What Happens in Knee Replacement Surgery?
Knee replacement surgery is a type of arthroplasty (joint replacement). The procedure works best for patients who experience extreme pain from arthritis or knee injuries. The orthopaedic surgeon uses artificial materials to replace the damaged section of your knee during the surgical procedure.
Doctors transfer patients to recovery rooms after surgery to monitor their vital signs and pain assessment. The doctor determines your hospital discharge date based on the information from your medical reports.
Types of Knee Replacement
Knee replacement is one of many types of surgery available to relieve pain and increase mobility in the knee area. Each type of knee replacement surgery is appropriate for different reasons, as they all treat specific conditions and the extent of joint damage. Below are the various types of common surgeries performed today:
Total Knee Arthroplasty:
Total knee arthroplasty (TKR) is considered the most frequently performed type of knee replacement surgery. In this procedure, the entire knee is surgically replaced with an artificial knee that consists of a metal part for the femur (thigh / upper bone) and a laminate block made of plastic for the tibia (lower bone), along with blocks of plastic that separate the prosthetic fittings. TKR surgery may be indicated for patients who have osteoarthritis, rheumatoid arthritis, or who have had a significant traumatic knee injury.
Unicompartmental partial knee replacement:
Unicompartmental partial knee replacement (PKR) refers to a surgical procedure where only some of the damaged joint is replaced by a new device. PKR is particularly effective when only one section of the joint becomes damaged (the medial inside, lateral outside, or patellofemoral front). Patients with localised arthritis and isolated knee joint problems often benefit from PKR.
Kneecap Replacement (Patellofemoral Arthroplasty)
Arthritis can cause severe pain and limitation with mobility in the knees. An option for treating arthritis in the knee joint is the medical procedure of replacing the kneecap (formally known as patellofemoral arthroplasty). With this procedure, the undersurface of the kneecap and its groove (trochlea) are replaced when affected by significant amounts of arthritis.
Complex Knee Replacement/Revised
There are instances where revision of a total knee replacement will either need to be performed or have previously been performed on a patient. Complex knee replacement has been designed to improve the function of the knee joint by correcting problems related to an implant (e.g., looseness), infection or loss of bone structure. The surgeon uses advanced techniques and customised implants to improve the patient's level of life function and reduce pain after failure due to a complex reason.
Gender Specific Knee Replacements
There have been minimal cases of gender-specific knee replacements due to complex reasons. However, there are both male and female implanted knee prosthesis that reflect the anatomical variations between males and females, with the hope of achieving a more compatible fit with more than equal performance and restoring the best possible function.
Custom Knee Replacement
Custom knee replacements use advanced imaging technology to create a uniquely fit implanted prosthesis specific to the patient's anatomy. This technique may provide for a more accurate assembled knee prosthesis and a higher probability that the knee will function better.
Knee Replacement Benefits
Knee replacement surgery (knee arthroplasty) involves replacing the damaged knee joint so that it is no longer painful and functions well. There are many different types of knee arthroplasty, but all are designed to relieve pain and improve the quality of life for patients who have severe damage to their knee joints.
Some benefits of knee replacement surgery include:
Relief of pain: The most significant benefit of knee replacement surgery is the significant amount of relief from chronic knee pain after surgery. Many patients who have lived with chronic knee pain because of osteoarthritis or rheumatoid arthritis report that they experience very little to no pain after their surgery.
Improved mobility: Many people with knee pain restrict their activities because they cannot move freely. People with severe knee pain and limited knee motion often must rely on help from others to carry out daily tasks or perform physical activity (e.g., gardening, swimming). Knee replacement surgery can help provide patients with the ability to perform activities independently by providing an artificial joint that restores full function to the knee.
Increase in Functionality: As pain from the knee decreases and the ability to move around becomes more accessible, patients will also experience an increase in overall functionality. Patients will be able to do things they were previously unable to do or found difficulty doing (i.e., walking, climbing stairs, bending their knees).
Improved Quality of Life: Chronic knee pain adversely affects a person's entire life. Knee replacement surgery can help people who have experienced chronic pain and limited mobility by improving their quality of life. Pain is reduced; functioning is increased; and persons can gradually return to a more physically active lifestyle due to pain relief from the procedure; therefore, there is a positive effect on both mental and emotional health.
