Coordinating Committee in Orthopaedics & Traumatology 全膝關節置換術 (Total Knee Replacement) Effective date: 19 February 2009 Version 1.0 Document no.: PILI

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1 Coordinating Committee in Orthopaedics & Traumatology 全膝關節置換術 (Total Knee Replacement) Version 1.0 Document no.: PILIC0053C version1.0 Page 1 of 3 全膝關節置換術簡介在進行全膝關節置換術時, 因病變受損的骨和軟骨會被切除關節的表面會裝上由金屬和塑膠組成的人工關節一般來說, 人工關節由三個部份組成股骨假體脛骨假體和臏骨假體人體的膝關節是由兩個部分組成 - 脛股關節和臏股關節一般情況下, 在進行全膝關節置換術時, 脛股關節會被置換你的主治醫生會因你病變的嚴重程度而決定會否進行臏骨置換適用情況晚期的膝關節炎 o 大部份病因是原發骨性關節炎, 類風濕性關節炎 o 其他病因包括痛風症缺血性骨壞死强直性脊柱炎血友病夏科氏關節 (Charcot joint) 等偶有腫瘤患者和骨折病人晚期關節炎的病徵包括疼痛膝關節變形和僵硬小數病人會出現關節不穩定的問題手術後, 痛楚將會大大減小, 亦可改善了原有的關節變形和僵硬但是屈曲度始終較正常人小如果手術前膝關節屈曲度巳經非常理想, 術後將很難再提高手術過程您需要接受全身麻醉或半身麻醉 ( 例如硬膜外麻醉腰麻等 ) 你的麻醉科醫生將會跟你討論那一種方法最適合你我們會給你注射抗生素如您過往有藥物過敏, 請通知醫務人員我們可能會放一個止血帶在你的大腿, 以減低手術中的出血手術的切口是在膝蓋前方病變的骨和軟骨會被切除, 跟着會用骨水泥將假體固定如果你的骨科醫生決定需要置換臏股關節, 這時便會切除臏骨病變的軟骨, 將假體以骨水泥固定在臏骨上術後可能留下引流手術後, 你將會在手術室內接受觀察當你的情况穩定後, 你才會返回病房手術風險或併發症一般風險跟其他手術一樣, 全膝關節置換手術存在的一般風險包括 : 關於麻醉的風險傷口癒合的風險術後肺炎心肌栓塞和中風的風險等

2 Coordinating Committee in Orthopaedics & Traumatology 全膝關節置換術 (Total Knee Replacement) Version 1.0 Document no.: PILIC0053C version1.0 Page 2 of 3 特別與手術有關的風險和併發症全膝關節置換術是一項安全和認受性高的手術但是, 手術仍是有機會出現風險和併發症翻修手術 - 所有人工關節都會出現機械性的磨損只要置換手術的時間夠長, 所有人工關節都會出現鬆脫而需要接受翻修手術細菌感染 - 人工關節術後有可能受到感染, 但發病在一般病人來說並不算高但在糖尿病患者, 感染機會較大關節脫位 - 全膝關節術後脫位是一個罕見的併發症神經線受損 - 神經線有可能在手術中受損患肢會感到麻痺, 活動功能受到影响傷口附近可能有些麻痺失血動脈受損 - 手術中動脈受損是非常罕見但如情况嚴重, 可能需要切除下肢骨折 - 骨折可以在手術中或手術後發生傷口癒合的問題 - 包括傷口持續滲漏, 傷口邊沿出現組織壞死如情况嚴重, 可能要再做手術深層靜脈栓塞和肺動脈栓塞 - 手術後出現深層靜脈栓塞並不罕見但肺動脈栓塞相對較少嚴重肺動脈栓塞須然並不常見, 但可以導致死亡膝關節伸展機制的併發症 - 膝關節伸展機制併發症包括臏骨不穩定, 臏骨骨折, 臏下腱撕裂和軟組織碰撞的問題膝關節僵硬 - 手術後僵硬的情況並不常見但是嚴重患者便有需要接受其他治療手術前準備矯正及穩定原有的疾病, 例如心臟病高血壓糖尿病貧血氣促等等手術前數小時開始禁食手術後須知病情穩定後便可進食你需要定時進行踝關節運動這有助小腿血液流動, 減低深層靜脈栓塞的機會物理治療師會指導你進行復康運動, 以保持膝關節活動幅度, 包括完全伸直和最大屈曲其次目標是儘快恢復四頭肌的力量手術後數天, 治療師便會指導你使用輔助器來走路當外科傷口癒合, 我們便可為你拆除傷口上的外科縫線可能需要的額外手術或治療輸血 - 進行手術時, 失血是無可避免的醫生將會根據你的身體情況, 決定你有沒有需要接受輸血

