The Most Painful Surgery Ever? — How Knee Replacements Work

The Most Painful Surgery Ever? — How Knee Replacements Work

In today’s video with the help of this Real human knee we’re going to see how Knee replacement surgeries are performed And what the patient can expect once It’s all said and done it’s going to be An interesting one let’s do this [Music] Now the proper name for a knee Replacement surgery is a knee Arthroplasty and there are two different Types of knee arthroplasties you can Have a partial or a total knee Arthroplasty and the names are probably Pretty self-explanatory but in a total Knee arthroplasty they’re going to Replace and resurface all of the Articular surfaces of the knee joint so That includes the femur the tibia which Is going to be this bone here you might Actually be able to see it a bit better If I go like this so the tibia as well As and it can reflect this back the Articular surface of the patella or your Kneecap now in a partial knee Arthroplasty they’re just going to be Doing less than a total so maybe they’re Resurfacing one or more of the condyles Of the femur now in order to be eligible For a knee arthroplasty it really comes Down to your age as well as how much Damage the knee has accumulated in terms Of age they tried to just do people who Are 60 or 65 or older and that’s because This is a really extensive surgery and

The recovery is no joke and the Prosthesis really only lasts for a Couple of decades meaning that if you do It at age 30 or 40 or 50 you’re going to Have to do it again and that is a whole Process in and of itself but again it Depends on the surgical team and your Specific circumstances they can Definitely do it when you’re younger in Terms of damage the damage typically Comes from arthritis and there are Different types of arthritis Um the first one I want to talk about is Called osteoarthritis and that is a Wearing down of the articular cartilage So if you look here at the femur and you Can see as I’m moving it around This whole surface would be covered in What’s known as hyaline cartilage which Is a very smooth and slippery type of Cartilage that allows for just you know Nice joint movement if that wears away You’ll get bone on bone contact and you Can create this so if you look here if You look you’ll see this red and I’ll Kind of move it around you can see the Shape is completely different That is arthritis that’s those are Called osteophytes they’re basically Bony outgrowths where the femur has Grown outwards to try and push the tibia That shin bone away it’s literally your Body is making things worse in an Attempt for you to stop moving right you

Can think of it as the bones just like Shoving the other bone away and saying Let’s not do any more movement and make This any worse but another type of Arthritis would be an inflammatory Arthritis so maybe you had gout which is Where you have like uric acid crystals Forming inside of the joint or maybe you Have rheumatoid arthritis which is where There’s an inflammation in autoimmune Disease type of inflammation on the Membranes that surround the joint or Maybe you had some kind of traumatic Knee injury and they just need to Resurface or help reconstruct the knee So all of those are going to be Indications for a knee arthroplasty real Quick I want to thank the sponsor of Today’s video yoga body Teachers College When this lab first opened we Exclusively taught in-person events to a Variety of different students so you had Medical assistants dental assistants EMTs parent Medics massage therapists And those going through yoga teaching Certification programs and I remember Being very surprised with how much yoga Teachers actually knew about the human Body which is one reason I’m even more Impressed with yogabadi Teachers College They specialize in science-based online Certification programs for yoga teachers Yoga breathing coaches yoga trapeze Teachers and stretching coaches if

You’re interested in starting a new Career or maybe even just a new side job Helping people improve their health Overcome injuries manage stress or just Live their best lives longer yoga bodies Courses might be right for you check This out since 2007 they have certified Over 23 000 teachers in 41 countries that is Ridiculously impressive they’re backed By yoga Alliance American Council on Exercise and American Council on Education making them one of the only Schools in the entire world eligible for College credits and they’ve put together A free report for you called how to Choose a yoga teacher training program You can access it immediately at Yogabody.com Iha or or you can just Click the link in the description below Alright let’s get back to it so before The procedure can even happen there Needs to be some pre-operative Medical Imaging and this is so that the surgical Team can properly plan for this surgery As well as determine the proper size for The prosthesis that will be inserted Into the knee so I want you to think About this Um every single one of our bones While they follow a plan right a femur Is shaped like a femur there’s still Going to be unique aspects to it that Are determined by posture weight and all

