Knee Replacement - What can I expect?
A total knee replacement is often performed to remove pain and restore optimal function in an arthritic knee where the benefits of conservative management are no longer felt. An awareness of the procedure and what to expect following surgery, will assist you in achieving the best outcomes for you to get the most out of your new knee.
The procedure
Total knee replacement (TKR), also known as total knee arthroplasty (TKA) refers to the replacement of the arthritic ends of both the thigh (femur) and shin (tibia) bones with a metallic compound.
Pre-operative planning using CT Scans and other forms of imaging allow for a highly specific approach to surgery for each individual patient. Precise instrumentation is utilised in order to prepare the individualised components that will form the newly replaced knee. This will allow for accurate alignment and fixation leading to a better fitted knee.
Both femoral and tibial components can be fixated to the bones by one of two methods, cemented and uncemented techniques. This decision is often guided by the surgeon and tailored to the specific needs of the patient.
Between the metal components on the ends of each bone, is a dense polyethylene plastic insert that allows the femoral component to glide smoothly over the tibial component. In some cases, the under-surface of the patella (kneecap) is also replaced with this highly dense polyethylene compound.
Now that you have some insight into the procedure and materials used, you’re probably wondering, what’s next? What happens post-surgery. Here are a few questions and answers that may be in your mind to help you get started.
How long will the replacement last? Will I need to have another?
Multiple factors will determine the durability of the prosthesis
Age
Gender
BMI
Social support
Functional status pre-surgery
Modern day knee surgery outcomes are generally excellent, with majority of patients experiencing good outcomes regarding pain and function and most lasting anywhere between 10-20 years.
Although knee replacement surgery generally has a really high success rate complications can occur, and in some instances revision of the total knee replacement may be indicated. These details can be discussed further with your surgeon.
How long will it take me to recover?
Recovery rates vary greatly between patients and are dependent upon a number of individual factors. Generally speaking, you will need to allow for a minimum 6-12 weeks to recover from the procedure. However, this does not mean, you, as the patient, are passively waiting for your knee to get better. In fact, your recovery is very much an active process and will influence your long-term outcomes post surgically.
In fact, recovery in the knee can continue to occur 1-2 years after the procedure. In this time, scar tissue will heal and muscles will re-gain their strength with exercise.
What does my rehab plan look like? Who can help?
Your rehab is governed by a multi-disciplinary team including but not limited to, surgeons, nurses, occupational therapists and physiotherapists.
Physiotherapy is an integral part of recovery post total knee replacement. In fact, your recovery will begin the day after (or in some cases the afternoon of) your procedure to begin the rehabilitation process.
A typical pathway of rehab may look like this:
Pre-operative rehab (prehab) > surgery > acute post-op rehab > inpatient rehab vs home
Physiotherapy is able to assist you long after your discharge from hospital and upon returning home to assist you with returning to the activities you enjoy.
Will I be able to return to the activities I enjoy doing most?
Resuming an active lifestyle is integral to good outcomes post surgery. Activities such as golf, cycling, walking and swimming are great ways to stay physically active post total knee replacement.
Strengthening exercises for all the major muscles and joints of your legs will also assist with longevity of the prosthesis and is a large focus of your post-operative physiotherapy
While walking is one of the most important exercise to regain function, individual exercises of the knee will assist in regaining movement, strength and confidence in your new knee, and physiotherapy can assist you in setting and achieving goals through a tailored rehabilitation program.
References
Artz, N., Elvers, K., Lowe, C., Sackley, C., Jepson, P., & Beswick, A. (2015). Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis. BMC Musculoskeletal Disorders, 16(1). doi: 10.1186/s12891-015-0469-6
Papakostidou, I., Dailiana, Z., Papapolychroniou, T., Liaropoulos, L., Zintzaras, E., Karachalios, T., & Malizos, K. (2012). Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskeletal Disorders, 13(1). doi: 10.1186/1471-2474-13-116
Pollock, M., Lanting, B., Somerville, L., & Firth, A. (2016). Outpatient total hip arthroplasty, total knee arthroplasty, and unicompartmental knee arthroplasty–a systematic review of the literature. Osteoarthritis And Cartilage, 24, S433. doi: 10.1016/j.joca.2016.01.784
