• Contact Us
The Leone Center for Orthopedic Care
  • Home
  • Hip & Knee Surgery
    • Philosophy
    • Hip Surgery
    • Hip Conditions
    • Knee Surgery
    • Knee Conditions
  • What to Expect
    • Vision
    • Meet Dr. Leone
    • State-of-the-Art Facility
    • In the News
    • Plan Your Visit
    • Personalized Care
    • Preparing for Surgery
    • Day of Surgery
    • Pain Management
    • Best Practices
    • Physical Activity Timeline
  • Testimonials
  • Blogs
    • English Blog
    • Spanish Blog
    • Portuguese Blog
  • Patient Resources
    • Ask Your Surgeon
    • Medicare & Insurance
    • Downloads
    • Patient Rights
  • Video Library
  • Search
  • Menu Menu
You are here: Home1 / Headlines2 / Knee Conditions3 / Determining the Need for Total Knee Replacement Surgery

Determining the Need for Total Knee Replacement Surgery

In the first of two blog posts focusing on computer assisted total knee replacement surgery (TKR), I will discuss the physiology of the knee joint, how it works, what causes its breakdown and the possible need for a TKR.

Orthopedic surgeons generally categorize the knee joint as having three compartments: the inside (medial compartment), the outside (lateral compartment) and the front (patella femoral compartment).

What many people don’t realize is the knee is much more than a large hinge joint.  Not only does the knee extend and flex, it also pivots around the medial compartment as it moves and the cruciate ligaments help direct this movement.

In a normal, well-functioning knee, the knee’s alignment ensures that weight bearing forces are distributed equally between the medial and lateral compartments of the joint. This is referred to as a neutral mechanical axis. Imagine holding a carpenter’s plumb line (a string with a weight on one end so it falls in a straight line due to the pull of gravity) directly over the middle of the hip joint (which is the center of the femoral head) and allowing it to fall over the middle of the ankle. In a normal knee with a neutral mechanical axis, the string crosses the middle of the knee joint. When a knee degenerates, often it develops an angular deformity, either bowlegged or knock-kneed.   The string then doesn’t pass through the middle of the knee but rather to the side and the angular eccentric forces cause the knee deformity to worsen with time.

The knee has a wonderfully complex soft tissue sleeve, which stabilizes and balances it throughout the normal range of motion. In a normal knee, the tension on these tissues is distributed equally. The anterior and posterior cruciate ligaments (ACL and PCL) help guide this precise movement (called kinematics) during extension and flexion.

The specialized cartilage that covers the bones in the knee joint is called hyaline cartilage. This cartilage miraculously minimizes friction as it distributes the joint reactive forces. Cartilage does not have a blood supply and when damaged heals very slowly.  When hyaline cartilage is damaged, the body replaces the damaged cartilage with fibrocartilage, not hyaline cartilage. Fibrocartilage does not have the same mechanical properties as hyaline cartilage and unfortunately, this sets the stage for progressive degeneration and osteoarthritis, the most common cause for TKR surgery.

As the knee cartilage breaks down, forces are concentrated focally on a smaller area of bone, rather than distributed over a larger surface. The over-stressed area of bone becomes denser (it looks white or “sclerotic” on an x-ray) and bone spurs develop. Some believe the formation of bone spurs is a physiologic attempt by the body to redistribute the forces over a broader area.

When cartilage is injured and breaks down on one side of the joint, the space between the bones decreases and the joint no longer is aligned.  Weight bearing forces progressively make the deformity worse, which causes pain and inflammation. The synovial fluid in the knee joint nurtures the cartilage. When the joint is inflamed, the lining of the joint secretes more synovial fluid. This can make the knee feel tight and swollen, often described as having “water on the knee.” With the lack of, or breakdown of cartilage, this increased amount of fluid, now under pressure, can get squeezed into small crevices of the bone, which creates a balloon-like hole called a degenerative cyst or geode. It also can cause a cyst to form as the synovial fluid pushes against a weakened area of the knee capsule and the capsule balloons outward.  A cyst that forms in the back of the knee is called a Baker’s Cyst. With time and progression of the degenerative process, the perfectly smooth surfaces of the knee bones are lost, areas of the bone collapse and the joint breakdown worsens. With the loss of normal alignment, the patella no longer tracks centrally over the femur causing pain and additional degeneration.

The most common area where symptomatic degeneration begins is in the medial compartment.  Although the arthritic process typically starts in one compartment, with time it progresses to the other compartments. If a patient has degeneration in only one compartment, a partial knee replacement can be a very effective way to resurface the worn-out compartment that is causing pain. The hope is that a partial knee replacement will stop the arthritic progression. If appropriate, this procedure requires much less dissection, results in a faster recovery and many patients report that it feels like a normal knee.

