Overview Of Knee Revision Surgery
The first step is removal of the existing implant. If there has been significant bone loss, bone grafts may be required to fill these voids. Bone grafts can be either autografts or an allograft . In some cases, metal wedges, wires or screws may be used to strengthen the bone.
Finally, specialized revision knee implants are inserted. Temporary drains may be placed to help prevent excessive swelling of the knee and are usually removed a few days after surgery. Additionally, specialized negative pressure incisional dressings are also frequently employed to improve wound healing as they have been shown to decrease post-operative wound complications in high risk patients. These dressings are usually connected to a small portable pump that stays on for about a week and keep the wound protected and dry.
Will I Need To Use Crutches Or Other Assistive Devices After Knee Replacement Surgery
Yes. And depending on the type of surgery youve had , youll probably need to use an assistive device for at least a few weeks during recovery.
Assistive devices make certain activities like walking, using the restroom and dressing easier to do. They also help keep you safe.
The types of assistive devices youll need after knee replacement surgery depend on your condition, but common devices include:
- Walking aids like crutches, canes or walkers
- Shoehorns and sock aids
- Raised toilet seat
- Tub chair
The good news is some assistive devices may be covered by your insurance, so be sure to check with your insurance provider before you go in for surgery.
What Seniors Can Expect After A Full Knee Replacement
A full knee replacement is a big operation, but its not as scary as people sometimes think. Its almost bread and butter for surgeons and physiotherapists, so its important to feel comfortable with professionals who are well-versed in the latest research and developments.
While the majority of full knee replacement patients enjoy a positive outcome, we cant guarantee it every single time.
A six-to-eight-week pre-habilitation program is something we do recommend and can help you achieve a best-case scenario to optimise your pre-surgery fitness, body weight, pain and mobility.
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When Can I Get Back To My Usual Activities
The timing for getting back to typical activities varies from person to person. The one thing that doesnt vary is the need for physical therapy to help get you there.
Heres a high-level look of the progress you can expect to see in the first three months of recovery with regular physical therapy:
- One month after surgery: Youll probably start doing low-impact, daily activities like driving, returning to work, household chores and regular errands.
- Two months after surgery: Around the seven-week mark, you can likely start enjoying low-impact physical activities again. Many of my patients love getting active by swimming, biking and taking longer walks at this point in their recovery.
- Three months after surgery: You may be able to return to high-impact physical activity like running, skiing or other activities you enjoy. Youll need to start slow and be gentle with yourself, but youll be able to work up to the level of activity you were used to.
All that said, its important to follow your post-op surgery instructions including regular follow-ups with your surgeon. Theyll let you know what youre ready for during your follow-up visits and coordinate recommendations with your physical therapist.
If youre not sure an activity will be safe on your new knee, dont hesitate to ask your surgeon or physical therapist.
Is It Time For A Total Knee Replacement
Climbing stairs has become an ordeal. Taking the dog for a long walk is out of the question. Squatting to pick up a grandchild just doesn’t happen anymore. When you’re not able to do the things you want and love to do, your body may be telling you it’s time for a total knee replacement.
A total knee replacement is a major surgery that requires a big commitment on your end to recover from it. For the first three months after surgery, you’ll be healing and doing exercises to build strength and improve your range of motion. Full recovery from a total knee replacement takes a up to a year.
Before you and your orthopedic specialist decide it’s time, you’ll want to give noninvasive therapies a chance, including:
- Modifying your activities.
- Using a cane or walker.
- Working with a physical therapist.
There’s no age range for having a total knee replacement. It’s a matter of decreasing function and increasing pain that matches up with what X-rays of your knee are showing. For instance, if you’re 50, have bad arthritis and are unhappy with your quality of life, then it’s reasonable to undergo a total knee replacement to regain function and mobility at a younger age.
You’ll also consult with an orthopedic surgeon and begin preparing for surgery by:
Depending on a number of factors, you may be a good candidate for same-day surgery. Be sure to discuss this option with your surgeon. Otherwise, expect to spend one or more nights in the hospital.
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Types Of Arthritis That Affect The Knee
Inflammatory arthritis
This broad category includes a wide variety of diagnoses including rheumatoid arthritis, lupus, gout and many others. It is important that patients with these conditions be followed by a qualified rheumatologist as there are a number of exciting new treatments that may decrease the symptoms and perhaps even slow the progression of knee joint damage.
Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments and therefore are not good candidates for partial knee replacement. However, inflammatory arthritis patients who decide to have total knee replacement have an extremely high likelihood of success. These patients often experience total, or near-total, pain relief following a well-performed joint replacement.
