Total Knee Replacement Over the Age of 85 – Risks and Outcomes

There are multiple reasons why a patient might require a total knee replacement. This surgical procedure is performed on a knee joint that is diseased. Artificial materials replace the joint that has broken down or been impacted by the injury. Our knees are hinge joints that provide our range of motion at the spot where the thigh connects to the lower extremity. The femur abuts the tibia at the knee joint.

In 2015, more than 675,000 total knee replacements were performed.

Why Total Knee Replacement for the Aged?

Total knee replacement is often recommended to SNF patients who have been battling severe osteoarthritis. With years of wear and tear, it is not uncommon for the elderly patient to need a knee replacement. If the patient’s joint has been diagnosed as being useless from the cartilage degrading over time, total knee replacement becomes the best treatment option to upgrade the quality of life.

How is Total Knee Replacement Performed?

When a total knee replacement is surgically performed the damaged cartilage and bone are removed. The surgeon begins by making an incision across the top of the knee to get to the kneecap (which is medically referred to as the patella). The incision typically is eight to ten inches long. There are minimally invasive surgeries that the incision is only four to six inches long.

The first portion of the knee that the surgeon can see is the patella. Once the knee is open, the surgeon will rotate the patella until it is outside of the knee area. This gives the surgeon a visible area that is needed to perform the total knee replacement.

The first bone that will be resurfaced is the femur (thighbone). Once the knee joint is exposed the bones will be measured and precise cuts will be made using special instruments specifically used for cutting bones during surgery. The bone and cartilage are cut away from the end of the femur. The end of the femur is then cut and the surface is altered to make it fit the first part of the new knee (the femoral component).

The surgeon will then attach the metal (or plastic) femoral component to the end of the femur and bone cement will be used to seal the component in place. The next bone that will get resurfaced is the tibia. This is also called the shinbone. The surgeon will remove and damage bone and/or cartilage will be removed from the top portion of the tibia and then the bone will be shaped to fit into the manmade tibial components.

The bottom part of the implant is called the tibial tray. It fits into the tibia and is secured by bone cement. When the tray is firmly in place the surgeon snaps in a polyethylene insert that is located between the tibial tray and the femoral component. It’s purpose is to be a buffer and provide support for the body as you bend, run, and walk.

Before the patella can be returned to the normal position, it may need to be flattened and fit with an additional plastic piece so that proper fit is ensured with the rest of the implant. There is a possibility the plastic piece may need to be set in place with cement to the underlying bone.

Once everything is in place, your surgeon will flex the knee to be sure that it’s working in the proper manner with suitable alignment, sizing, and position. The final step will be closing the incision with stitches or staples. The knee will then be bandaged.

TKR Benefits

Total knee replacement surgeries are declared to be successful and safe when performed by a qualified orthopedic surgeon.  The surgery offers pain reduction in the joints which can often plague seniors that have osteoarthritis. They can then move around with improved stability and less pain.

When the patient is older than 75 years old, any surge can pose a risk (including total knee replacements). Before a recommendation for surgery is made, doctors will focus on treatments first such as medicinal treatments or physical therapy. When these don’t work, a total knee replacement is the next step.

Risks for Elderly Patients

The biggest risk with any surgery comes with the anesthesia needed to perform procedures. In some patients, a local (also called regional or local) anesthetic is used to number the area that the patient is having surgery performed on. Usually, anesthesia doesn’t display with side effects but some elderly patients experience dizziness with nausea and vomiting, drowsiness, difficulty to rouse, and/or an irregular heart rate. Blood clots can also be a serious issue. Clotting is a natural reaction of the human body to any type of wound or injury. The body will naturally try to clot the blood so that the flow of bleeding will be naturally restricted. Sometimes the blood clots when it should not, though. If a clot occurs in a blood vessel during or after surgery it can block the adequate flow of blood through the rest of the body and cause serious complications. This happens in less than 3% of all surgeries. Quite often doctors will prescribe blood thinners and exercise post-operatively.

Risk of Infection

The knee joint is completely exposed during surgery so there is a risk for infections. Diabetics and arthritis are prone to infection with any surgery they undergo. If infection sets in, it may prolong wound healing.  Patients with pre-existing conditions or infections in other parts of their bodies such as their throat, mouth, or kidneys can become a catalyst for infection in the knee. Every hospital takes precautions during operations but a small number of patients get infected during the procedure.

Aged patients should be made aware of the risks and benefits of all surgeries. Total knee placements have a 99.75% success rate.

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