Sorts of individual circumstances so What they’re going to have to do is Measure things right they’ll they’d Measure the tibia they’d measure the Patella they’d measure the femur in Order to just have a properly fitting Prosthesis so they’ll do an MRI they Might do a CT scan it really just Depends now for the procedure itself You’re obviously going to get an IV You’re going to go underneath general Anesthesia so you’re not awake for any Of this but from there this is where They have the option to provide a Tourniquet so this is actually kind of Controversial and it depends on the Specific surgical team and institution And whether they elect to do it because Think about it when you apply a Tourniquet right you’re stopping blood Flow to this entire area so first off if You stop blood flow what’s nice about That is it makes for a cleaner area Because the blood is not obstructing The View However this means there’s going to be An increased chance of blood clots Also what they find is that the patients Tend to experience more pain post Surgery and that means they’re going to Have more medications and that just Comes with a whole slew of problems in And of itself But again with the tourniquet since

Things are cleaner what they’re going to Be able to do is build the surgery Quicker right if you can see things more Easily they’re going to do things Quicker so you have reduced surgical Times so I mean look it just it kind of Depends on the surgical team and what They want to do they’re now going to Make their incision and they’re going to Do what’s called an anterior midline Incision so they’re going to be making a Longitudinal incision that’s going to Travel from above the patella about 6 to 12 centimeters above the patella over The patella and then down towards this Spot here which is known as the tibial Tuberosity you can feel this it’s a Little bump on your shin bone what They’re going to do is they’re going to Actually going to make that cut when the Knee is in a flexed position and the Reason they do that is because when the Knee is flexed and you cut it all the Tissue can fall to either side if the Knee was in the extended or kind of Straight position and they made that Same cut all the tissue would be bunched Up and they’d have to pull it apart and It just wouldn’t be as efficient so They’ll Flex the knee like this Hopefully that’s coming across like this Then they’ll make that anterior midline Incision tissue falls to the side Revealing all of this here so what

You’re looking at is part of the Quadriceps tendon so the patella Is a bone that is actually suspended and Immersed in a whole bunch of tendons Because you have four quadricep muscles That are all going to be sending their Individual tendons to this one location Which will then go down to the tibial Tuberosity so they’ll be able to see the Patella and they’ll be able to see all Of this from here this is where they’re Going to perform What’s called the Medial para patellar incision or at Least the median parental approach and What that means is like think about this There’s a lot of tissue here you’re Going to have to cut through it or go Around it in some capacity what they’ll Do is they’ll make an incision that will Go around the patella and they’re Cutting into this aspect so what would Happen is there’s a muscle that would be Right here called the vastus medialis And this is its at its contribution to The quadriceps tendon so what they’ll do Is they’ll cut that going around that Patella but leaving enough tissue that They can reattach this when the surgery Is done and when they’ve done that they Will then be able to grab the patella And slide it laterally and as they slide It laterally they’re then going to flip It now I can’t actually flip it in the Way that they do instead I’m going to

Have to flip it like this But you can still see exactly what they Would see right this is what they’re Seeing but instead this whole aspect Would just be reflected like so and what That does is it exposes the articular Surface of the patella and then as they Pull it aside and hold it with Retractors it gives them operation space Now at this point they can start Removing tissue and so the things They’re going to remove go ahead and Reflect this open again are going to be Say the meniscus guy so if you look Right here I’ll try this in my probe There’s kind of like these cartilaginous Pads that are separating the femur from The tibia now these cartilaginous pads Are shock absorbent and they’re there to Cushion impact now Typically if you’re getting a knee Replacement these are probably damaged If not almost gone outright but they’re Still going to remove it because they’re Going to be replaced with a polyethylene Plastic They’re also going to remove the ACL so If you look inside of there you might be Able to see I’ll try with my probe right In there is the ACLS what I’m directly Palpating with the probe but these are The cruciate ligaments you have the ACL You have the PCL Stands for anterior and posterior