Long-Term Results: The way knee replacements are designed provides the patient with a long-term result. The life expectancy of a total knee replacement varies. Therefore, life expectancy of an artificial knee will depend on factors such as how active the patient is and their overall health. However, many patients can anticipate that a total knee replacement will last for 15-20 years or longer. This extended life of an artificial knee allows the patient to benefit from having had the procedure for a long time.
Risks and Complications
Even though knee replacement surgery has many advantages for patients, it is very important that patients know that risks and complications can occur with the surgery. Before performing surgery, the patient's overall health will be evaluated by the medical professionals who will be performing it to ensure that they meet the expectations for the surgery; however, it is still important for the patient to know some complications that can occur from the surgery.
Infection: After any type of surgery, an infection can develop, such as in knee replacement surgery. To reduce the chance of infection, orthopedic surgeons will take precautions to prevent it. Patients will receive antibiotics and will also need to follow strict instructions to help reduce the risk of developing an infection following surgery.
Blood Clots: Blood clots, also called DVT (deep vein thrombosis), can occur from surgery after the patient has had knee replacement surgery. These blood clots can be life-threatening if they break free and travel to the lungs (pulmonary embolism). After knee replacement surgery, measures will be taken to stop the formation of blood clots; then the patient will be required to take medications to prevent blood clots and to start mobilising as soon as possible after surgery.
Knee implant problems: In some instances problems can occur with the actual knee implant itself including poor positioning, instability and loosening of the knee implant over time; therefore regular follow up visits to your surgeon to check for these types of problems after surgery are very important so that they can monitor how well the implant is working, identify possible implant problems and address them.
Nerve/blood vessel damage: There is a small risk of nerve/blood vessel damage from the surgical procedure to replace the knee joint (arthroplasty). However, there is a very low chance of damage occurring because of an improper position or direction of the surgical tools used to perform knee arthroplasty on you. If any nerve damage does occur, it will generally lead to numbness of part or all of the leg or foot or a decrease in feeling in the affected area; this does happen infrequently; however, it is important for the surgeon to protect these structures as best as possible during your arthroplasty.
Allergic Reactions: Allergic reactions from the materials making up artificial knees such as metals, cement and plastics have occasionally occurred but usually allergy testing can be done prior to surgery to identify if you may have an allergy to those materials; however even if you have been determined to have an allergy to those materials there is still a chance that you may react negatively to any of those materials so the best determination will be made for each individual subjectively and based on clinical experience of the surgeon.
What Are the Tests Recommended Before a Knee Replacement?
The necessary medical tests and assessments must be completed before a patient can proceed with knee replacement surgery. The evaluations serve as essential tools to evaluate patient wellness while finding hidden medical issues and determining their surgical eligibility. The assessment should be conducted at the top knee replacement hospital in India to provide optimal patient treatment.
Physical Examination: The orthopaedic surgeon performs a complete physical assessment of the knee joint to evaluate its movement capacity, joint stability and any existing deformities.
Medical History: The medical team conducts a full medical history assessment to discover all existing health issues, including allergies and current medications, and details about past surgeries.
X-rays: Doctors use X-ray technology to examine the knee joint, which enables them to measure the degree of joint damage while detecting alignment problems and evaluating the knee's general state of health.
Blood Tests: Blood tests serve two purposes, which include evaluating overall health and detecting medical conditions that include anaemia, infections and clotting disorders.
MRI (Magnetic Resonance Imaging): An MRI scan provides detailed knee joint imaging to evaluate the condition of soft tissue structures, which include ligaments and tendons.
Bone Density Scan (DEXA Scan): Doctors typically use this test to measure bone density in elderly patients to determine their likelihood of developing osteoporosis.
Assessment of Mobility and Functional Status: The surgeon evaluates the patient's daily activities, functional limitations and mobility skills to decide how surgery will benefit the patient.
Knee Replacement Recovery Time
The process of recovering from knee replacement surgery takes different lengths of time for each patient because their recovery depends on three main factors, which include their current health status, the surgical technique used and their compliance with the rehabilitation program.
Hospital Stay: Patients following knee replacement surgery typically need a hospital stay, which lasts several days. Patients receive their first post-operative treatment in the hospital during this time while their recovery process receives constant monitoring and they receive rehabilitation direction.
Immediate Postoperative Period (Days 1-7): Patients in the hospital period start their knee mobility exercises while learning to walk with help from physical therapists who use walkers and crutches for support. The administration of pain relief medications occurs during this stage when patients require pain management support.
