Total Knee Replacement
What causes knee pain?
The knee is the most used and therefore stressed joint in the body. The common causes of pain in the knee are injury, arthritis and infection.
Is there a cure?
This depends entirely on the nature of the problem. Sometimes knee pain can be treated through rehabilitation, and on occasion surgery may be required. It is important to consult a doctor for proper advice as soon as the symptoms are evident.
What is Total Knee Replacement?
Total Knee Replacement is a procedure in which the parts of the bones that rub together are resurfaced with metal and plastic implants. Precision instruments are used to remove and replace damaged parts of the bone with implants. The surface of the femur is replaced with a rounded metal component that matches closely the curve of your natural bone. And the surface of the tibia/leg bone is substituted with a smooth plastic component.
How to tell if you need a knee replacement?
If your knee pain is so severe that it causes difficulty in walking and performing daily activities, knee replacement might be called for. However it is mandatory that these symptoms be taken to a doctor for an accurate diagnosis. Doctors try and delay the procedure for as long as possible by using non-invasive treatment. However if the disease is in an advanced stage, knee replacement is a means to achieve relief from pain as well as return to daily activities.
How do you prepare for Total Knee Replacement surgery?
A complete physical check-up is required to rule out any medical problems that may interfere with your surgery. At this time the doctor will also review your medical history. Do not forget to inform the doctor about any medication that you may be taking. A few routine pre-surgery tests will also be performed. The surgery can result in blood loss which will require transfusion. So you might be asked to donate a few units of your own blood prior to surgery.
What happens during Total Knee Replacement surgery?
Prior to surgery an IV line will be inserted into your arm to administer medication during the operation. Thereafter anesthesia is administered in the OT. Once anesthesia has taken effect, the knee is scrubbed and sterilized. The surgery then begins with an incision to expose the knee joint. The surgeon then uses precision guides and instruments to remove damaged surfaces. The ends of the bones are then shaped to accept the implants. The implants are then fixed, and the incision closed. A sterile bandage is applied to the wound and routine post operative care will follow as anesthesia wears off.
How is the implant affixed in the body?
Bone cement is used to secure the knee implants.
What can you expect after the surgery?
A specially designed rehabilitation routine will be started to help regain strength, balance and movement in the knee. 24 hours after surgery, you will be asked to stand. And in 48 hours, you will start to walk with support. You can expect to stay in hospital for 3 days after surgery. Your sutures will usually be removed before discharge, and you will be advised on exercises to continue at home.
How soon can you return to normal activities?
On an average, patients walk with a cane in 6 weeks, and start to drive in 2 months. While the surgery will relieve you of pain and allow you to resume most normal activities, this does not include contact sports and activities that put excessive strain on your knees.
How long will a joint replacement last?
Longevity of the prosthesis depends on the patient's activity levels, weight as well as the accuracy of the implant placement. Recent studies have found common implants to be functional in 96% patients even after 20 years. However it must be understood that implants are not as durable as the natural knee, and will eventually wear out and no assurance can be given about its longevity.
PHYSICAL TRAINING AFTER KNEE PROSTHESIS
Rehabilitation goals are to improve ambulation, enhance range of motion, develop muscle strength, provide emotional support and control pain.
Outcome variation exists despite excellent surgical technique, refined implants, and uncomplicated postsurgical recovery. In addition to perioperative surgical care, presurgical variation in patient risks factors and variation in prÃ© and post-TKA rehabilitation exercises and activity may also contribute to varied functionnal return. The loss of muscle quadriceps strength is an important determinant of disability in patients before and after TKA. The reduction in voluntary activation of the muscle is considered to be among the mechanisms involved in the decline in muscle strength. These voluntary activation deficits are at least in part reversible after TKA . Effectiveness of physical therapy and rehabilitation is focused on increasing muscle strength after surgery.
Therefore, the improvement of exercise therapy and muscle strength within the first 3 months after surgery is an important outcome measure in the effectiveness of TKA.
A recommended daily exercise shedule at home after TKA surgery is an important component of knee function.
TRAINING AFTER OPERATION
- walk : 20 mn walk twice a day when the knee is nor too painfull, even with crutches.
