Long-term injury and severe arthritis can be debilitating and affect a person’s quality of life. As a result, common, day to day essential activities such as walking, climbing stairs, or sitting and standing up could be challenging and cause pain.
If pain medications, rehabilitation, and assistive devices cannot provide relief, it might be time to consider a total knee replacement surgery.
A total knee replacement surgery is done to replace parts of the knee joint surface with metal and plastic prosthetic devices. It gives you an artificial and functioning knee joint that does not hurt throughout the day.
This procedure is designed to permanently ease severe pain and improve the joint function of people with chronic joint diseases such as severe arthritis.
In some cases, total knee replacement surgery is needed to restore the function of the knee joint in people affected by tumors in the knee region.
Total knee replacement comes with a lot of benefits. Replacing parts of the joint surface will allow you to regain mobility and experience pain relief on the knee.
More importantly, you will be able to perform routine tasks and daily activities such as walking, doing chores, and exercising to maintain optimal health.
In many cases, patients with artificial knee joints can participate in low-impact sports that don’t rely heavily on the knee, such as swimming, diving, golf, sailing, and many more.
Like any other medical and surgical procedure, total knee replacement has risks and limitations.
After the surgery, it is expected to experience swelling of the knee for a few weeks while you are recovering. As the incision site heals, a scar will eventually form. Several factors, such as sun damage, genetics, and scar management, can influence how well your scar will heal.
Your risk for blood clots and infections increases for a few weeks after the surgery. In addition, diabetic and obese patients have a higher risk of complications. Therefore, it is vital to follow your doctor’s recommendations as well as the exercises that will be prescribed to you.
Depending on your physical activity and how well you take care of your artificial joint, it might last up to 10 to 15 years. Unfortunately, this means that younger patients may require one or more surgeries throughout the rest of their lives.
After consideration and consultation with your doctor, you will be given several days or weeks to prepare for the total knee replacement surgery.
At the start of the procedure, the anesthesiologist will administer anesthesia so you won’t feel pain or discomfort throughout the surgery. You can choose to stay awake or unconscious during the procedure.
The surgeon will make an incision of about 15 to 25 centimeters (6 to 10 inches) long to gain access to the structures of the knee joint. Next, the surgeon will remove the damaged bone surfaces and shave the knee cartilage. Then they will attach prosthetic implants to the remaining bone.
Depending on your case, specialized cement may be used to bond the metal implants to the bone and keep it stable. In other cases, the surgeon will use a cementless technique and embed the implants into bones. Over time the bones will grow to the parts of the implant and essentially become part of you.
Before closing the incision, your surgeon will bend and rotate the knee to ensure that your new joint can function as a normal knee joint. A small tube may also be placed to help drain excess fluids in the knee joint and prevent the accumulation of blood inside the wound.
After the surgery, the incision site will be covered with a large adhesive dressing to protect it from infection and promote wound healing.
Before you undergo total knee replacement surgery, there are a few things you need to do to prepare yourself and ensure the success of the procedure.
It is vital to be in optimal health before the surgery. Therefore, it is advisable to modify your lifestyle to ensure your greatest chances of undergoing successful surgery. Such changes that have to be made may include avoiding alcoholic drinks, quitting smoking, and being physically active as much as possible.
It is also essential to understand the roles of your healthcare team. Your medical team is usually the result of collaboration from physicians of different specializations. Their task is to ensure the success of your treatment and to maximize the efficacy of your recovery.
Your health care team will include the following:
You will undergo physical rehabilitation during your stay in the hospital to help you regain your mobility, improve the strength of your leg muscles, and learn to walk again. You will be given different exercises to achieve these goals.
A few weeks before the surgery, improving the strength of your arms and upper body muscles is recommended to easily adapt to using assistive devices such as crutches or a walker.
To relieve the stress on the knee, your physician may advise you to lose some weight through proper diet and exercise.
After the surgery, you will have to use an assistive device such as crutches or a walker. This will help you reduce the stress on your knees while your body is still recovering. A physiotherapist can show you how to safely use assistive devices and create an individualized plan to improve your strength and endurance.
You will stay in the hospital for a few days after the surgery. You will be given pain medication and antibiotics to ease your pain and prevent infection.
You’ll have to temporarily wear pressure stockings to prevent the formation of a blood clot on your legs.
Within 24 hours, a physiotherapist will visit you for your rehabilitation. They will provide exercises and help you bend and straighten your knee. In addition, your physio will teach you how to walk with your new knee joint using crutches or a walker.
Your physio will also improve your mobility and show you how to independently get in and out of bed. They will ensure you have sufficient strength and balance to move around safely.
On day 2, most patients can stand and walk again for a few steps with assistive devices. Your physio will help you gradually perform different activities and safely climb a few steps.
You can go home after 1 to 5 days of hospital stay depending on how well you are recovering, also taking into account your progress with rehabilitation. However, some patients will have to stay longer if a complication occurs or they have an existing condition that needs hospital care.
