The knee is an important joint connecting the tibia and femur to the patella. With his injuries, the patient’s quality of life can significantly deteriorate; sharp pain and problems with walking will accompany the sick person. It is difficult to recover from chronic articular pathology; this process requires immediate surgical intervention by a doctor. The disease progresses quickly, and the disease will soon lead to serious complications. Knee replacement is a procedure that allows you to cope with pathology. As a result of replacing a damaged area of the body, it is possible to restore its lost functions.
Indications
The joint of a healthy person can withstand stress much easier. In sick people, even slight bending causes pain. An unpleasant sensation occurs because the balance in the work of the ligaments of the joint capsule is lost, which causes excessive muscle tension.
If recovery with drug therapy turns out to be ineffective, the patient must consult a surgeon. It should not be assumed that this situation can be avoided without intervention. Surgery is necessary if the patient suffers from the following pathologies:
- arthrosis of the knee (dystrophic joint disease);
- rheumatoid polyarthritis (systemic disease of human connective tissue);
- pathologies during recovery after fractures;
- problems with the ligamentous apparatus of the joint;
- severe obesity;
- various tumors and intra-articular infections;
- necrosis of bone tissue.
The treatment package is prescribed by an orthopedic surgeon. The doctor first assesses how worn the joint is. The specialist makes the decision on surgical intervention as a result of tests and examinations. It is impossible to postpone the treatment process for a long time, because the consequence of lameness is spinal deformation and other complications. The ankle will begin to transfer the load and body weight incorrectly. The doctor is obliged to eliminate the cause of the patient's pain.
Moscow City Center for Bone and Joint Replacement
The endoprosthetics center is equipped with the latest equipment to carry out high-tech operations according to the most modern standards. We use computer navigation for knee and hip replacements. 80% of knee replacements are performed using navigation technology. Currently, the clinic has accumulated unique experience in performing 1.2 thousand total knee replacements using computer navigation.
Knee replacement using navigation equipment
We perform hip and knee replacement using minimally invasive methods. This technique was introduced in our clinic more than 10 years ago and is successfully used and developed. The technique allows endoprosthetics to be performed without significant muscle damage, which, in turn, makes it possible to more quickly restore limb function.
Recently, along with the increase in primary endoprosthetics operations, the number of revision operations to replace unstable hip and knee joints has also increased. These operations are unique because each of them is individual. Here we have developed and implemented our own instruments and technologies into clinical practice, and received patents. The use of shoulder arthroplasty for injuries and chronic diseases of the shoulder joint is also expanding. All this allows patients to get rid of pain and return to an active life.
In revision surgery, we use the most modern materials, we use only proven endoprostheses produced by companies that occupy a leading position in the world in terms of product quality. The endoprostheses installed in the clinic are equipped with the most modern friction pairs.
The equipment of the clinic allows performing operations of any complexity. In this case, low-traumatic techniques are used, both in relation to soft tissues (minimally invasive approaches) and in relation to bones (components of endoprostheses that ensure minimal damage to bone tissue).
In addition to using the most modern world developments in their practice, the clinic’s specialists themselves create and implement new techniques. The clinic's staff defended 24 patents for inventions and utility models related to both new treatment methods and new surgical instruments.
The center has a clinical base of the Department of Traumatology, Orthopedics and Disaster Surgery of the First Moscow State Medical University. THEM. Sechenov. The head of the Center is a professor in this department. In addition, the Center employs workers from the Department of Traumatology, Orthopedics and Disaster Surgery.
Weekly in the consultative and diagnostic clinic at the City Clinical Hospital named after. S.P. Botkin undergoes a commission of about 30 patients to determine indications for joint replacement. Every year, about 2 thousand patients undergo inpatient treatment at the Center. The Center's staff continues to monitor patients months and years after the operations.
Contraindications
Treatment is recommended for people even in old age. Surgery will relieve pain and eliminate the problem in the joint. But it is better to postpone the operation if the patient is found to have:
- uncontrolled diabetes mellitus;
- inflammatory processes;
- severe anemia;
- leg paralysis;
- vein thrombosis;
- joint tuberculosis.
Also, you should not go under the knife if patients have not recovered from infections. Any contraindication may be a reason to prohibit surgery, but the final decision is made by the doctor. A person must inform the doctor that he is suffering from one of the above ailments. Thus, it is possible to avoid undesirable consequences. If there are no contraindications, then the patient can safely lie down on the operating table.
The patient is not assigned disability after surgery.
Arthroscopy or open surgery?
Previously, treatment of knee injuries and diseases was carried out only using open surgery. But several decades ago, equipment for arthroscopic interventions appeared. Since then, arthroscopy has been steadily replacing open operations, and sooner or later will replace them completely. This is due to the fact that such interventions:
- less traumatic;
- better tolerated by the patient;
- have a lower risk of complications;
- more effective.
At the same time, they are more affordable than open surgical operations. What is this connected with? Of course, clinics that are arthroscopy centers are forced to invest money in order to purchase the necessary equipment for such operations. This increases the cost of treatment. However, every year the cost of arthroscopy becomes less and less, and open operations become more and more numerous. They include a number of other expenses, namely:
Preparing for surgery
When preparing for surgery, the doctor must examine the sore leg and joint, and then prescribe a number of additional examinations. Both lower extremities are subject to examination. X-rays, ultrasound and MRI are often recommended to the patient. The patient also needs to get advice from a cardiologist, therapist and other specialized specialists (it all depends on the specific case). You won’t have to go through all the doctors if your blood and urine test results are normal. Elderly people and heart patients are required to undergo an ECG. In preparation, doctors often draw blood for possible transfusion during surgery.
