KNEE SURGERY

The Duval Clinic has been specializing in knee joint replacement for the last 20 years. Below you will find many answers to your questions and how we can give you back your quality of life. Our surgeons are happy to elaborate in detail with you during your consultation.

WHAT IS KNEE JOINT DEGENERATION?

When the protective joint surface layers (cartilage) are damaged, they are rough and do not slide well together. The result is pain, stiffness, and inflammation. This is called joint degeneration or osteoarthritis. It can be secondary to a fracture, a bone defect, aging, normal wear and tear and rheumatoid arthritis.

WHO SHOULD HAVE THE SURGERY?

Knee joint degeneration can take several months or years to significantly limit your activities and quality of life. When the condition has not improved satisfactorily with non-surgical treatments and:

  • You are having difficulty or can no longer work;
  • Your quality of life is diminished;
  • You have frequent pain;

A knee joint replacement is a solution to consider.

KNEE JOINT REPLACEMENT SURGERY

Knee joint replacement aims to improve your quality of life, relieve your pain, and allow you to return to an active life.  At the Duval Clinic, our surgeons are experts in knee replacement surgery and are performing personalized joint replacement surgery. In combination with our unique enhanced recovery protocol, our surgeons are using the latest technologies like computer navigation or robotic assistance and the most performant implants available.

Two types of surgery are possible:

Unicompartmental knee replacement consists of replacing only the worn cartilage surfaces of a single portion of the knee, either internal or external.

Total knee replacement involves replacing the internal and external articular surfaces of the knee. In addition, the surface of the kneecap is replaced depending on its degree of wear.

The super-specialist surgeons at Duval Clinic are experts at each of the six main methods used to replace the knee joint. These methods are; total knee replacement, cemented, uncemented, with computer navigation, with robotic assistance, and unicompartmental knee replacement. Your surgeon will make an assessment of the method that is most appropriate for your specific condition.

You will certainly have many questions on the subject, please consult the following tabs where we offer you brief answers.

AM I TOO YOUNG FOR A KNEE REPLACEMENT?

There is no minimum age to benefit from a knee joint replacement. Your degree of pain and disability is the best indicator. In general, knee replacements are performed on people 65 years of age or older for whom conservative treatments are no longer effective. However, if you are younger and severely affected by wear and tear on your knee, improvements in prosthesis materials and surgical techniques allow most patients to have a good quality of life and to possibly keep their prosthesis for the rest of their lives (see this article on the subject in the prestigious Lancet journal). For younger patients, our surgeons favor a biological implant fixation (without cement). With such prosthesis, your bone will grow on the metallic implant surface, providing a durable living interface. We will be happy to evaluate your condition and advise you on the best treatment options for you.

CAN I HAVE A TOTAL KNEE REPLACEMENT IF I AM OBESE?

There is no maximum weight, but all the general complications associated with knee replacement surgery are increased: wound healing problems, infection, re-operation, etc. Therefore, it is best to lose weight before surgery. However, the surgeons at the Clinic regularly perform joint replacements on overweight patients. With their experience, expertise, minimally invasive instruments, and special implants, we can optimize obese patient’s care. We use prostheses with cementless fixation, which have been shown to be more durable in obese patients (see our results with cementless prostheses).

WHAT IS THE MAXIMUM AGE FOR A KNEE REPLACEMENT?

There is no age limit for knee replacement surgery. However, your overall health must be good enough for the surgery to proceed without major medical problems. Before surgery, a detailed medical evaluation is performed by our qualified medical team at Duval clinic. Patients over the age of 80 can have surgery at the clinic. Importantly, the Duval clinic is the only private orthopaedic clinic in Canada to offer hospitalization for more that 24 hours after surgery, providing a save environment for recovery. No need to be transferred to the hotel after surgery! Moreover, with our post-operative ERAS protocol, recovery after surgery is made much easier. 

IS IT TRUE THAT A SURGICAL ROBOT CAN BE USED FOR MY KNEE SURGERY?

Yes, robotic assisted knee replacement surgery is now available in Canada. We are proud to announce that on Monday, February 1, 2021, we successfully performed our first two total knee replacements with a surgical robot. The addition of the ROSA robot to our palette of technological tools is another key to ensuring that each of our patients receives impeccable care. The ROSA Knee System is a tool that accompanies the surgeon during a knee replacement operation and allows him to perform the surgery with superior precision. Click this link to see it in action.  Dr. Massé, a specialist practicing at the Duval Clinic, has extensive expertise in robotics. He reminds his patients that “the robotic tool is not there to replace the surgeon, who remains in control of the operation, but rather to transmit information that will allow him to make better decisions and perform gestures with greater precision.» While robotic instruments are an important development in technology and medicine, Dr. Massé says, “the experience and dexterity of the clinic’s surgeons remain the most important elements in a procedure.»
Clinique Duval has always made sure to offer the latest technological tools to ensure an optimal level of care and precision. “The various studies on this subject currently point to a simpler and faster recovery with less postoperative pain,” says Dr. Massé. “Satisfaction levels appear to be higher in patients who have undergone surgery with a robotic device.»

Please listen to Dr. Massé explaining the personalized knee replacement principles and demonstrating the ROSA robot precision here.

