Total Knee Replacement:
The knee comprises the joint between the femur and the tibia but also the joint between the patella and the front of the femur. Either or all of these parts of the knee may be affected by arthritis to various degrees. The procedure of joint replacement includes removing the affected joint surfaces and replacing them with metal components with a high-density polyethylene-bearing surface between the metal components
What is Total Knee Replacement?
A total knee replacement involves replacing the damaged bone and cartilage of the knee joint, which provides articulating surfaces.
The total procedure takes approximately an hour to hour and a half to perform and recovery time varies between patients which ranges from 2-3 weeks to 2-3 months. Correct rehabilitation following surgery significantly improves outcomes.
In the total knee replacement procedure, each prosthesis is made up of four parts. The tibial component has two elements and replaces the top of the shin bone (tibia). This prosthesis is made up of a metal tray attached directly to the bone and a plastic spacer that provides the bearing surface. The femoral component replaces the bottom of the thigh bone (femur). This component also replaces the groove where the patella (kneecap) sits. The patellar component replaces the surface of the kneecap, which rubs against the femur. The kneecap protects the joint, and the resurfaced patellar button slides smoothly on the front of the joint. This may or may not be replaced depending on the condition of the patient.
Advantages of Total Knee Replacement
The most important advantage is that this operation produces very effective and long lasting relief from joint pain. It also gives a joint which functions normally. The recovery period from the operation is very short and the patient is able to walk from the second or the third day after the operation. Walking support that is needed can often be discarded by around 2-3 weeks or a month's time. The patient regains a normal lifestyle and mobility with significant improvement in quality of life.
Frequently Asked Questions about Knee Replacement Surgery
Who is the candidate for a total Knee replacement? What are the risks of Total Knee Replacement? Should I have a total knee replacement? Who develops a more severe or an earlier arthritis? When can I return home? What measures should be taken after the surgery/operation (post operative instruction)? What activities should I avoid after knee replacement?
Q 1 who is a candidate for a total replacement?
Total knee replacements are usually performed on people suffering from severe arthritic conditions. Most patients who have artificial knees are over age 55, but the procedure can be performed in younger people if joint is already damaged. So criteria for surgery based on age is non dependent. The circumstances vary somewhat, but generally you would be considered for a total knee replacement if:
- You have daily pain which affects your ADL (Activities of Daily Living).
- Your pain is severe enough to restrict not only work and recreation but also the ordinary activities of daily living.
- You have significant stiffness of your knee.
- You have significant instability (constant giving way) of your knee.
- You have significant deformity (knock-knees or bowlegs).
Q 2 what are the risks of total knee replacement?
Total knee replacement is a major operation. The most common complications are not directly related to the knee and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in a leg, or blood clots in a lung. Complications affecting the knee are less common, but in these cases the operation may not be as successful. These complications include:
- some residual knee pain
- loosening of the prosthesis
- infection in the knee joint
A few complications such as infection, loosening of prosthesis, and stiffness may require reoperation. Infected artificial knees sometimes have to be removed. This would leave a stiff leg about one to three inches shorter than normal. However, your leg would usually be reasonably comfortable, and you would be able to walk with the aid of a cane or crutches, and a shoe lift. After a course of antibiotics the surgery can often be repeated to give a normal knee.
Q 3 Should I have a total knee replacement?
Total knee replacement is an elective operation. The decision to have the operation is not made by the doctor, it is made by you the (Patient). All your questions should be answered before you decide to have the operation. If you have any questions, please feel free to write to us.
Q 4 who develops a more severe or an earlier arthritis?
One who has family history (this having a strong hereditary influence), who has history of injury in the joint (e.g. a fracture or a ligament/meniscal injury in the knee), who has deformity of knees and the one who is overweight. Medicines are not the treatment for this form of arthritis. Weight reduction, regular exercises, and local heat therapy help in early stages. Physiotherapy is the mainstay of the treatment. Painkillers should be used only occasionally as they adversely affect our kidneys, cause intestinal ulcers and bleeding. Another form of Arthritis is inflammatory arthritis (Rheumatoid or its variants). This does need medical treatment (DMARD's), which changes the course of the disease and prevents further damage to joints. Surgical treatment is needed when structural joint changes have taken place. Before and after the surgery, the patient should remain under care of a Physician/Rheumatologist. Post Traumatic Arthritis can follow a serious knee injury. A knee fracture or severe tears of the knee's ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
Q 5 When can I return home?
You will be discharged when you can get out of bed on your own and walk with a walker or crutches, walk up and down three steps, bend your knee 90 degrees, and straighten your knee.
Q 6 What measures should be taken after the surgery/operation (Post operative instruction)
The success of your surgery also will depend on how well you follow your orthopaedic surgeon's instructions at home during the first few weeks after surgery. Wound Care you will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal. Avoid soaking the wound in water until the wound has thoroughly sealed and dried. A bandage may be placed over the wound to prevent irritation from clothing or support stockings. Diet some loss of appetite is common for few days after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Activity Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within three to six weeks following surgery. Some Pain with activity and at night is common for several weeks after surgery. Your activity program should include:
- A graduated walking program to slowly increase your mobility, initially in your home and later outside.
- Resuming other normal household activities, such as sitting and standing and walking up and down stairs.
- Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.
Driving usually begins when your knee bends sufficiently so you can enter and sit comfortably in your car and when your muscle control provides adequate reaction time for braking and acceleration. Most individuals resume driving about two to four weeks after surgery.
Q 7 What activities should I Avoid after Knee Replacement?
Even though you may increase your activity level after a knee replacement, you should avoid high-demand or high-impact activities. You should definitely avoid running or jogging, contact sports, jumping sports, and high impact aerobics. You should also try to avoid vigorous walking or hiking, skiing, tennis, repetitive lifting exceeding 50 pounds, and repetitive aerobic stair climbing. The safest aerobic exercise is biking (stationary or traditional) because it places very little stress on the knee joint.