First Few Weeks (Weeks 1-6): Patients continue their rehabilitation journey at home or in an outpatient facility after being discharged. The patients start to increase their weight-bearing capacity and mobility skills of the lower body. The patients start using walking aids after their mobility skills show improvement.
Six Weeks to Three Months (Weeks 6-12): The phase maintains its focus on improving mobility and strength during the period from six weeks to twelve weeks. Most patients receive clearance to resume driving after consulting with their surgeon. The patients need to continue their physical therapy sessions, which aim to improve their knee motion range and strengthen their knee and adjacent body muscles.
Three to Six Months (Months 3-6): During the period from three months to six months, patients experience a major decline in knee pain, which leads to better knee function. The surgeon determines when patients should start their low-impact exercise program, which includes swimming and cycling. The timing for resuming activities such as golf and light jogging differs from person to person.
Six Months and Beyond (Months 6+): Most patients have reached full recovery at this point, and they can start their normal activities, which include sports and recreational activities.
Exercises after Knee Replacement Surgery
After having surgery to replace your knee, it is important to follow an exercise routine that helps your recovery. This type of activity will help increase the strength, range of motion and flexibility of your new knee. Here is what you should know about the different kinds of exercises that will benefit you:
Ankle Pump: Ankle pump exercises work on the calf and ankle muscles, which help to stretch them and also provide post-operative swelling relief while increasing blood circulation in your lower legs and reducing the chances of developing blood clots.
Heel Slide: Heel slides encourage the quadriceps as well as the gluteal muscles to stretch and assist in increasing the range of motion in your knees, which will enable you to have increased flexibility and improved overall mobility in the future.
Knee Extension: This exercise involves pushing against a flat surface or wall (or in a machine) to lengthen the quadriceps, which will increase the range of motion and flexibility of your knee.
Leg Raises: Leg raises are an important exercise for strengthening the glutes and quadriceps at the hip and above the knee, supporting your knee better while walking.
Quad Squeeze: The quadriceps are responsible for supporting and controlling the knee joint while you move around. By doing quad squeezes, you will strengthen these muscles without over-stressing your knees.
Living with a Knee Replacement
Individuals can significantly increase their outcomes after temporarily recovering from the knee replacement operation through adherence to guidelines that promote healthy habits and lifestyles. Here are some key treatment strategies that will help individuals live positively with their replacement knee.
Physical Therapy & Rehabilitation: The success of your recovery ultimately depends on how committed you are to your physical therapy program. Physical therapists will help guide you along your path to recovery by teaching you exercises that will improve your strength, flexibility, range of motion in your replaced knee, and overall physical function.
Weight management: Achieving and maintaining a reasonable weight is very important so that you continue to minimise the stress and load on your replaced knee joint from your overall body weight. Eating a healthy, balanced diet can assist with weight control, as will participating in activities that keep you fit and active on a regular basis.
Avoiding High Impact Activities: Generally, a knee replacement will allow you to resume various forms of exercise with a reduction in discomfort and, therefore, improve your quality of life. However, you will need to avoid any high-impact activities or other strenuous activities that could potentially create excessive loading or stress on the knee after surgery. When you meet with your orthopedic surgeon for your postoperative visit, be sure to ask him or her what exercises are appropriate for you and what specific activity modifications may be necessary.
Be Careful and Mindful: Though knee replacements are made to handle everyday activities, it remains very important to conserve movements that do not lead to harm and, at the same time, carry out preventive measures. It mainly involves resorting to support equipment like a cane or a walker, most especially when the patient is in the very early phase of the recovery period.
Follow-up on a Regular Basis: Regularly scheduled post-operative checkups with the surgeon are very important to keep an eye on the condition of the knee replacement and be able to raise any worries or problems in due course. In fact, the very purpose of these visits is to make it possible for the range of the patient's condition to be as broad as possible so that if the patient gets any trouble at all, it can be detected and treated in a timely way.
Talk to Medical Professionals: If people have serious, long-lasting discomfort, their knee gets larger in size, feel like the knee is going to give out, or experience other symptoms causing them to worry, they should be in touch with a healthcare provider without delay. Getting medical help fast can avert complications and lead to better results.
To Conclude…
Individuals who have significant damage or osteoarthritis in the knee can benefit greatly from a knee replacement. Patients should know about the advantages and disadvantages of replacing a whole or part of the knee and about the types of replacement options that are available before making an informed decision regarding their treatment. After the procedure, adopting a healthy lifestyle, participating in rehabilitation, and following the physician's orders will contribute to better long-term results from knee replacement surgery.