For patients who do require TKR, I choose the implant that is best suited to each person’s medical and lifestyle needs. Implants are individualized for each patient’s unique anatomy and precisely implanted using computer assisted navigation and robotic techniques.

In my next blog I will discuss how computer assisted TKR surgery has revolutionized the reconstruction of knee joints, providing surgeons with ability to more accurately restore knee functionality and pain-free quality of life for patients.

We thank you for your readership. If you would like a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com.

Share this entry
  • Share on Facebook
  • Share on X
  • Share on Pinterest
  • Share on LinkedIn
  • Share by Mail
  • Link to Instagram
https://holycrossleonecenter.com/wp-content/uploads/2018/12/shutterstock_388421632.jpg 684 1024 Joseph Corsino https://holycrossleonecenter.com///wp-content/uploads/2017/11/Leone-Center-Logo@2x.png Joseph Corsino2013-06-11 09:16:452019-10-19 09:30:27Determining the Need for Total Knee Replacement Surgery
You might also like
Pain and Discomfort after Total Knee Replacement Surgery: Signs TKR Has Failed
VERASENSE Sensor is a game changer for knee replacement surgery
Arthroscopic Techniques to Stimulate the Production of Joint Fibrocartilage
Frequent Reader Questions about Knee Replacement Surgery
Using Sensor Technology to Diagnose and Precisely Correct TKR Failures During Revision Surgery
Poor Results after TKR Due to Infection: Diagnosis and Treatment
Make an Appointment

Categories

  • Approaches
  • Awards
  • Best Practices
  • Cadera
  • Complications
  • Concierge
  • Hip Conditions
  • Hip Surgery
  • joelho
  • Knee Conditions
  • Knee Surgery
  • la Obesidad
  • Most Shared
  • News
  • Pain Management
  • Patient Concerns
  • Philosophy
  • Physical Activity Timeline
  • Procedures
  • Quadril
  • Rodilla
  • Surgical Techniques
  • Technologies
  • Uncategorized

Archives

ABOUT

Hip & Knee Surgery
What to Expect
Patient Resources
Blog
Testimonials
Contact Us

TOPICS

Approaches
Complications
Pain Management
Patient Concerns

Procedures
Surgical Techniques
Technologies

The Leone Center
for Orthopedic Care

1000 NE 56th Street,
Fort Lauderdale, FL 33334
Get Directions

Phone: 954-489-4575
Fax: 954-489-4584
Email us

© Copyright 2018 - 2023 The Leone Center for Orthopedic Care
  • Privacy Policy
  • Terms of Use
When to Have Hip Revision Surgery Due to Metal-on-Metal ProsthesesComputer Assisted Total Knee Replacement Surgery
Scroll to top

This site uses cookies. By continuing to browse the site, you are agreeing to our use of cookies.

OKLearn more

Cookie and Privacy Settings



How we use cookies

We may request cookies to be set on your device. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website.

Click on the different category headings to find out more. You can also change some of your preferences. Note that blocking some types of cookies may impact your experience on our websites and the services we are able to offer.

Essential Website Cookies

These cookies are strictly necessary to provide you with services available through our website and to use some of its features.

Because these cookies are strictly necessary to deliver the website, refusing them will have impact how our site functions. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. But this will always prompt you to accept/refuse cookies when revisiting our site.

We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. You are free to opt out any time or opt in for other cookies to get a better experience. If you refuse cookies we will remove all set cookies in our domain.

We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. Due to security reasons we are not able to show or modify cookies from other domains. You can check these in your browser security settings.

Google Analytics Cookies

These cookies collect information that is used either in aggregate form to help us understand how our website is being used or how effective our marketing campaigns are, or to help us customize our website and application for you in order to enhance your experience.

If you do not want that we track your visit to our site you can disable tracking in your browser here:

Other external services

We also use different external services like Google Webfonts, Google Maps, and external Video providers. Since these providers may collect personal data like your IP address we allow you to block them here. Please be aware that this might heavily reduce the functionality and appearance of our site. Changes will take effect once you reload the page.

Google Webfont Settings:

Google Map Settings:

Google reCaptcha Settings:

Vimeo and Youtube video embeds:

Other cookies

The following cookies are also needed - You can choose if you want to allow them:

Privacy Policy

You can read about our cookies and privacy settings in detail on our Privacy Policy Page.

Privacy Policy
Accept settingsHide notification only