Osteoarthritis
Osteoarthritis is also called OA or degenerative joint disease. OA patients represent the large majority of arthritis sufferers. OA may affect multiple joints or it may be localized to the involved knee. Activity limitations due to pain are the hallmarks of this disease.
OA patients who have symptoms limited to one compartment of the knee sometimes are good candidates for minimally-invasive partial knee replacement .
Use Walking Poles In The First Few Month
You will need to use a walker immediately after TKR. In a few days, you will transition to walking poles or a cane.
I recommend walking poles and it is important to have them on hand. The poles will help you maintain balance when you begin walking again and they will also take some weight off of the knee and hip.
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Technical Details Of Total Knee Replacement
Total knee replacement surgery begins by performing a sterile preparation of the skin over the knee to prevent infection. This is followed by inflation of a tourniquet to prevent blood loss during the operation.
Next, a well-positioned skin incision–typically 6-7 in length though this varies with the patients size and the complexity of the knee problem–is made down the front of the knee and the knee joint is inspected.
Next, specialized alignment rods and cutting jigs are used to remove enough bone from the end of the femur , the top of the tibia , and the underside of the patella to allow placement of the joint replacement implants. Proper sizing and alignment of the implants, as well as balancing of the knee ligaments, all are critical for normal post-operative function and good pain relief. Again, these steps are complex and considerable experience in total knee replacement is required in order to make sure they are done reliably, case after case. Provisional implant components are placed without bone cement to make sure they fit well against the bones and are well aligned. At this time, good function–including full flexion , extension , and ligament balance–is verified.
Finally, the bone is cleaned using saline solution and the joint replacement components are cemented into place using polymethylmethacrylate bone cement. The surgical incision is closed using stitches and staples.
Anesthetic
Length of total knee replacement surgery
Pain and pain management
What Are The Risk Factors For A Failed Knee Replacement
Age, activity level, surgical history and a persons weight can contribute to implant failure. Younger, active patients, people who are obese, and those who have had prior knee surgeries all have a higher increased risk of a failed implant.
Younger, more active patients have a higher rate of revision than older, less active patients because they place more stress on their prosthesis over more time. Obese patients have a higher incidence of wear and loosening because of the increased force of their weight, and they are more prone to infections because of their increased risk of wound healing. Patients with previous knee surgeries are at higher risk for infection and implant failure.
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Contact Orthobethesda To Learn More
If you believe that you are a candidate for total knee replacement, we invite you to reach out to us online to schedule an appointment at OrthoBethesda.
- 1635 N. George Mason Drive #180 Arlington, VA
- Ph 567-4706
- 4420 North Fairfax Drive, Suite 100 Arlington, VA
- Ph 419-3002
- 10215 Fernwood Road, Bethesda, MD 20817
- Ph 530-1010
Looking After Your New Knee
- continue to take any prescribed painkillers or anti-inflammatories to help manage any pain and swelling
- use your walking aids but aim to gradually decrease the amount you rely on them as your leg feels stronger
- keep up your exercises to help prevent stiffness, but do not force your knee
- do not sit with your legs crossed for the first 6 weeks after your operation
- do not put a pillow underneath your knee when sleeping as this can result in a permanently bent knee
- avoid twisting at your knee
- wear supportive shoes outdoors
- do not kneel on your operated knee until your surgeon says you can
- raise your leg when sitting and apply an ice pack wrapped in a tea towel for 20 minutes every 3 or 4 hours to reduce any swelling
Page last reviewed: 02 August 2019 Next review due: 02 August 2022
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Knee Extension Stretches And Exercises
Expect to perform a variation of these knee extension exercises:
- Quad Sets
- Seated calf stretch with towel/belt
- Standing TKE
Some patients will use a continuous passive movement machine that will repeatedly assist bending and straightening your knee slowly for hours each day for a couple weeks until they have reached a desired range of motion.
How Long Does It Take To Recover From A Knee Replacement
There are many factors that determine how long it takes to recover from a total knee replacement.
Patients are typically discharged from the hospital within five to 14 days after knee replacement surgery.
Short-term recovery, in which a patient can walk with minimal aid or no aid and only needs over-the-counter pain relief generally occurs within twelve weeks after surgery, and most patients can return to full normal activities within 3 to 6 months.
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How Long Does It Take To Recover After A Hip Replacement
On average, hip replacement recovery can take around two to four weeks, but everyone is different, says Thakkar. It depends on a few factors, including how active you were before your surgery, your age, nutrition, preexisting conditions, and other health and lifestyle factors.
Achieving a certain level of activity before you have the surgery can help you bounce back more quickly, shares Thakkar. We use a regimen called prerehabilitation, or prehab, to help patients get in a physical shape that will set them up for a successful recovery.