Arthroscopy and conservative treatment
Some patients, having learned how much knee arthroscopy surgery costs, refuse it. Such financial costs seem too great to them. While conservative therapy is much cheaper. After all, you can simply fix your leg in the correct position and wait for the knee to recover on its own!
But in reality, this approach has many disadvantages. Indeed, conservative treatment is cheaper than surgical treatment. And it turns out to be successful to one degree or another. After the end of the acute period, swelling goes away, pain decreases or is completely eliminated. After a few months, a person achieves final results. It may even seem to him that a complete recovery has occurred.
However, in reality, the risk of complications is present in 50-90% of patients who refuse surgical treatment. Possible consequences:
How is it carried out?
Surgery is carried out exclusively within the walls of the hospital. The duration of the procedure varies depending on the specific case and the qualifications of the doctor. It is difficult to place an endoprosthesis; only an experienced surgeon can do this.
Most often, the operation lasts from one to several hours (such a complex intervention cannot last less). During this time, the person will be under anesthesia and will be given a special drug.
During the operation, damaged fragments and destroyed knee joint cartilage are removed. The price of the procedure depends entirely on the complexity of the damage. The recovery course will begin immediately after the operation.
How much does a knee replacement cost without a quote?
The knee replacement procedure is quite expensive (only a similar operation on the hip joint is more expensive).
Surgery prices vary:
- From the venue. In private clinics, you also have to pay for a diagnostic examination, surgery, anesthesia, the cost of a prosthetic joint, and hospital stay; on average, this will cost from 100 thousand rubles. In a public institution, the operation will be cheaper - the patient will only need to buy a prosthesis.
- From the type of prosthesis. Their price depends on the manufacturer (imported - from 200 thousand rubles, domestic - from 130 to 170), the material of manufacture (metal or ceramics - from 170 thousand, combined materials - from 130), the method of prosthetics (cement-based - cheaper, from 120 thousand).
- Depending on the type of operation. Partial replacement of the joint surface (femur or tibia) is 2 times cheaper than total replacement.
The cost of the operation may be increased by individual production of the prosthesis, additional diagnostic tests, or visiting a foreign clinic.
Unipolar prosthetics
Surgeons replace a damaged joint with biologically compatible artificial structures (endoprostheses) using several types of endoprosthetics. Doctors distinguish the following types of prostheses:
- total (total knee replacement);
- unicondylar (partial or unipolar replacement);
- revision (repeated).
When installing a unipolar system, a person can actually save the osteochondral segment; the ligaments will not be affected (but they must be in good condition). Thus, only the damaged area is replaced.
Getting a quota: where to start
The first step to free endoprosthetics is to contact a traumatologist or orthopedist at the clinic. He will help prepare documents for submission to the quota committee (they are created in health care institutions at the place of residence). The period for reviewing documents is 3 working days, after which a decision is made on the need for endoprosthetics. What documents are needed:
- An extract from the medical history with information about diagnosis and health, certified by the attending physician and the head of the organization (chief physician) who refers the patient to endoprosthetics.
- Results of diagnostic, clinical laboratory examinations, doctors’ conclusions indicating the need for surgery.
- Radiographs of the joint in different projections.
X-ray of the knee joint
If the committee makes a positive decision, the patient is given a protocol with which he applies to the Department or Ministry of Health of the region.
Having received the protocol (in the original), you need to collect:
- original referral for hospitalization from the attending specialist (traumatologist) with an extract from the medical history;
- original written application from the patient (consent to data processing).
Copies are also needed:
- identification document;
- pension insurance certificate (if available);
- health insurance policy;
- disability documents (if available).
Sample referral for hospitalization
The Department (Ministry) of Health reviews received documents within 10 working days. If the decision is positive, the patient’s data is transferred to the nearest clinic, where prosthetics are performed according to the quota. The hospitalization period is determined there. The patient is notified of the timing of the procedure (usually by telephone or email).
conservative treatment
conservative treatment
- chronic pain syndrome;
- instability of the joint, its subluxation;
- restriction of physical activity;
- impossibility of intense exercise, including sports and physical labor;
- damage to other ligaments (for example, with a torn collateral ligament of the knee, the anterior cruciate ligament suffers over time);
- degeneration of articular cartilage and development of gonarthrosis.
If the ligaments are torn, in most cases they do not heal. They have to be restored using arthroscopic plastic surgery. If one of the ligaments is damaged, then it does not hold the joint in the correct position. There is a constant hyperextension of it, since there is no limiting factor. Due to instability and constant subluxations, a person is forced to use orthoses. But they provide only temporary relief. Over time, the thigh muscles atrophy and articular cartilage degenerates.
If the menisci are damaged, their restoration without arthroscopy is sometimes possible. But in most cases you have to undergo surgery. The meniscus has poor blood supply. It is able to regenerate only in the zone that is located in close proximity to the joint capsule. Some components may come off completely or partially. Partial avulsion provokes repeated blockades of the knee (limitation of movement). A complete tear leads to a piece of the cartilaginous plate dangling inside the joint, causing constant pain and mechanically damaging the intra-articular structures.
