Who Is Offered Knee Replacement Surgery
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, have not reduced pain or improved mobility.
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you’re feeling depressed because of the pain and lack of mobility
- you cannot work or have a social life
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
Possible Benefits Of Total Knee Replacement Surgery
Regardless of whether a traditional total knee replacement or a minimally-invasive partial knee replacement is performed the goals and possible benefits are the same: relief of pain and restoration of function.
The large majority of total knee replacement patients experience substantial or complete relief of pain once they have recovered from the procedure. The large majority walk without a limp and most dont require a cane, even if they used one before the surgery. It is quite likely that you know someone with a knee replacement who walks so well that you dont know he even had surgery!
Frequently the stiffness from arthritis is also relieved by the surgery. Very often the distance one can walk will improve as well because of diminished pain and stiffness. The enjoyment of reasonable recreational activities such as golf, dancing, traveling, and swimming almost always improves following total knee replacement.
When Do I Need A Total Knee Replacement
If your knee joint is severely injured or damaged by a disease like arthritis, a total knee replacement may be the answer for you. But how do you know if you’re a candidate and if the time is right?
Because total knee replacement is a major surgery, orthopedists prefer to begin with non-invasive treatment options. For that reason, most patients who undergo knee arthroplasty are at “the end of the line” with non-invasive approaches. They’ve tried everything to improve mobility and reduce pain, but nothing has worked for long.
If you’ve tried a variety of treatments for your knee pain and you’re not seeing results, it may be time to visit an orthopedist to talk about a total knee replacement.
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Youre Okay With Avoiding Certain Activities Afterward
Patients should know what to expect after knee replacement surgery and understand that regular high-impact activities may not be advisable.
Total knee replacement is quite successful in enabling patients to return to an active lifestyle patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf, Lieberman says. In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear of the prosthesis.
Radiofrequency Ablation For Knee Pain
If all of these methods fail to control your knee pain from osteoarthritis, there are still options. Radiofrequency ablation controls pain in the knees by destroying the sensory nerves that carry the pain signal from the knee to the brain.
RFA is likely a temporary fix, as nerves will grow back in six months to two years, and the pain may return.
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What Should You Expect After Knee Revision Surgery
Most patients who undergo revision procedures can expect to have good to excellent results. Although expected outcomes include pain relief with increased stability and function, complete pain relief and restoration of function is not always possible.
Up to 20% of patients may still experience some pain following revision knee surgery. This can persist for several years after the procedure. Additionally recovery after revision total knee surgery is heavily dependent on the state and function of the knee prior to the revision surgery.
Who Needs Knee Revision Surgery
A knee revision may be necessary for anyone whose prosthetic knee implant fails due to injury or wear, or who gets an infection in the area around implant. In elderly people who have a knee replacement, the artificial knee implants may last for life. But in younger patients, especially those who maintain an active lifestyle, knee prostheses may eventually fail, requiring a second replacement later in life.
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The most common reasons people for knee revision are:
- Infection: The risk of infection from a total knee replacement is less than 1%, but when infections do occur, a knee revision of one kind or another is necessary.
- Instability: This occurs when the soft tissues around the knee are unable to provide the stability necessary for adequate function while standing or walking.
- Stiffness: In some patients, excessive scar tissue may build up around the knee and prevents the joint from moving fully.
- Wear and tear: This can include loosening or breakage of prosthesis components due to friction over time.
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Should You Have Both Knees Replaced At The Same Time
Many people with osteoarthritis have problems with both knees, but usually one knee is worse than the other. Most people have surgery on one knee at a time, though some patients want to have surgery on both knees at the same time. The plus side of this is that you only need one operation, but the downside is that its a harder, slower recovery.
There are strict criteria for having both knees operated on at the same time, including being in overall good health and being motivated to undergo a more difficult recovery.
Characteristics Of Severe Arthritis Of The Knee
Pain
Pain is the most noticeable symptom of knee arthritis. In most patients the knee pain gradually gets worse over time but sometimes has more sudden flares where the symptoms get acutely severe. The pain is almost always worsened by weight-bearing and activity. In some patients the knee pain becomes severe enough to limit even routine daily activities.