Cruciate ligaments and they’re Crisscrossing in the dead center of the Joint and their goal is to actually Prevent translation of the tibia in Relation to the femur so what I mean by That is so we have the tibia here we Have the femur here this isn’t obviously Going to work but you can kind of Picture if the ACL ruptured the tibia Would actually slide in front of the Femur that’s what the ACL is going to Prevent while the PCL will prevent Posterior translation going backwards so They’re going to remove the ACL they Might remove the PCL it kind of just Depends that also is controversial just Understand that whatever you remove You’re going to have to then you know Give back in terms of the prosthesis or Some kind of attachment to the Prosthesis so it just kind of depends on The surgical team and your specific Circumstances Now once they’ve done this they’ve Removed these tissue there’s also some Fat that they can remove in this area This is where they’re then going to Actually start resurfacing the tissue And if I haven’t made this clear I want To make it very clear right now it’s not As though they are like chopping off the End of the femur and then replacing the Entire thing with titanium what they’re Doing is they’re resurfacing they’re

Going to actually cut away the arthritic Or damaged components or portions of the Knee and then they’re going to replace Those with the metal alloy So in order to do this there’s two Different ways you can do this manually So the surgeon is doing this with their Eyesight and expertise alone well There’s going to be some assistance but Or robotic or technologically assisted So if they’re doing a manual one what They’re going to do is they’re actually Going to drill into about right here They’re going to drill into the Medullary cavity so as you can see here This is the femur there’s a hollow Center to the Bone and inside of there Is going to be yellow bone marrow what They’re going to do is they’re going to Drill into it in order to provide an Anchor point which they’re then going to Insert what’s called a guiding block and This block is going to make it so that When the surgeon starts to manually put In the saw blade that it’s going to be Guided to only cut the correct amount And in the correct direction see when They’re resurfacing The Joint they’re Only going to be cutting around 7 to 10 Millimeters of bone so I mean it’s Significant but it’s not nearly as Significant again as though you were Just taking entire chunks of bone but These guidance blocks are going to

Ensure that they’re come at the right Angle and they’re getting the right Amount every single time but it’s still Relying on the surgeon to hold the saw Blade and manually do all of this Now the other option is to do again Robotic assistance now if they do Robotic assistance they’re actually Going to insert into the tibia two Different guidance sensors and then in The femur another two guidance sensors So you can kind of picture there’s just Like these sensors coming off of the Bones that they have drilled into the Actual bones And what they’re doing is they are Relaying positional information for the Femur as well as the tibia because During the procedure they’re going to Actually be moving the knee through Range of motion to make sure that Especially once they get the prosthesis In place that you’re tracking right like You don’t want to rebuild the knee and Then it’s gowampus you know that’s my That’s my anatomical term and so what They’ll do is they use these sensors to Help guide them but also helps guide the Robotic cutting equipment So they will drill those and put those Guidance sensors in there and then what They’re going to do is start actually Digitally measuring so the surgeon will Actually able to using a point system

Actually analyze the topography the Surface of the bone itself and relay That to the computer to provide a Digital image of the surface of the bone And it’s going to use this in Conjunction with the CT scan that was Performed pre-operatively and what will Happen is now the computer has an Understanding of where the bone is and Whether or not it’s been cut so then the Surgeon will actually bring the blade Over and it’s on a robotic arm and so They’re not holding it but they are in Control of a trigger and actually Causing the saw blade to go and what They’ll do is they will then start Resurfacing and what they’ll do is they Will say for the femur they’re going to Make five different cuts completely Cutting off all of the articular surface You’re seeing here at least that’s what They would do in a total knee Arthroplasty so they’ll make five Different cuts completely removing these Are called condyles for the tibia They’re actually going to make one cut That’s going to just take off that Entire top aspect and the two condyles Of the tibia and then for the patella They will also remove this articular Surface again that’s also controversial It doesn’t happen in every single knee Arthroplasty but that is another option And so it’s all robotically assisted now

