If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities. Total knee replacements are one of the most successful procedures in all of medicine.
In this procedure, the knee is replaced with an artificial joint. It requires a major surgery and hospitalization. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic “button” may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.
- Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
- Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”
- Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.
Preoperative Period Of TKR – What Should You Expect?
- Before surgery, the joints adjacent to the diseased knee (hip and ankle) are carefully evaluated. This is important to ensure optimal outcome and recovery from the surgery.
- All medications that the patient is taking are reviewed.
- Blood-thinning medications and anti-inflammatory medications may have to be adjusted or discontinued prior to surgery.
- Routine blood tests of liver and kidney function and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism.
- Chest X-ray and EKG are performed to exclude significant heart and lung disease that may preclude surgery or anesthesia.
Postoperative Period Of TKR – What Should You Expect?
- After surgery, patients are taken to a recovery room, where vital organs are frequently monitored. When stabilized, patients are returned to their hospital room.
- Passage of urine can be difficult in the immediate postoperative period, and this condition can be aggravated by pain medications.
- Patients can begin physical therapy 48 hours after surgery. Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy
Surgery Success Rate
The good news is that more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. However for the final success of your surgery you need to follow your orthopaedic surgeon’s instructions after surgery and take care to protect your knee replacement and your general health.
After surgery, make sure you also do the following:
- Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
- Take special precautions to avoid falls and injuries. If you break a bone in your leg, you may require more surgery.
- Make sure your dentist knows that you have a knee replacement. Talk with your orthopaedic surgeon about whether you need to take antibiotics prior to dental procedures.
- See your orthopaedic surgeon periodically for a routine follow-up examination and x-rays, usually once a year.