How much does a knee replacement cost?

Example of wear and tear on a knee joint implant.

Surgery to replace the knee joint

Knee replacement surgery is also known as knee replacement surgery. It is the last resort when the knee can no longer function properly or is causing constant, severe pain. The most common indication for knee surgery is gonarthrosis (deforming osteoarthritis of the knee).

Knee replacement surgery is called endoprosthesis. It is the last resort if the knee can no longer function properly or is constantly causing severe pain. The most common indication for knee surgery is gonarthrosis (deforming osteoarthritis of the knee).

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Knee replacement surgery is called endoprosthesis. It is the last resort when the knee can no longer function properly or is causing constant, severe pain. The most common indication for knee surgery is gonarthrosis (deforming osteoarthritis of the knee).

As a specialist clinic for traumatology and orthopedics, we are familiar with joint pain and know how we can help you. Our patients are cared for around the clock until they fully recover.

author

Glazkov Yuri K. Chief physician of the clinic

Who needs them?

Endoprosthesis is most often used for advanced knee osteoarthritis that does not respond to conservative treatment. The frequency of these operations is constantly increasing. This is due to increasing life expectancy. Osteoarthritis is a disease of older people. The average age at which knee surgery is performed is 70 years.

When it comes to knee replacement rates per population, the 70-80 age group is most commonly affected. 400 people in this age group per 100,000 inhabitants per year need a knee endoprosthesis. Women in this age group undergo surgery even more frequently – up to 1,000 per 100,000 population per year.

Main indications for endoprosthetics:

Women are twice as likely to undergo surgery as men. This is not just because they have weaker cartilage that wears out more quickly. It should also be taken into account that women have a longer life expectancy and, as we have already established, arthrosis is a disease of older age.

clinics in Moscow

In Moscow there are numerous hospitals and clinics that perform various types of endoprosthetics (unicondylar, total, revision). Operations are performed in both public and commercial medical facilities.

NN Priorov Central Research Institute of Traumatology and Orthopedics. NN Priorov Center for Traumatology and Orthopedics.

In the Priorov Clinic, new methods of treating diseases of the musculoskeletal system are being developed. ESI endoprostheses for primary and revision arthroplasty were developed in the Department of Traumatology No. 2 and are now widely used. The first indigenous MATI-MEDTECH implants were used in the research institute.

Endoprostheses are performed at the Priorov Institute. Medical students, doctors and professors perform endoprostheses at the Priorov Institute. The cost of the operation is slightly higher here. Both domestic and imported prostheses can be used.

Pyrogov Medical-Surgical Center

Federal state budgetary institution providing all types of high-tech medical care. Endoprosthetics of the knee joint is carried out in the Department of Traumatology and Orthopedics №1.

Trauma Clinic of the First Moscow State Medical University. IN Sechenov Medical Center

Performs high-tech surgeries using endoscopic and minimally invasive techniques. Many orthopedic centers in Israel, Western Europe and the USA work with the clinic. Joint conferences and seminars are organized at which doctors from different countries exchange their experiences.

Botkin City Clinical Hospital

The largest multifunctional medical institution in Moscow. The hospital has equipment and instruments from Zimmer, Biomet and Stryker. The knee arthroplasty is carried out here in trauma ward 26.

Methods and technologies used

Practically the same instruments and devices for monitoring patient conditions are used in Russia as in the world. If a patient has quota surgery, they will likely receive the cheapest domestically manufactured prosthesis.

Table 1 Types of knee replacements.

Before arthroplasty, each patient undergoes an examination and a series of tests. In this way, serious diseases that can cause intra- or postoperative complications can be identified. During the operation, the medical staff of each clinic or hospital scrupulously observes all the rules of asepsis and antisepsis. In order to avoid undesirable consequences, doctors prevent infectious and thrombotic complications in patients.

The knee arthroplasty procedure usually takes 45-60 minutes. If there is a large condylar defect that requires bone grafting, the procedure can take two to three hours.

Classification of endoprostheses

There are many factors that differentiate knee implants from one another. Talking to your surgeon can help you decide which implant is right for you.

layout

• Prosthesis with a firm hold. A traditional endoprosthesis used in elderly patients with a sedentary lifestyle. The tibial component is made of polyethylene and is connected to a lower metal part. The thigh component has a soft surface. Patients with these implants have a 20-50 % greater range of motion;
• a prosthesis with a removable bearing. It offers the knee additional degrees of rotation compared to the previous version. Mobility is guaranteed by a polyethylene insert. This type of prosthesis requires support from the surrounding soft tissues, including ligaments, which reduces the risk of dislocation. Studies show that both types of prostheses are almost equally effective, but doctors prefer this type for younger, more active patients. Inserting the prosthesis requires a lot of experience on the part of the surgeon.

Classic knee implant.

material

Prostheses differ not only in their construction, but also in the materials used. Most of them consist of several components that differ in terms of medical quality.