What’s super cool about this though is That there’s also going to be like Digital boundaries within the computer System that ensures that the surgeon Doesn’t go too far because look Um over here this right here is called The medial collateral ligament or the MCL then on this side you have the lco Or the lateral collateral ligament you Don’t want when you’re resurfing Resurfacing this to go too far and cut a Ligament that you didn’t want to cut so What will happen is there’s these Digital boundaries that will prevent Let’s say the surgeon accidentally goes Too far as soon as it goes too far and Goes beyond the boundary the saw blade Shuts off and they won’t cut anything That they don’t want to including blood Vessels and other nerves so really Really interesting uh ability right There so again it comes down to and this Is really just comes down to the Surgical team in the institution whether Or not they’re going to do this manually Or they are going to do it robotically Now interestingly In terms of recovery In medium and long-term recovery Outcomes there doesn’t seem to be a big Difference on whether the patient Received a manual arthroplasty or a Robotic assisted arthroplasty meaning You know 10 15 years down the road

People are the exact same no matter how It was performed the difference though Does show up in the short term they do See that recovery times and pain Possibly is going to be diminished when It’s done robotically but again this Also will depend on your surgical team So now that they’ve done all the Resurfacing they can finally start Attaching the prostheses so the Prostheses are typically going to be Made out of a titanium alloy and what They’re going to do is whether it was Robotic or manual they will drill into The medullarian cavity and that will Allow an Inca point to kind of like Place it in so if I kind of turn this to The side you know they could slide it in Like so and it’ll plug into the drilled Hole but they’re not just going to like Slide it in and leave it instead what They’re going to use is a quick drying Bone cement that will attach the Prosthesis to the actual bone tissue Itself and this is one of the benefits Of using a tourniquet is that with the Lack of blood this whole area is more Dry and it does seem as though the bone Cement will attach better and so you’re Less likely to to have complications Down the line it’s again kind of toss Tossing that back and forth but they Will attach the prosthesis to both sides And possibly to the patella the surface

Of the patella if they did decide to Resurface it and then between remember If you recall me just saying a moment Ago there’s not going to be any meniscus So instead they will insert a piece of Plastic of polyethylene that will act as The new meniscus guy and cushion between The new titanium surfaces of the femur And the tibia and so once they’ve done This you know they have everything done They’re now going to make sure that Everything’s tracking properly so They’ll start bringing the knee into Different ranges of motion and they’re Going to actually be analyzing The varus and the valgus aspects of the Knee so basically is it bow legged or is It more knock knee they’re going to try To get that range motion and tracking as Even as possible and if it’s robotic Assisted they can actually move as They’re moving the knee back and forth They can see the exact degrees of range Of motion that is occurring in real time And they’re going to get that knee to Where they want it when that’s all done It’s time to stitch everything back up So they’re going to start putting Everything back into place so if you Recall again this was actually shifted More laterally like the patella was Ladder so they can reflect that back They can actually Stitch this area back Here they’re also going to be doing pain

Injections all around the joint because This to probably no one’s surprise this Is extremely painful recovery because You mean the amount of trauma that You’ve done to the area but they’ll They’ll do the pain injections they will Then put the skin back and the Integument and they will do multiple Levels of suturine to kind of get Everything back together and then Essentially the surgery is over now the Recovery process is extended again to Absolutely no surprise but in fact it Starts essentially immediately so as Soon as the patient is back in their Hospital room and they have their Anesthesia has worn off this is where They’re going to have to start rehabbing This immediately so they’re going to Have to go through you know they’re Gonna have to walk up be able to go up And down stairs they’re going to have to Demonstrate the ability to walk and then Once they eventually do get home after a Few days maybe a week in the hospital They are then going to have to be part Of a multi-week long Physical Therapy Regimen I mean it could take as long as Six weeks to make sure that they are Tracking properly because here’s the Problem If you don’t do the proper Rehabilitation with the knee right you Don’t go through the right movement the

