During total knee surgery, Dr. Berger creates a small, 3- to 4-inch incision directly over the knee to reveal the end of the thigh bone, the top of the shin bone and the back of the knee cap: the arthritic knee. This is the space where cartilage has been lost, causing the bone-on-bone contact that causes the extreme arthritic pain patients experience. Dr. Berger begins by removing the arthritic bone on the bottom of the thigh bone, using special guides to help shape the bone so the prosthesis fits securely. He then removes bone from the top of the shin bone and the back of the knee cap. Dr. Berger then carefully removes any bone spurs or scar tissue that may have formed around the knee joint as a result of arthritis.
Once the arthritic bone has been removed, Dr. Berger sizes the patient’s bone to find the perfect-size prosthesis. Using sizer pieces that range in increments of millimeters he is able to create a perfect fit. When Dr. Berger is confident he has the optimal individual size, he secures the first part of the prosthesis to the end of the thigh bone using cement. The second part of the prosthesis is cemented to the top of the shin bone. He then snaps a polyethylene liner to the top of the shin bone component. This liner acts as cartilage and facilitates smooth and fluid movement.
The final piece of the prosthesis is a polyethylene liner that is cemented to the back of the knee cap. Once all prosthesis pieces are in place, Dr. Berger tests the patient’s range of motion by manually straightening and bending the patient’s knee. He finishes the surgery by washing the inside of the knee with an antibiotic wash to prevent infection and sews up the incision. On average, the whole process takes just over an hour. After surgery, the patient is sent to a recovery room and then to a hospital room. A few hours after surgery, the patient is examined by one of Dr. Berger’s nurses. The patient will walk down the hospital hallway and climb and descend one flight of stairs. Once the patient has been thoroughly examined and all questions have been answered, the patient is discharged from the hospital the same day of surgery.