The metal parts are made of titanium or cobalt-chromium alloys, known for their strength, stable (inert) chemical properties and insensitivity to the human body.

The photo shows two legs of the same patient: the procedure was partially performed on the left and completely on the right.

In some cases, patients may have an allergic reaction to certain metals.

Gender-specific implants

When developing implants, manufacturers focus on the average size. This usually narrows the selection down to 2 or 3 suitable prostheses. However, some companies such as Zimmer and Biomet produce gender-differentiated models. According to the company, these products make it possible to take into account and correct the anatomical differences between men and women.

An example of a 'female' knee implant by Smith@Nephew. There are no visual differences to conventional endoprostheses.

There is no conclusive evidence that gender-specific endoprostheses are more effective. Many experts believe that this is just a marketing ploy to increase sales.

contraindications

There are few contraindications to arthroplasty. Even older and chronically ill people can tolerate the operation.

• Bacterial infections in the body;
• Diseases accompanied by changes in blood clotting (thrombophlebitis, thrombophlebitis);
• diseases of the cardiovascular system;
• infectious inflammation in the knee area;
• Dysplasia of bones and cartilage.

Relative contraindications are: neurological and psychiatric diseases, immune disorders.

In any case, you will be examined at the knee replacement center to determine whether there are any contraindications to the operation.

How is knee replacement surgery performed at Hospital No. 1?

First, make an appointment with an orthopedic surgeon who will take your medical history, conduct an examination, and order tests and necessary examinations.

• An x-ray;
• an electrocardiogram;
• take a urine and blood test;
• obtain a report from your cardiologist and your family doctor;
• X-rays, CT or MRI scans (as directed by the doctor).

It is advisable to treat teeth, bring chronic diseases into remission and eliminate skin infections, especially at the surgical site. If you are overweight, you should try to reduce your body weight and avoid gaining weight. It is advisable to stop taking blood thinning medications for 2 weeks before surgery.

On the eve of surgery, accommodation should be prepared to facilitate recovery during the rehabilitation period. Remove loose carpets and furniture from hallways, install handrails, and purchase supplies of food, water, and medications. It is advisable to organize help from friends or relatives for 1-1.5 months after the operation.

There is an option to book a place in a knee replacement rehabilitation center, where specialists will care for the patient.

Procedure of the operation in the clinic №1:

1. The patient is taken to the operating room and placed on the operating table.
2. The anesthesiologist anesthetizes the patient or gives him an injection in the spine so that he does not feel pain in the lower part of his body.
3. The doctor makes an incision on the knee no more than 15 cm long, pushes the kneecap back and reaches the joint.
4. The orthopedist removes parts of the tibia and femur and fixes the endoprosthesis. If the kneecap is damaged, it is replaced with an implant.
5. The doctor stitches the wound, treats it and applies a sterile bandage.

The operation lasts no more than two hours. The patient is transferred to the intensive care unit and to the normal ward after the anesthesia has worn off.

When is the procedure carried out?

Indications for implanting an artificial joint are:

• deforming arthritis;
• Rheumatoid arthritis;
• Lesions of the knee joint resulting from gout or psoriasis;
• aseptic necrosis of the femoral condyle;
• intra-articular fractures of the tibia;
• intra-articular fractures of the femur;
• Bechterew's disease (if there are symptoms of osteoarthritis);
• Tumors in the knee joint area;
• Diseases of the kneecap;
• Conditions after intra-articular fractures of the tibia and femur.

Surgery is usually performed when other treatments are insufficient, when the disease progresses rapidly, or when the articular surfaces are so damaged that normal function of the limbs cannot be restored by other means.

A knee endoprosthesis is usually used in the following cases:

• If the patient has difficulty performing the simplest movements (climbing stairs, getting up from a chair, putting on shoes, etc.).
• If he has severe pain at night;
• if severe pain occurs after physical exertion, limiting physical activity and reducing quality of life;
• if physiotherapeutic or medical treatments are ineffective.

contraindications

Traumatology defines absolute and relative contraindications for endoprosthetics. Absolute contraindications include:

• Chronic decompensated pulmonary and cardiovascular diseases;
• Purulent foci of infection (pustular skin lesions, tonsillitis, chronic otitis media, chronic maxillary sinusitis, dental caries);
• psychiatric and neuromuscular diseases that increase the risk of complications in the postoperative period;
• acute and chronic infectious lesions in the knee joint area;
• sustained growth in children and adolescents;
• acute thrombophlebitis of the lower extremities.

Relative contraindications include oncological diseases, severe obesity, doubts about the need for the operation or the patient's unwillingness to actively participate in rehabilitation measures after the operation.

Types of endoprostheses

An artificial knee joint is a complex structure made of several materials. A metal alloy is usually used for the part of the prosthesis that sits on the femur. The component for the articular surface of the tibia is more often made of metal and a special plastic. Plastic is used for the internal kneecap replacement.