Stiffness
Morning stiffness is present in certain types of arthritis. Patients with morning stiffness of the knee may notice some improvement in knee flexibility over the course of the day. Rheumatoid arthritis patients may experience more frequent morning stiffness than patients with osteoarthritis.
Swelling and warmth
Patients with arthritis sometimes will notice swelling and warmth of the knee. If the swelling and warmth are excessive and are associated with severe pain, inability to bend the knee, and difficulty with weight-bearing, those signs might represent an infection. Such severe symptoms require immediate medical attention. Joint infection of the knee is discussed below.
Location
The knee joint has three compartments that can be involved with arthritis . Most patients have both symptoms and findings on X-rays that suggest involvement of two or more of these compartments for example, pain on the lateral side and beneath the kneecap . Patients who have arthritis in two or all three compartments, and who decide to get surgery, most often will undergo total knee replacement .
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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
Does Your Knee Injury Need Surgery
Maybe it was a high school sports injury that you never got around to treating. Or maybe it was that spill you took skiing last winter that still gives you problems today.
Whatever its cause and however long ago it happened, a knee injury can affect how well you move. Fortunately, you can usually treat it with physical therapy, weight loss, and other strategies. Sometimes, if itâs more serious, your doctor may suggest surgery.
But how do you know when an operation is your best choice? That’s a discussion to have with your doctor. Surgery can’t fix every knee problem, and not everyone is a good candidate.
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Types Of Knee Surgery And Recovery
A total knee replacement surgery involves replacing the joint ends of the femur and the tibia with prostheses consisting of surgical metal and plastic. A partial knee replacement is done when only a small portion of the tissue and bone in the knee is damaged. Once the new joint has healed, the patient is typically able to resume normal activity with little or no pain. Knee replacement recovery time can depend on the age of the patient and the extent of the surgery.
For patients that receive a knee replacement when they are young, dislocate their prosthetic, or experience other extenuating factors, joint revision surgery may be necessary.
After The Knee Replacement Operation
Following the procedure, you will be taken to a recovery room. Your orthopedic doctor will prescribe medication to help control pain while you heal, and you will be provided with complete aftercare instructions.
Soon afterward, a physical therapist will meet with you to discuss your exercise program. The physical therapy program is designed to help you start to move your affected knee joint through complete range of motion as soon as possible.
Once you are discharged from the hospital, you will need to keep the surgical site clean and dry as it heals. Although you will probably experience some swelling, it can be controlled with a combination of elevation and ice therapy. Your physical therapist will explain how to do this properly and without causing further injury.
Full recovery is a process over several months, but most of the physical therapy work is in the first 3 to 4 weeks. The good news after knee replacement surgery is the typically, the harder you work on your physical therapy exercises the quicker you recover.
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Difficulty Walking And Climbing Stairs
Stiffness, pain, and decreased mobility have a tremendous impact on daily life. If youre struggling to walk and climb stairs, it may be time to consider knee surgery.
However, if you undergo a partial or full knee replacement, you can expect to walk again within eight weeks after your surgery. Physical therapy is usually recommended to recover the muscle lost during bed rest and strengthen the knees even further.
For total knee replacements, recovery may take up to a year. However, most patients report significant improvements in their pain, stiffness, and life quality.
Knee replacements can last anywhere between 15 and 20 years. If you have the replacement at a younger age, you can undergo a second surgical procedure to replace the worn-out knee replacements with new ones.
Before Knee Replacement Surgery
You will first undergo a thorough review of your medical history and a physical examination to ensure that you are healthy enough for the surgery and are a good candidate for the procedure.
Prior to the surgery, you should prepare your home for your recovery phase. You will need the support of a family member or friend for household chores, and you may want to set up a resting area to use while you recuperate. Be sure to place frequently used items within easy reach, and have no-preparation snacks ready on the counter in the kitchen.