- fitness and aerobic exercices alone or in group : twice a week
- home exercices : stretching and reinforcement of muscles, ankle pump, active contractions, active assisted knee flexion : do this twice a day.
Put an Ice Pack after the exercice or coming back home. Two rules : NO PAIN - NO SWELLING
Partial Knee Replacement
A partial knee replacement is surgery to replace only one part of a damaged knee. It can replace either the inside (medial) or outside (lateral) parts of the knee.
Surgery to replace the whole knee joint is called total knee replacement.
Partial knee replacement surgery removes damaged tissue and bone in the knee joint. The damaged areas are replaced with a man-made implant, called a prosthetic.
Before surgery, you will be given anesthesia, which is medicine that blocks pain. You will have one of two types:
- General anesthesia makes you sleep through the procedure and unable to feel pain.
- Regional (spinal or epidural) anesthesia numbs you below your waist. You will also receive medicines to make you relax or feel sleepy.
The surgeon will make a cut over your knee. This cut is about 3 to 5 inches long.
- Next, the doctor examines the entire knee joint. If there is damage to more than one part of your knee, you may need a total knee replacement. Most of the time, however, this is not needed since the tests you had before the procedure would have shown this damage.
- The damaged bone and tissue is removed.
- A man-made part made of plastic and metal is placed into the knee.
- Once the part is in the proper place, it is attached with bone cement.
- The wound is closed with stitches.
Why the Procedure is Performed
The most common reason to have a knee joint replaced is to relieve severe arthritis pain.
Your doctor may recommend knee joint replacement if:
- You can't sleep through the night because of knee pain.
- Your knee pain prevents you from doing daily activities.
- Your knee pain has not gotten better with other treatments.
You will need to understand what surgery and recovery will be like.
Partial knee arthroplasty may be a good choice if you have arthritis on only one side of the knee, and you:
- Are older, thin, and not very active
- Do not have very bad arthritis on the other side of the knee or under the kneecap
- Have only minor deformity of the knee
- Can move your knee in a good range
- Have stable ligaments in the knee
However, most people with knee arthritis have a surgery called a total knee arthroplasty (TKA).
Knee replacement is most often done in people age 60 and older.
Risks for this surgery include:
- Blood clots
- Fluid buildup in the knee joint
- Failure of the replacement parts to attach to the knee
- Nerve and blood vessel damage
- Pain with kneeling
- Reflex sympathetic dystrophy (rare)
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, including herbs, supplements, and medicines bought without a prescription.
During the 2 weeks before your surgery:
- Prepare your home.
- Ask your doctor which medicines you can still take on the day of your surgery.
- You may be asked to stop taking medicine that makes it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), blood thinners such as warfarin (Coumadin) and other drugs.
- You may need to stop taking any medicines that weaken your immune system, including Enbrel and methotrexate.
- If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see the doctor who treats you for these conditions.
- Tell your doctor if you have been drinking a lot of alcohol (more than one or two drinks a day).
- If you smoke, you need to stop. Ask your doctor or nurse for help. Smoking slows healing and recovery.
- Let your doctor know if you get a cold, flu, fever, herpes breakout, or other illness before your surgery.
- You may want to visit a physical therapist before surgery to learn exercises that can help you recover.
- Practice using a cane, walker, crutches, or a wheelchair.
On the day of your surgery:
- You will usually be asked not to drink or eat anything for 6 - 12 hours before the procedure.
- Take the drugs your doctor told you to take with a sip of water.
- Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
Most patients go home the day after surgery.
You can put your full weight on your knee right away.
After surgery, you will be encouraged to do as much as you can for yourself. This includes going to the bathroom or taking walks in the hallways with help.
Most people recover quickly and have much less pain than they did before surgery. People who have a partial knee replacement recover faster than those who have a total knee replacement.
Outlook (Prognosis) Many patients are able to walk without a cane or walker within 3 to 4 weeks after surgery. You will need physical therapy for 4 to 6 months.
Most forms of exercise are OK after surgery, including walking, swimming, and biking. However, you should avoid high-impact activities such as jogging.
Unicompartmental knee arthroplasty; Knee replacement - partial; Unicondylar knee replacement; Arthroplasty - unicompartmental knee; UKA; Minimally invasive partial knee replacement