Amount of trauma that has just happened To this area is obscene to the point Where there’s going to be significant Scar Tissue formation and if you don’t Move that scar tissue is going to lock Down and when it locks down and then you Try to move it’s going to be too Restrictive so you have to move despite Not wanting to throughout the Rehabilitative process to ensure as I Mean not minimal scar formation but Proper scar formation that it’s Happening in the right places to allow Proper range of motion because the last Thing you want is to get a knee Replacement not go through the proper Rehabilitation and then all of a sudden Now you’re just locked into this Position and there’s nowhere to go from There so you’ve got to make sure to go Through with your physical therapy now When it comes to complications I mean There’s a lot of factors that go into it I mean we’ve talked about a tourniquet And whether or not you use it in Potential complications from either side I mean there’s conflict potential Complications on whether it was a manual Arthroplasty or robotic right if it was A manual and say the surgeon went too Far that creates some significant Complications but the most common Complications whether it’s robotic Assist it doesn’t matter is just

Improper placement or maybe the Prosthesis is coming loose over time and If that happens that’s going to create Tracking issues that’s going to create Lots of pain and you have just a brand New problem the other thing is a lot of This is one of those very unpredictable Procedures in terms of like if you talk To anybody who’s got this or say like You talk to two people who’s gotten a Knee replacement they can give you Wildly different accounts right one can Say this is the best thing they’ve ever Done they should have done it sooner They feel brand new they can play with Their grandkids everything’s great and Then the other person is like I’m in Worse pain I’m worse off than I was and Then you’re gonna have everywhere in Between and there’s no real way to know Exactly how this is going to go I mean These procedures are meticulous the Surgeons are fantastic in what they do But this this is a and I say this term Appropriately immediately this is a Violent procedure what they’re doing They’re using mallets they’re drilling Into bone orthopedic surgery for those Of you who’ve never observed it is it a Very intense type of surgery and it Comes with a lot of risks and the body Is not meant to you know be shaved off The bones and have resurfaced and put With titanium and plastic and all these

Types of things and so there are Significant complications which again Goes back for potential complications Which again goes back to why they prefer You to be older in age Because if this say it doesn’t work out I’m not saying we want to be immobile When you’re 75 but it’s better in a way To be immobile and in pain in 75 than at 35. Um so again it’s one of those toss-ups So you just want to be very careful with Your when you’re do you want to have if You’re actually thinking of having a Knee arthroplasty this is these are all Conversations you want to have with your Surgical team you want to make sure you Have a really high quality surgical team You’re discussing all of this with them So you’re aware of all the potential Risks and outcomes and everything that Comes in between but it is possible that I mean I’ve seen people say this is the Best thing they’ve ever done they feel Brand new everything’s fine they’re in The garden they’re on their knees and Everything’s great so you know you just Want to make sure that you do your due Diligence when it comes to this Procedure thanks for watching everybody I really hope you enjoyed today’s video Personally I’m having a blast doing These what to expect I mean they’re not Really instructional but kind of like

Step-by-step understandings of surgical Procedures and trust me I still left out Plenty but if you knew every single Detail you’d essentially be training to Be a surgeon but I really hope you’re Enjoying these videos be sure to let us Know in the comments if you enjoy these Or any other types of videos Jonathan And I are always interested in seeing What you have to say but be sure to Click the link in the description below Go to yogabody Teachers College and see And get your free report on how to Choose a yoga teacher training program As always be sure to like comment Subscribe if you haven’t I don’t know Why you haven’t subscribed to us if You’ve made it this far you should be Subscribed by now but uh thanks again And I’ll see you in the next video Foreign [Music]

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