All endoprostheses can be divided into implants with cemented anchoring, prostheses with uncemented anchoring and artificial joints with a combination of cemented and uncemented anchoring technology. There is no 'best' endoprosthesis option, type of endoprosthesis or fixation method that is suitable for everyone. The choice of the optimal design and method of fixation depends on the patient's age, the level of his physical activity, body weight, health status, characteristics of the pathological process in the joint and many other factors.

Preparation for the endoprosthesis

Before the operation, the patient must undergo the prescribed examinations, including tests and a specialist examination. The implant is selected based on x-rays of the knee joint, CT scans, MRI scans and external examination data. The size of the prosthesis components is determined based on the x-ray images. The surgical set includes several endoprostheses of similar size, allowing the surgeon to adjust the surgical plan as needed.

Knee arthroplasty is performed under general anesthesia or anesthesia and takes an average of 2-4 hours. The doctor makes a longitudinal incision, bluntly and sharply separates the underlying tissue, pushes the kneecap back and exposes the joint. After the joint has been opened, the damaged articular surfaces are removed, the cut edges are processed and first the lower femur and then the upper tibia are replaced. The endoprosthesis is inserted and checked on a trial basis. If the size matches exactly and functionality is good, the final fixation takes place. The intact ligaments are protected. If the ligament apparatus is damaged, a ligament replacement is indicated.

How much does knee replacement surgery cost?

This surgical procedure is very complex and requires a highly qualified doctor who has and knows how to use special equipment and instruments. Therefore, the cost of knee replacement surgery will always be high. However, these vary depending on the

• the extent of the joint damage and therefore the scope of the operation;
• the material of the knee joint replacement.

Knee replacement gives the patient the opportunity to lead a fulfilling life and work without restrictions.

complications

With any surgical procedure there is always a risk of complications. Statistically speaking, most side effects are minor. Possible complications are:

• intra-articular bleeding - may be due to vascular damage or the use of anticoagulants;
• purulent inflammatory processes due to infections;
• Early instability of the joint or its individual components;
• allergic reaction to the endoprosthesis material;
• limitation of motor activity of the joint;
• Sensory disturbances in the knee area;
• disappearance of stitches, opening of the wound;
• Dislocation of the kneecap, displacement of the prosthesis.

In the long term, rough growths and scars can form around the prosthesis, the length of the limb changes, and chronic pain occurs. The risk of these complications is very low if the prosthesis is selected correctly, the operation is carried out well and the patient follows the doctor's instructions.

rehabilitation

After knee replacement surgery, a rehabilitation phase begins. Depending on the type of operation, the patient remains under the care of the doctors for several days, sometimes up to two weeks. For the first 24 hours, the patient lies in bed to protect the limbs. After the operation, patients are given painkillers and, if necessary, antibiotics and other medications.

The next day, the first dressing is applied if a drain has been placed, and the amount and type of discharge is assessed. After the operation, the wound is stitched or the edges are stitched with special staples and removed within a few days. If absorbable sutures are used, they do not need to be removed. In the clinic, the wound is redressed every one or two days. After defecation, she must be kept dry. When bathing, the suture material is protected from water.

For six weeks after the knee replacement, the patient moves with crutches or walking aids and walks short distances. Walk with your heel touching the ground first. Climbing stairs should be avoided until healing occurs, as this puts strain on the joint. If you need to use stairs, you will need help and should always hold onto the railing with the hand opposite the operated limb.

During the first recovery phase, deep knee bends and hip bends of more than 90° are prohibited. It is important to wear compression garments to prevent thrombosis. From the first week you start to train your knee gently. Your doctor will select a series of therapeutic exercises for each patient. Regular exercise, physiotherapy and massage of the joint will help you recover quickly and easily and avoid complications.

After discharge, the patient continues the exercises independently and reports to physiotherapy. After a certain period of time, with the approval of the doctor, you can start training on a stationary bike and do more advanced exercises. The exercise program is designed so that it does not damage the joint and builds the complex structure painlessly.

rehabilitation

An important step in the treatment of ligamentous lesions is restoring function and strength to the entire knee joint. After the main surgical phase, this is achieved through special exercises with a gradual increase in the workload.

The rehabilitation measures also influence the evaluation of the surgical procedure. The duration depends on the extent and type of manipulation and is usually between several months and a year.

pricing

Once a cruciate ligament rupture in the knee is diagnosed, the price of treatment depends on the origin and location of the lesion, as well as the volume of the affected tissue. Several main criteria also influence pricing:

• The number of performed manipulations required to achieve an effect.
• The type of manipulation and access to the changed elements.
• The amount of medication needed to prepare for the procedure and to cope with the period after the procedures.
• The duration of the period after the main procedure and the rehabilitation course.

The total cost of the operation and the entire course of treatment is also influenced by the form of ownership of the health center, as well as its general pricing policy.

Arthroscopy itself is a relatively expensive service. It shortens the duration of tissue healing and rehabilitation while reducing the cost of the entire treatment.

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