Dr. Kiss, in action, using the ROSA robot during a total knee replacement performed at Duval clinic.

WHAT IS PERSONALIZED SURGERY?

Knee arthroplasty is a highly effective procedure, even though it is affected by significant rates of residual symptoms. Unsatisfactory clinical outcomes may be due to the neglect of each individual’s unique joint anatomy and kinematics. The precision and accuracy of implantation has improved dramatically with the use of technological tools (e.g., computer-assisted or robotic surgery). This has allowed the development of a more personalized philosophy of reconstruction of the knee joint.

The Clinic’s surgeons are international leaders in the application of the personalized anatomical/kinematic alignment technique. This technique aims to reproduce the patient’s native anatomy and physiological joint laxity, thus improving knee prosthesis kinematics and functional results (see this article for more information). One of our surgeons, Dr. Pascal-André Vendittoli, is the president and founder of the Personalized Arthroplasty Society.

 

WHAT ARE THE EXPECTED RESULTS AFTER A KNEE REPLACEMENT?

Knee joint replacement is an effective surgery with a high rate of satisfaction. Most operated patients see their pain greatly reduced and can resume many activities they had to give up since the onset of their disease. Patients must be aware that the full benefit of surgery will often not be achieved until 6 to 12 months after the operation, although after 2 to 3 months, their activity level can already be greatly increased.

 It is important to know that the operated knee rarely feels like a natural knee. The surfaces of the prosthesis are in contact with one another may therefore produce noise. The range of motion of your knee will be reduced compared to a healthy knee.

There are some permanent restrictions following knee joint replacement such as difficulty squatting and kneeling. In addition, it is preferable to avoid heavy work requiring lifting loads of more than 25 kg or climbing ladders and scaffolding. Sports with sudden jumps or stops are not recommended after surgery.

WHAT WILL HAPPEN AFTER SURGERY

Thanks to our enhanced recovery protocol, post-operative pain should be well controlled and acceptable. Back in your private room, you can eat a full meal and drink whenever you feel like. You will get up for the first time 3-4 hours after the surgery with the assistance of the nurse and physiotherapist. The physiotherapist will help to improve the range of motion of your knee, start muscle strengthening exercises, and start walking.

Once the surgery is over, your prosthesis is firmly anchored to your body. Until you are stable and safe to walk, the use of a walker or cane is recommended (usually 1-4 weeks). Follow the recommendations given by your physiotherapist.

From day one, you will need to follow the exercise program that you will learn before your surgery. You will then do these exercises at home to walk properly and resume your household and sports activities.

We use skin glue to close the incision. This will help reduce discharge from the wound after surgery. You can take a shower starting from the first day since the dressing is well adhered to your skin.

Your stay at the Clinic will last 1 to 2 days. When you leave, an appointment will be made for you to see your surgeon approximately 4 to 8 weeks after the surgery. You will be given the required prescriptions for your medications, necessary equipment, as well as a requisition for x-rays.

HOW LONG WILL I STAY IN THE CLINIC AFTER MY SURGERY?

The Duval Clinic is the only private clinic in Canada to offer individual convalescence rooms should your condition require a short stay. The length of stay varies from one patient to another between 1 and 2 days. However, the advancement of operative techniques, optimization of postoperative pain control, better organization of home care, as well as effective multidisciplinary collaboration have made it possible to offer you the possibility to spend less than 24 hours in the clinic after your surgery and have an organized and safe discharge. Your surgeon and attending team will inform you if you are eligible for this accelerated recovery protocol (day surgery).

CAN I PLAY SPORTS WITH A KNEE PROSTHESIS?
  • 1-2 weeks after your surgery you can start using a stationary bike.
  • 3 to 4 weeks after surgery, you can return to the pool for some water walking or gentle swimming. It is important that the wound is well sealed;
  • During the first 3 months, you should avoid regular and intense sports;
  • From 3 to 5 months after your surgery (depending on your condition), you can do social dancing, skating, skiing, hiking, bowling, golfing.
  • It is generally not recommended to practice activities with repeated impacts and pivots such as: jumping, jogging, volleyball, soccer, basketball, mogul skiing, aerobic dance, contact field hockey, yoga, karate, etc. Talk to your surgeon at the Clinic for recommendations specific to your condition.

    Dr. Frank Gunston

    Canadian orthopedic surgeon Frank Gunston, born in Flin Flon, Manitoba, was the man who created the first total knee replacement in the early 1970s. He passed away on February 15, 2016.

    Did you know?

    A Montreal orthopaedic surgeon, Dr. J. Edouard Samson is a founding member of the Canadian Orthopaedic Society. In his honour, the university training program at the Université de Montréal is named after him. The Canadian Orthopaedic Foundation annually awards the J. Édouard Samson Prize to an orthopaedic surgeon for the quality of his/her research program. In 2016, Dr. Pascal-André Vendittoli, a surgeon at the Duval Clinic, won this award for his work on optimizing the care of patients requiring joint replacement (see this document).

    Contact the clinic
    By Telephone: 514-500-7432
    By Fax: 450-663-0776

    Opening hours

    • Monday to Friday from 9:00 a.m. to 4:00 p.m.
    • The hospitalization unit is open 24 hours a day.

    Address:  1487 des Laurentides Blvd, Laval (Quebec) H7M 2Y3