Some knee replacements are done on an outpatient basis, but you may need to stay in the hospital overnight if your condition warrants it. Talk to your surgeon about what you should expect.
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What Are Some Types Of Knee Surgery
The most common knee surgeries involve arthroscopy â a surgical technique used to repair many different types of knee problems â or knee replacement.
Arthroscopic surgery
Arthroscopy is a type of keyhole surgery used to diagnose and treat a wide range of knee problems. A keyhole surgery is one in which long, thin instruments are inserted into the patientâs body through small incisions.
For arthroscopic knee surgery, the surgeon inserts a probe with a small camera, called an arthroscope, into the knee joint. The scope displays pictures on a video monitor to help guide the surgeonâs work. Surgical instruments are inserted into the joint through a second incision.
The American Academy of Orthopaedic Surgeons describes the following as the most common arthroscopic procedures for the knee:
- Removal or repair of a torn meniscus â a type of cartilage in your knee that cushions and stabilizes the joint
- Reconstruction of a torn anterior cruciate ligament , which is a ligament that helps stabilize the knee joint
- Removal of inflamed synovial tissue
- Trimming of damaged articular cartilage
- Removal of loose fragments of bone or cartilage
- Treatment of patella problems
- Treatment of knee sepsis
Knee replacement
In a knee replacement operation, the surgeon removes damaged parts of the knee joint and replaces them with new parts made of materials such as metal, ceramic, or plastic. Contrary to the name of the procedure, the surgeon does not replace the entire knee joint.
Looking After Your Knee Replacement
Your new knee will continue to improve for as much as two years after your operation as the scar tissue heals and you exercise your muscles. You’ll need to look after yourself and pay attention to any of the following problems:
Stiffness Sometimes the knee can become very stiff in the weeks after the operation for no obvious reason. Try placing your foot on the first or second step of the stairs, hold on to the banister and lean into your knee. This should help to improve movement and flexibility in your knee. Its very important to continue with the exercises you were working on in the hospital.If the stiffness doesnt improve after about six weeks your surgeon may need to move or manipulate your knee. This will be done under anaesthetic.
Pain Pain caused by bruising from the operation is normal in the first two months, and you’ll probably still need to take painkillers at six weeks to help you sleep through the night. You may still have some pain for as long as six months. If you still have pain after this, speak to your physiotherapist or GP.
Infection You should speak to your GP or hospital if you notice any signs of infection, for example:
- breakdown of the wound with oozing/pus or sores
- increased pain
- redness and the affected area feeling warmer than usual or smelling unpleasant.
You should also look after your feet see a doctor or podiatrist if you notice any problems such as ingrown toenails that could become infected.
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Symptoms You May Need Knee Replacement Surgery
Knee replacement surgery is one of the most successful procedures that help to reduce pain and restore the ability to move better. But, how to know when its time for surgery? No worries. The best Orthopedic surgeons at Inodaya Hospitals explain the signs of knee replacement that you should not ignore.
Knee replacement or total knee replacement is a surgical treatment to resurface a knee damaged by arthritic conditions. Metal and plastic pieces are used to cap the ends of the bones that form the knee joint, along with the kneecap.
Youve Given Up On Your Normal Daily Activities
Have you recently given up on doing important everyday activities because youre in too much pain?
Whether thats shopping, gardening, or even just walking around your neighborhood, if you cant do the normal activities youre used to doing, thats a major red flag your knee pain is more serious than generalized pain.
You shouldnt have to avoid doing things you love because of your knee pain. If thats something youre already doing, it may be time to talk to Dr. Howell about a total knee replacement.
You shouldnt have to avoid doing things you love because of your knee pain.
If youre still unsure by this point, there is one more method to find out if youre a good candidate for total knee replacement surgery: Take the knee function assessment.
This free quiz will give you a series of questions to answer and then it will generate a knee score to give you an idea if you might be a candidate for total knee replacement surgery. We encourage you to take the quiz ASAP to see how you score.
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Why You Might Say Not Yet
Here are a five reasons knee replacement might not be right for youat least for now: