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Years ago, I fell and broke my kneecap and the upper part of the tibia. They didn't take the kneecap out. Instead, they wired it back together. I still have the wire and two screws (holding my tibia together) in place. Over the years, arthritis has set in that joint. I'm thinking it's time to see a doc for a joint replacement. Will I have much trouble with that?

There isn't a quick and easy answer to your question. There are lots of things to consider here. Your age first. Younger, active patients will need to hold onto their joint for as long as possible. That could mean a different kind of salvage procedure. Two choices come to mind immediately: an osteotomy or an arthrodesis. Osteotomy refers to the removal of a wedge-shaped piece of bone from one side of the knee. The remaining bone is moved to fill in the area where the wedge was removed. This procedure helps realign the bones and joint and redistribute weight and load. Arthrodesis is a fusion of the joint. Older patients who are less active may go ahead with the joint replacement. With any of these choices, the surgeon has a lot to consider. Past injuries, leftover hardware, scars from the incisions, fibrosis from scar tissue, and bone loss are just a few potential problems that must be addressed before the next surgical procedure. Before any decisions can be made, an orthopedic evaluation is in order. Location and quality of pain are noted. Range of motion is measured. The patient's gait (walking pattern) is examined and analyzed. Tests for knee instability are performed. X-rays are taken to look for limb malalignment, fractures, and status of the hardware. And finally, lab tests are ordered if there is any suspicion of joint infection. The surgeon takes into consideration the patient's age, expectations, and goals, along with current activity level and desired activity level. The condition of the knee joint is also a deciding factor in what surgical option is best. Once you've had this done, then the surgeon can outline what your options are and the any pros and cons for each one. The long-term outlook for total knee replacement for traumatic arthritis is fair-to-good. Patients experience a reduction in pain, increased motion, and improved function. The results aren't always perfect. The postoperative range-of-motion depends on how much motion was there before surgery. Sometimes the patella (knee cap) doesn't move up and down like it should. This motion is called patellar tracking and is important for normal knee function. If scar tissue or muscle contracture is preventing normal patellar tracking, then additional surgery may be needed to correct the problem. In some cases, the old patella is removed and a new one installed as part of the joint replacement. Tendon rupture, failure of the wound to heal, and even implant failure are common problems that may be encountered. Patients should be counseled ahead of time what can happen and what to expect. The surgeon can expect and should watch for a high rate of complications after total knee replacement for these posttraumatic arthritis patients.

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