Having a caregiver with you is essential to assist you following initial discharge from the hospital. Your caregiver or family should also tidy up your home and free it from clutter so you can safely move around the house.
Typically, your wound’s dressing should be left in place for two weeks. If your dressing is waterproof, you can shower the day after surgery. Otherwise, you must wait a week before showering and avoid soaking the dressing for 3 to 4 weeks. Your dressing will be removed during your follow-up appointment two weeks after the surgery.
You will be given exercises to continue your rehabilitation even if you are at home. In addition, you need to come back to your physio for outpatient treatment. Usually, 2-3 sessions per week of outpatient physiotherapy are required to ensure your complete recovery. 3 weeks after the surgery, you will be able to walk independently again without an assistive device.
Most pain medication causes constipation. Therefore, it is recommended to maintain a high-fiber diet and ensure that you are always hydrated. It is best to take light food and clear fluids for a few days if you are experiencing nausea after the surgery. Then, as you recover, you can gradually transition to your regular diet.
Medication and pain management
Most medication that you regularly take may be resumed after surgery. In addition, your doctor will prescribe you pain medication to help you control your pain.
As your condition improves, you must reduce your reliance on pain medications. In addition, it is also advisable to take pain medicines when your stomach is full to prevent nausea.
After 8 to 12 weeks of regular physiotherapy and commitment to home exercises, you’ll notice a significant improvement in your balance, strength, and overall activities that you can partake in. For example, you will be able to safely walk for longer distances and climb up and down the stairs on your own.
Your full recovery will depend on your overall health status and exercise regimen. It could take six months to a year before your knees are as resilient as they can be.
Few risks and side effects may occur after a total knee replacement surgery. These may include the following:
Some stiffness is normal for a few months following knee surgery. However, sometimes stiffness can last for longer than it should.
Chronic stiffness is often the result of excessive scar tissue and lack of joint mobility. This is why physiotherapy and commitment to home exercises are crucial to your recovery.
All surgical procedures require penetrating the skin. This means that there is always a slight chance of developing an infection. Your physician will prescribe you antibiotics to prevent this from happening.
It is also essential to follow your doctor's instructions and keep your wound clean and dry. A significant amount of swelling and redness could be a sign of infection, and you'll need to contact your doctor immediately.
Blood clots (DVT)
Blood clots can develop due to the lack of using your leg muscles while recovering. In addition, knee replacement can also affect the blood flow around your knees, resulting in an increased risk of blood clot formation.
In rare cases, blood clot formation may lead to severe complications and travel to the lungs causing a pulmonary embolism. To avoid this, your physician may prescribe you blood thinners. It is also recommended to wear compression stockings and keep your leg muscles moving.
Injury to nerves or blood vessels
There is a slight chance of damage to the blood vessels, nerves, and tissue around the knee. Fortunately, most injuries will heal on their own after some time.
Loosening or dislocation of prosthetic devices
Artificial joints and subsequent implants are built to last long. However, there is a slight chance of implant failure, causing the joint replacement to not function properly.
Infection, instability, and stiffness are the usual reasons for implant failure. In rare cases, a fracture and loosening of some parts of the prosthetic device may cause the implant to be unstuck.
Persistent pain, knee instability, swelling, and stiffness are the main signs of implant failure. If you are experiencing these symptoms, visit your doctor immediately.
What are the things you need to prepare at home for recovery?
Make sure your home, especially the walking pathways, is free of clutter and obstructions, including power cords, unnecessary furniture, and kid toys.
Handrails are ideal in high-risk areas such as the bathroom and kitchen to provide additional support and prevent potential accidents.
Setting up a bed and space on the ground floor of your home when you first return is advisable to avoid the unnecessary use of stairs.
What activities will I be able to partake in following total knee replacement?
12 weeks after your surgery, you should be able to return to your regular routine and walk without an assistive device. In addition, you will be able to do low-impact activities that don’t stress the knee joint such as stationary biking, swimming, and similar activities.
However, avoiding jumping, running, and other high-impact movements is vital to protect your new joint from wear and tear.
How long will the artificial knee joint last?
About 89 percent of patients with total knee replacements reported having a functioning artificial knee after 15 years. However, it is recommended to have a follow-up assessment with your surgeon every 3 to 5 years.
Due to wear and tear, younger patients will require revision surgery sometime during their lifetime.
When is the right time to have a knee replacement?
No standard criteria for deciding when to have a total knee replacement exists. Ultimately, it all comes down to your decision and preference.
If the pain significantly affects your quality of life and conservative management fails, it may be time to consider surgery.
Can I avoid surgery?
In some cases, conservative management may help knee joint problems. However, surgery could be the best option if your symptoms are getting worse and start affecting your daily routine.
Delaying surgery for too long could further damage the knee joint and lead to a more complex operation and poorer prognosis.