Prior to deciding that
a total knee replacement is the best treatment option, the orthopedic
surgeon performs a thorough physical examination of the patient,
including range of motion testing and x-rays, a complete medical
history is taken, and all alternatives are discussed with the patient.
There are many factors used
to determine if a patient is a candidate for total knee replacement in
general, and the Zimmer MIS Quad-Sparing technique specifically. These
can only be evaluated by an orthopedic surgeon, after the patient undergoes
the examination and testing mentioned above.
The Zimmer MIS
patient may need to donate one or two units of blood. Although the “mini
total knee” procedure generally results in less blood loss compared
to traditional knee replacement, transfusions may still be needed during
surgery. The patient must also be cleared by his or her regular physician
The surgery is performed under
either a general anesthesia or a regional epidural, which numbs the lower
half of the patient’s body. Special guides and instruments allow
the procedure to be done utilizing the smaller incision discussed earlier.
The damaged surfaces of the knee are removed and the ends of the bones
are re-shaped to allow for placement of the implants. The implants are
secured to the bones and, if necessary, the surgeon adjusts the ligaments
that surround the knee to allow for unimpaired knee function. Once the
surgeon has completed this procedure, the incision is closed.
The surgery usually takes between
one and three hours. A drain is inserted into the wound to reduce the
fluids that accumulate at the surgical site, then the incision is covered
by a sterile bandage.
Postoperatively, the knee will
remain swollen and tender for a few days. A rehabilitation program is
begun in the hospital, as soon as possible following the surgery. About
four to six hours after surgery, the patient is helped to stand; within
the first 24 hours, the patient begins walking, usually using a walker.
As soon as the physical therapist has cleared the patient to ambulate
and actively extend the knee, the patient is discharged home. This usually
occurs within 24 to 48 hours from the time of surgery. A home exercise
program and physical therapy will then be prescribed. Follow-up visits
with the surgeon are scheduled within the first one to two weeks after
Within weeks of the surgery,
most patients are able to walk with a cane, or with no support at all.
Some patients are even able to resume most normal activities (other than
driving) within seven to ten days after surgery. Of course, these recovery
times vary with each individual.
The goal of a successful
total knee replacement is to relieve pain and stiffness, and allow a return
to normal daily activities. But, of course, there are still some restrictions
– contact sports or activities that put excessive strain on the
knee are not allowed. The surgeon and his staff give clear guidelines
to each patient, and following these are in the patient’s best interest.
Revisions of the total knee procedure can be done down the road, but usually
a second surgery of this type is not as effective as the first.