Knee replacement surgery is a procedure that has been performed in orthopaedics for many years and has a high success rate. However, like any major surgery, it carries certain risks. These risks are primarily related to the patient's age, any existing chronic conditions, their overall health, and the quality of postoperative care. The operation itself is not considered high-risk; it is mainly the preparation of the patient and the management of the postoperative process that determine the level of safety.
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The concept of risk is often misunderstood and equated with serious danger. In reality, the majority of risks associated with knee replacement are preventable or can be managed when detected early. The most common complications include infection, blood clot formation, bleeding, delayed wound healing, and, more rarely, mechanical problems related to the prosthesis. When the procedure is carried out by an experienced team and the patient follows the medical recommendations, the likelihood of these complications decreases considerably.
Among older patients, the question of risk arises particularly often. Age alone does not constitute a risk factor. The patient's biological condition, functional capacity, and the proper functioning of their organs are far more decisive factors. In older individuals who are in good general health and whose chronic conditions are well controlled, knee replacement surgery can be performed safely. Risk assessment must therefore always be individualised and cannot be subject to generalisations.
Who Is at Greater Risk of Infection?
The risk of infection following knee replacement surgery is higher in certain patient groups. Individuals with diabetes, particularly when blood sugar levels are poorly controlled, face an increased risk. Elevated blood sugar weakens the immune system and slows wound healing, which facilitates bacterial growth at the surgical site.
Obesity is also a major risk factor. Excess weight can prolong the duration of the procedure, increase tension on the tissues, and complicate wound healing. Furthermore, as blood supply to fatty tissue is less efficient, the body's defence mechanisms are less effective against infection. For this reason, nutritional support and weight management before the operation are strongly recommended.
Patients with a weakened immune system are also at greater risk of infection. This includes individuals with rheumatic diseases who are on immunosuppressive treatment, those receiving long-term corticosteroid therapy, or patients with chronic kidney or lung disease. Smoking, existing skin infections, dental abscesses, or urinary tract infections can also increase the risk of infection. It is therefore essential to identify and treat all potential sources of infection before the procedure.
How Can the Risk of Thrombosis Be Reduced During Replacement Surgery?
The risk of blood clot formation after knee replacement surgery is a significant concern, particularly during the first few weeks following the operation. This risk is primarily linked to the slowing of blood circulation in the lower limbs after surgery. Early mobilisation of the patient is one of the most effective measures for reducing this risk. Getting up promptly and moving the leg in a controlled manner promotes venous circulation and limits blood pooling.
Medication also plays a key role in thrombosis prevention. After the operation, anticoagulants are prescribed for a duration tailored to the patient's risk profile. The choice of medication, dosage, and length of treatment are personalised. In patients with a history of thrombosis, prolonged immobility, or severe vascular disease, these preventive measures are applied more strictly and for a longer period.
Mechanical measures complement this approach. The use of compression stockings, compression devices, and regular ankle mobilisation exercises all help to improve venous return. Adequate hydration, avoiding prolonged static positions, and following medical advice in daily life are equally important. Early recognition of warning signs such as sudden leg swelling, pain, or shortness of breath allows for prompt intervention in the event of a complication.
How Are Risks Assessed Before the Operation?
Risk assessment before knee replacement surgery is a crucial step in ensuring the safety of the procedure. This assessment is based on a detailed review of the patient's medical history. Heart, lung, and kidney conditions, hypertension, diabetes, current medications, and previous surgical procedures are all carefully examined. The aim is to identify in advance any factors that could lead to complications and to take the necessary precautions.
In addition to the patient's general health, the structural characteristics of the knee joint are also taken into account. The degree of joint wear, bone quality, the condition of the ligaments, and the alignment of the lower limb are analysed in detail. This evaluation helps to select the most suitable type of prosthesis and to determine the optimal surgical technique. Precise planning reduces the duration of the procedure and limits the risk of complications.
Preoperative preparation is an active phase of risk reduction. Controlling blood sugar and blood pressure levels, stopping smoking, improving nutritional status, and treating any existing sources of infection are all integral parts of this preparation. The patient is also prepared both psychologically and physically for the postoperative period. Explaining the rehabilitation programme and clarifying expectations promotes better adherence to the treatment plan and contributes to an overall reduction in risk.