Preparing for Hip Replacement Surgery | Q& A with Savya Thakkar, M.D.
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Who Should Consider Total Knee Replacement Surgery
It is usually reasonable to try a number of non-operative interventions before considering knee replacement surgery of any type. Prior to surgery an orthopedic surgeon may offer medications knee injections or exercises. A surgeon may talk to patients about activity modification weight loss or use of a cane.
The decision to undergo the total knee replacement is a âquality of lifeâ choice. Patients typically have the procedure when they find themselves avoiding activities that they used to enjoy because of knee pain. When basic activities of daily lifeâlike walking shopping or reasonable recreational pastimesâare inhibited or prevented by the knee pain it may be reasonable to consider the surgery.
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Knee Replacement Recovery Tips
Need some tips to enhance your knee replacement recovery? Some of these ideas I learned from friends and acquaintances that had already had knee replacement surgery and they shared their experiences with me.
I read as much as I could before my TKR so that I would have a good understanding of what my recovery was going to entail. Then, I learned the old fashioned way by experiencing TKR and the recovery process myself.
You dont have any control over the actual surgery , but once the operation is complete it is solely up to you to decide how hard you are going to work at recovery. Below are my suggestions for a successful TKR recovery.
As I mentioned in other articles, the rehab starts immediately after your surgery. Physical therapy begins in the hospital, continues at home, and then to an offsite therapist and finally, you can continue the rehab as long as you want it to last.
What Can I Do To Help Ease The Pain
Once the knee replacement surgery is completed, its imperative that the patient gets up and walking on the new knee as soon as possible to prevent blood clots. Putting pressure on the newly operated joint, as well as bending the knee will cause initial pain but will fade as the healing continues. Fortunately, knee replacement surgery technology and pain management have come a long way since the first days of the procedure, so today knee replacement surgeries involve less pain and patients are able to heal faster than ever before.
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How Do I Manage Pain And Discomfort After Joint Replacement Surgery
Try to take your pain medication as soon as you begin to feel pain. Don’t wait until the pain becomes severe. Follow the instructions on the prescription label. Remember to take your pain medication before activity and bedtime.
If you need to have stitches or staples removed and you’re still taking pain medications, be sure to have a friend or family member drive you to your appointment.
Pain medication may cause nausea. If this happens, decrease the amount you are taking or stop and contact your surgeons office.
If you need additional pain medication, please contact your surgeons office. Give at least a few days advance notice before you run out of the medication. Please plan ahead, especially for holiday weekends.
Also remember:
- You aren’t permitted to drive a car while taking narcotic pain medication.
- It may take several days to have a bowel movement. Anesthesia and pain medication often cause constipation. Drink plenty of fluids and eat whole grains, fruits, and vegetables. A stool softener or laxative can help bowel function return to normal.
- Don’t hesitate to call your surgeons office with any questions or concerns.
Incision care
Walker, crutches, cane
Use your assistive devices for balance as instructed by your surgeon or therapist. By your first post-op visit with your surgeon, you may have already improved and changed from using a walker or crutches to a cane .
How Do You Know If You Need Knee Replacement Surgery
Each patient is unique, which is why it is essential to schedule an examination and testing with an experienced sports medicine doctor. Our team will determine a diagnosis before deciding if you need to schedule a date for surgery. The preference is always to use minimally-invasive treatments first before surgery is necessary.
But there are times when surgery is required. Whether the minimally-invasive treatments arent working, or youve had a severe injury, you might need to schedule surgery to achieve the recovery you desire.
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What Are The Alternatives To Revision Surgery
Alternatives to revision knee surgery are rarely used as they can sometimes be more complex and lead to worse results than revision surgery, but they include knee fusion or .
The following alternatives are employed depending on the seriousness of the problem affecting the knee:
- of the knee joint may relieve pain but at the expense of keeping the knee in a fixed, non-bending position.
- may be used in extreme cases in which the knee joint has a severe infection that cannot be eradicated
What Are Risks And Complications Of Knee Replacement
Complications of knee replacement surgery include:
- Blood clot in the deep veins of the leg
- A DVT can be deadly if it travels to the lungs so see a doctor if you have symptoms that could indicate a DVT, such as leg pain or swelling
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Work On Your Walking Form
Pre-surgery my leg was bowed and walked with a noticeable limp. Once you start walking after TKR you may have to relearn to walk correctly.
My in-home therapist made it a point to walk behind me reminding me to walk with proper form. On your other walks, have your caregiver or walking partner critique your walking form.
Discard those old shoes that show wear from walking incorrectly.
If you can, video record you walking form before surgery and then have your walking partner video your new form occasionally.