The Anterior Reference Total Knee Replacement was developed for you to succeed after having dealt with a condition like knee osteoarthritis and be able to move comfortably and without pain throughout your day. Knee replacement surgery removes the entire knee joint to be replaced with an artificial joint made of metal and plastics held in place by cement. 

It is integral that during this surgery and the cement bonding process, the area is clear of blood. In the past, doctors cut blood flow to the surgical field utilizing tourniquets. This standard practice is now getting replaced with a new, cutting edge technology to clear the area of blood without the need for a tourniquet.
What You Need to Know About Tourniquet-Less Knee Replacements:
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• What is a Tourniquet
• Signs and Symptoms You Need a Knee Replacement?
• Benefits of a Tourniquet-less Knee Replacement Surgery
• History of the Tourniquet-less Knee Replacement Surgery
• Tourniquet-less Knee Replacement Surgical Process
• How Long Does a Tourniquet-Less Knee Replacement Last?
• How Long Does It Take To Recover From A Tourniquet-Less Knee Replacement?
• Knee Replacement Exercises

What is a Tournique

A tourniquet is a device created to restrict blood flow to an arm or leg by applying circumferential pressure around the extremity.  Developed with necessary things for military injuries to stop bleeding, tourniquets have advanced significantly from sheets and pant legs tied around legs to complex air pumps that can apply over 350mmHg of pressure.  
Where they function in extreme blood loss situations, they are no longer a necessity for knee replacement.  While most of the country uses a tourniquet for knee replacement, our doctors have focused on reducing tourniquet related pain and problems for all of our patients.

This picture shows a patient with a tourniquet on their leg. By applying circumferential pressure, blood flow can be stopped to the leg.

Signs and Symptoms You Need a Knee Replacement?

When you are suffering from chronic knee pain, your daily activities' consequences can be devastating and life-altering. There are a variety of non-surgical treatment options that may be effective in helping you overcome your knee pain, including over-the-counter pain medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, creams and ointments, injected medications like corticosteroids, physical therapy, exercise, weight loss, and nutritional supplements. 
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If you have tried all of these methods (As per your doctor’s recommendations) and you still have not found any relief for your knee pain, it may be time to consider a more invasive option like knee replacement surgery. The following are signs that knee replacement surgery may be an effective treatment for you:

• Severe pain in your knee which limits your everyday activities
• Moderate or severe pain while resting
• Inflammation and swelling that is long-lasting and is not relieved by rest or medications
• Bowing of the leg, either inward or outward
• NSAIDs are ineffective or cannot be taken

These symptoms may prompt your doctor to recommend knee replacement surgery as the best way to relieve your pain.

Benefits of a Tourniquet-less Knee Replacement Surgery

There are many benefits to a Tourniquet-less knee replacement, including:

• Significantly less pain by not compressing and crushing thigh muscles during surgery
  
• No difference in rates of loosening
  
• Less blood loss- surgeon can see all bleeding vessels during surgery rather than assume there is no bleeding
  
• Faster muscle recovery
  
• Less time in the Operating Room- never have to spend 2-3 minutes applying and setting tourniquet
  
• Possible decrease in risk of blood clots (limited data to support this)
  

History of the Tourniquet-less Knee Replacement Surgery

Twenty years ago, the idea of doing a knee replacement as an outpatient was seen as "crazy."  Today, patients are going home the same day as their knee and hip replacements. 
Dr. Maurice Jové, a pioneer in joint replacement surgery, has never used a tourniquet during knee replacement for the last 25 years.  

He may have been one of the only surgeons in the country performing knee replacements without a tourniquet between 1990 and 2010.  Now, as we progress as surgeons and our group puts ourselves at the forefront of outpatient joint replacement, we want to make sure we bring you not only our group's own experience but the data from around the United States that supports what our most senior partner has been doing over the last 25 years!

Tourniquet-less Knee Replacement Surgical Process

Total knee replacement surgery is a complex and precise procedure that requires the experience and expertise of an exceptional surgeon. If you are considering utilizing the surgical process to help you find relief for your knee pain, here is a necessary step-by-step explanation of the procedure so that you understand exactly what will happen when you undergo surgery:
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• The incision is made in front of the knee for access to the knee joint.
• A knee instrumentation device is placed on the end of the femur to cut pieces of bone from the distal femur to be replaced by an artificial knee.
• The top of the tibia is cut with another knee instrumentation device to ensure alignment.
• Undersurface of patella removed if severely damaged.
• Metal prosthesis is cut to match the taper and cemented to the end of the femur
• The metal tray that holds the polyethylene spacer is cemented onto the top of the tibia, and the spacer is then attached to the tray.
• A patella button may be cemented into place behind the patella, if necessary.
• Incision is closed.

This whole process can take 1-2 hours, depending on the severity of the knee’s condition.

How Long Does a Tourniquet-Less Knee Replacement Last?

In research published by The Lancet, approximately 82% of total knee replacements lasted 25 years. The individual results for tourniquet-less knee replacements may vary based on wear and tear from daily activities. A more active lifestyle may also reduce the lifespan of the replacement knee, so your doctor should be consulted to discuss prolonging the longevity of your replacement.

How Long Does It Take To Recover From A Tourniquet-Less Knee Replacement?

In general, most people can get up and walk approximately 24 hours following the surgery with the assistance of a walker or crutches. After the surgery but on the same day, a physical therapist will help you bend and straighten your knee, get out of bed, and learn to walk with the replacement knee. 
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2-3 days post-operation, most people are discharged from the hospital, but physical therapy will still need to continue regularly for several weeks. There are specific exercises that need to be completed to improve your functionality and more quickly return you to your usual way of life.

Knee Replacement Exercises

Once you have had total knee replacement surgery, you must follow your doctor’s recommendations and the exercises given to you by your physical therapist so that you can get accustomed to using the new metal knee and return to daily activities. During your early recovery, physical therapists will often recommend that you exercise 20-30 minutes, 2-3 per day, and then walk 30 minutes, 2-3 times per day. 

Other postoperative exercises include:

• Quadriceps sets 
• Straight leg raises
• Ankle pumps
• Knee straightening exercises
• Bed-supported knee bends
• Sitting supported knee bends
• Sitting unsupported, knee bends

Early activities following your surgery include walking as well as stair climbing and descending. These are very important to develop strength and flexibility with your new knee. Full recovery will take many months, but you will soon be able to regain movement independence and increase your activity. More advanced exercises include standing knee bends, assisted knee bends, resistance exercises, and cycling on a stationary bike. All training and activity should be working to gain more strength and mobility. If you experience persistent pain or swelling during or after exercising, you must contact your doctor as soon as possible.

Contact Our Experienced Knee Replacement Surgeons

If you are suffering from chronic and persistent knee pain and non-invasive treatment methods have failed to provide you any relief, you may be a candidate for total knee replacement surgery. At Atlanta Bone and Joint Specialists, we have been serving patients in the Atlanta Metropolitan Area for nearly 50 years. We have the experience needed to perform exceptional tourniquet-less total knee replacement surgery. 

We also offer other knee replacement procedures, including anterior reference knee replacements, and partial knee replacements. 

Our practice is patient-driven, and your satisfaction is the only thing that matters to us. We will discuss treatment options for your knee pain, take x-rays, and make a recommendation based on the scans, but we will never force you into a surgery you are not ready for. You will tell us when you are prepared for the surgery. We are dedicated to helping you regain your independence in daily activities through knee replacement surgery. Contact us today to make an appointment to discuss your condition and find out if you are a candidate for tourniquet-less total knee replacement surgery. 

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