3 Coordinating Committee in Orthopaedics & Traumatology 全膝關節置換術 (Total Knee Replacement) Version 1.0 Document no.: PILIC0053C version1.0 Page 3 of 3 骨折固定 - 當手術中出現骨折, 你的骨科醫生可能有需要將切口延長, 以內固定的方法將骨折穩定血管修補 - 雖然動脈受損的機會是非常罕見, 但是, 動脈受損的後果可能非常嚴重, 導致下肢因缺乏血液供應而壞死因此, 要是發現這個罕見的併發症, 你便需要血管修補或重建的手術其他治療方法你的骨科醫生建議你進行全膝關節置換手術, 一般來說, 都是因為一般的保守療法 ( 如藥物治療物理治療等 ) 都不能有效地控制你的病情但是, 全膝關節置換手術並不是一個拯救生命的手術你可以選擇繼續接受保守療法手術後跟進你要保持傷口乾爽及清潔, 應依照醫生處方按時服藥, 並於預定的日期覆診如果出現嚴重事故, 如大量出血休克劇烈痛楚發燒傷口紅腫發炎或傷口分泌物有惡臭等, 則應盡快求診或到就近的急症室診治備註可能發生的風險或併發症, 不能盡錄不可預計的併發症亦偶有發生, 某類病人的風險程度亦為不同如有查詢, 請聯絡你的醫生

4 Version 1.0 Page 1 of 4 Introduction Total Knee Replacement Total Knee Replacement is a surgery involving replacing your existing diseased cartilage and bone in the knee joint by a prosthesis composed of metal and plastic. There are usually three components: femoral prosthesis, tibial prosthesis and patellar prosthesis. The knee joint can be divided into two parts: femoral-tibial articulation and femoral-patellar articulation. Depending on the severity of disease in your knee, the femoral-tibial articulation, with or without the femoral-patellar articulation, will be replaced by the prosthesis. Indication End stage arthritis of the knee joint o Usually due to osteoarthritis, rheumatoid arthritis o Sometimes gouty arthritis, osteonecrosis, ankylosing spondylitis, haemophilia, Charcot joint, etc. Occasionally for tumor, fracture, etc. The most common symptoms in end-stage arthritis are pain, deformity and stiffness. Occasionally, patients may complain of instability of the joint. After surgery, pain is usually much reduced. Original deformity and stiffness are usually improved. However, the range of motion is usually not as good as a normal knee. If the knee range was already very good before the surgery, it is difficult to further improve the range of motion. The Procedure You have to undergo general anaesthesia or regional anaesthesia (e.g. epidural anaesthesia, spinal anaesthesia, etc). Your anaesthetist will discuss with you about the anaesthetic procedure in details. You need antibiotic prophylaxis for the operation. Please inform your doctor or nurse if you have drug allergy history. A tourniquet may be put around the thigh region of the limb. It will be inflated during the procedure to decrease the blood flow to the leg. Incision is made in the anterior aspect of the knee joint. Diseased cartilage and bone are then removed. The femoral prosthesis and tibia prosthesis are usually fixed to the bone by cement or other mechanical means. If your patella needs to be replaced, your surgeon will implant the patella prosthesis. At the end of the procedure, drain(s) may be inserted for drainage of haematoma. Before going back to a general ward, you may be kept in the recovery room of the operation theatre for observation.

