Knee Replacement

Total knee replacement has proven to be one of medicines most successful surgeries allowing people to return to an active life without pain. It is well proven that quality of life and productivity improves with total knee replacement and is one of the reasons workplace productivity continues to improve in this country.  Many patients state “ I wish I had done this sooner.”

The Normal Joint

Your knee is a hinge joint found where the end of the thigh bone (femur) meets the beginning of the large bone in you lower leg (tibia). A healthy knee has layers of smooth cartilage that cover the ends of the femur and the tibia. The smooth cartilage acts as a cushion and allows the surfaces of the two bones to glide smoothly as you bend your knee. The muscles and ligaments around the knee joint support your weight and help move the joint smoothly so you can walk without pain.

As the knee joint degenerates, the smooth cartilage can wear down on the ends of the femur and the tibia. The smooth surfaces become rough, like sandpaper. Instead of gliding smoothly when you bend your knee, the bones grind and you have pain and/or stiffness.

A Healthy Knee
A Problem Knee A Knee Prosthesis
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Total Knee Replacement

To create a new knee joint, the ends of the bones forming the joint are surgically removed. The cartilage coating the bones has been worn away and replaced or resurfaced with the new device. It is better to think of a knee replacement as a resurfacing of the knee. We do not "chop" the knee out but resurface the end of the bones. The bones are in essence "capped." The collateral ligaments (MCL and LCL), and in some cases the Posterior Cruciate (PCL), and even Anterior Cruciate (ACL) ligaments are preserved. This creates a smoothly functioning joint, free of pain.

The knee replacement Dr. Hickman uses has been described by the FDA as the knee replacement which most closely replicates the function of a normal knee. In other words the motions or kinematics of this knee design recreates the normal motions of a normal knee. The parts of the prosthesis are made of a ceramic like cap (oxinium), titanium, and a very strong plastic. The prosthesis provides new smooth surfaces on the ends of the bones. The FDA has given clearance to state this combination of materials may last as long as 30 years in humans.

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We are currently working on and performing knee replacements that preserve all the ligaments of the knee and truly is a resurfacing of the knee. Its is known as a bicruciate retaining knee or anterior cruciate preserving knee. It is in its infancy and may not provide the long-term results that traditional replacement has seen. However, we are optimistic and remain involved in its development. 

Minimally Invasive Knee Replacement

The procedure is performed in a minimally invasive fashion with a small incision in an attempt to preserve the quadricep muscle complex (see video below). It is our feeling that patients recover faster and regain more strength with this difficult approach. In addition to the benefits of the minimally invasive approach, our advanced anesthetic and pain control approaches along with aggressive physical therapy help speed recovery and make the process easier.

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Robotic Knee Replacement

Dr. Hickman and his team were one of the first ten centers in the United States to utilize the Mako Robotic Total Knee Arthroplasty. Beginning in 2016, we have been actively involved in performing this revolutionary approach to knee replacement. We have been intimately involved in collecting data on this new technology which allows for accurate alignment and positioning of the components. We have been teaching other surgeons from around the globe here in Salt Lake. 

Bountiful hospital pioneering robotic-assisted knee replacement

 Results

The results of total knee replacement are excellent with over 95% of patients experiencing a dramatic relief of pain and demonstrating significant improvements in activity. These excellent results can last over 15 years depending on the patients activity level and size. Though the results are excellent, a certain percentage will fail over time requiring a second surgery.

The most common cause of failure of a total knee replacement is loosening of the implant. Loosening is most frequently caused by wear of the joint surface. If the implant becomes loose, the patient experiences pain and in some instances bone loss. The treatment is a more complicated operation than the first surgery but often is successful leading to pain relief and improvements in activity. If wear of the surface is noted prior to the development of pain, bone loss, or loosening - the polyethylene pad or surface can be replaced as an outpatient surgery. This surgery is much less complicated than a first time replacement and most patients return to normal and normal activities within a few weeks.

Most surgeries proceed without complication. Serious complications, though rare, do occur and include infection, loosening of the implant, loosening/stretching of the ligaments, joint stiffness, and blood clots. Other complications reported by joint replacement surgeons but far less common include nerve or vascular injury, excessive bleeding, and fracture of the bone or implant.

 

In selected patients with knee pain, other surgical treatment options are used by our team including arthroscopy and partial knee resurfacing. Partial knee replacement (unicompartmental or patella femoral replacement) involves resurfacing one or two of the compartments which can restore normal mechanics of the knee by preserving the ligaments of the knee.