show the amount of bone incision just before making real incision, making it possible for the surgeon to check the operation of each operation. In this way, it is ensured that the operation is performed with maximum quality and without error.
WHICH ORTHOPEDIC SURGERIES ARE PERFORMED WITH ROBOTIC NAVIGATION?
According to the system used, beside total knee replacement surgery, hip replacement, partial knee replacement, bone correction surgery, various operations such as anterior cruciate ligament operations can be done. System developers continue to increase this diversity over time. Many operations are expected to be computer-aided in the future.
WHAT ARE THE ADVANTAGES OF ROBOTIC NAVIGATION?
  • - Proper placement of the prosthesis,
  • - Correcting the leg shape more accurately,
  • - Having longer life of TKR,
  • - Less bone loss,
  • - Less blood loss,
  • - Smaller skin incision,
  • - Less pain,
  • - Reduction of the risk of emboli
  • - More bending angle,
  • - Early recovery and return to daily life early than usual.
ARE THERE ANY DISADVANTAGES OF ROBOTIC NAVIGATION?
  • - Cost increase,
  • - Prolongation of 10-20 min.
  • - Increased risk of fracture in patients who has the excessive bone resorption.

Total Knee Replacement (TKR)

WHEN SHOULD I HAVE AN TKR?
As a result; whatever the cause, damage to the joint causes severe pain and disruption of joint movements, and if these complaints do not go through rest, painkillers, or physical therapy, and if one begins to reduce the quality of life of the person, TKR is a must. Although it is generally recommended that physicians perform TKR after 60 years of age to avoid repeated change surgeries by physicians, this condition is not always correct. For example, a 35-year-old patient with severe damage to the joint after rheumatism or an accident will have to wait 25 years for this operation to be performed. This is not possible.
WHAT IS THE SUCCESS RATE OF TKR?
In our society, TKR applied to people who suffer from pain and difficulty in walking and who cannot perform their daily activities due to the damage caused by cartilage on the articular surface, eliminate many difficulties. The success rate of these operations is over 90%.
WHAT IS THE SUCCESS OF TKR?
Success of TKR; depends on many factors like good surgical technique, good quality of the prosthesis used, good control of bleeding, good technical facilities of the operating room, the use of additional techniques such as navigation, the good quality of the postoperative care and the patient's ability to make good enough exercise and physician recommendations by adhering to the post-operative treatment.


If you have a majority of the following conditions, you may also have a knee replacement:


  • Being over 60 years of age,
  • Long-term, severe and non-sustained joint pain,
  • Lack of healing with other methods such as painkiller, physical therapy and intra-articular needle therapies,
  • To take painkillers in a continuous and increasing dose to relieve pain,
  • Shortening at walking distance day by day,
  • Restriction of joint movements or inability to fully open the joint,
  • Visible shape disturbances such as shortness and distortion of the legs,
  • The difficulty of meeting the daily activities of the person, such as climbing stairs, sitting on the chair, having difficulty in sitting on the toilet, having difficulty in going to the toilet, going to the house or neighbors, and having difficulty in socks.


FOR A SUCCESSFUL PROSTHESIS OPERATION, IT IS NECESSARY TO HAVE THE KNOWLEDGE AND SKILLS TO PLAN AND SOLVE THE PROBLEMS THAT MAY OCCUR BEFORE THE OPERATION, SURGERY EXPERIENCE, SURGERY, AND AFTER SURGERY.

Prof. Levent ALTINEL MD.
Prof. Levent ALTINEL MD.


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