5 Version 1.0 Page 2 of 4 Risk and Complication General Complications Like other surgical procedures, there are associated risks and complications with total knee replacement surgery, for example, those associated with anaesthesia, wound complications, pneumonia, stroke, heart attack, etc. Specific Complications Total Knee Replacement is a safe and well accepted surgical procedure internationally. However, similar to other surgical procedures, there are still chances to encounter potential undesirable effects and complications. Revision Surgery The artificial joint is expected to suffer from mechanical wear. The joint will be loosened eventually and revision surgery will be required. Infection One of the biggest enemies of artificial joint replacement is infection. The infection rate increases if you have adverse comorbidity, for example, diabetes mellitus. Dislocation The chance of dislocation in a total knee replacement is infrequent. Nerve palsy Nerve may be injured during total knee replacement. Nerve injury can result in loss of sensation and function. Some numbness of skin around and at the outer side of the incision should be expected. Bleeding Some amount of blood loss during a total knee replacement is expected and transfusion may be required. Vascular injury There is a remote chance of major vessel injury during total knee replacement. Major vascular injury may result in the loss of a limb. Fracture Fracture can occur both within the operation and in the post-operative period. Problem in wound healing The problem encountered in wound healing may range from persistent wound discharge to wound edge necrosis and wound dehiscence, which may require further surgical reconstruction.

6 Version 1.0 Page 3 of 4 Thromboembolic disease Deep vein thrombosis after Total Knee Replacement is not uncommon. However, the chance of subsequent pulmonary embolism is low. Death can follow pulmonary embolism but the incidence is very low. Complications associated with extensor mechanism of knee The complications of extensor mechanism complication include symptomatic patellar instability leading to the need of re-operation, patellar fracture, rupture of patellar tendon and soft tissue impingement problem. Stiffness Stiffness occurs occasionally after surgery which may require any further treatments. Before the Procedure Treat and optimize existing disease conditions, e.g. ischemic heart disease, hypertension, diabetes mellitus, anemia, lung disease Fasting few hours before the procedure After the Procedure You will be allowed to eat and drink when your condition is stable. You need to start mobilization exercise of the ankle. This will help the circulation of blood inside your calf and decrease the chance of deep vein thrombosis. Physiotherapy will be started later to maintain the range of motion gained during the operation. These include achievement of full extension, maximal flexion and regaining the strength of quadriceps. After a few days, therapists will start to train you to walk. The stitches / staples will be removed after the wound heals. Possible Additional Procedures Transfusion Bleeding is inevitable in total knee replacement. Blood transfusion may be required. Additional Procedure for Fixation of Fracture The chance of intra-operative fracture is low. However, if fracture is encountered, your surgeon may need to stabilize the fracture by extending the wound and fixing the fracture with additional metal implants. Additional Vascular Procedure Despite the chance of major vessel injury in total knee replacement is remote, the consequence of such injury can be devastating and may lead to potential loss of the limb. If such injury occurs, vascular surgery will be needed.

7 Version 1.0 Page 4 of 4 Alternative Treatment Your surgeons will consider total joint replacement for you only if the symptoms cannot be controlled after exhausting other means of conservative treatments, including analgesics, physiotherapy and activities modification. On the other hand, total knee replacement is not a life saving surgery. One can always select to adopt conservative treatments, despite the presence of significant symptoms in terms of pain, stiffness and deformity. Follow Up You should keep your wound clean and dry You must follow instructions strictly on taking medication, see the doctor as scheduled If you have any excessive bleeding, collapse, severe pain, fever or signs of wound infection such as redness, swelling or large amounts of stinking discharge, see your doctor immediately or attend the nearby Accident and Emergency Department Remarks The information contained is very general, the list of complications is not exhaustive and other unforeseen complications may occasionally occur. In special patient groups, the actual risk may be different. For further information please contact your doctor.

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