Irrespective of the cause, arthritis may cause pain, stiffness and difficulty to perform activities of daily living. Even though the disease process of arthritis cannot be reversed, total knee replacement is not the only option. In a number of instances, arthritis can be very well managed by weight loss, exercises and activity modification. Physical therapy can help you to manage arthritis better, Different types of injections are available to help manage arthritis. There are different joint preservation surgeries available in appropriate patients. These surgeries are usually performed as day care surgeries and are aimed to preserve the natural joint, rather than replacing it.
A total knee replacement is a prosthesis that is used to replace a knee joint that is affected by arthritis. It consistents of several components:
Femoral component that is shaped and sized to fit to the contour of the end of the femur bone.
A tibial component which is flat and has a small stem attached to its undersurface. It sits on top of the tibia bone on the opposing side of the knee joint. Success story: Total Knee Replacement
Both the femoral and tibial components are made of metal alloys, comprising of cobalt-chrome or titanium. They are both fixed to the bone with a special polymer called “bone cement”
Between the femoral and tibial component is the plastic insert (“polyethylene insert) which locks in to the upper surface of the tibial component. The plastic is made of a special polymer called polyethylene which has been carefully manufactured to allow it last a long time with out wearing out. However, even with the latest manufacturing techniques, this still is similar to your articular cartilage in that it has a limited life span, and excessive forces are placed on it, it will wear out more quickly.
A patellar button which resurfaces the back of your knee cap. This is also made of polyethylene. This may not be replaced all the time, and it is at the discretion of your surgeon.
Decision to undergo a total knee replacement is purely individual. Here are a few reasons when you can consider a knee replacement.
Severe knee pain restricting you from doing your daily activities like walking, stairs, getting in and out of the chairs.
> Moderate or severe pain when you are resting
> Pain which disturbs your sleep.
> Failure to improve with the above mentioned treatment modalities.
I feel I am obese/ overweight. Can I still undergo Knee replacement?
There are no weight or age restrictions for this operation. The recommendations for surgery is based on a patient’s pain and disability, not age. Most patients who undergo total knee replacement surgery are between 50 to 80 years old, but each patient is individually evaluated. Total knee replacements have been performed successfully at all ages, from the young patient with juvenile arthritis to the elderly patient with degenerative arthritis. It is very important to have a detailed discussion with your surgeon before making a decision.
To have a successful outcome following a knee replacement, your expectations from the operation should be realistic. Following a total knee replacement you may expect your life style to be a lot like before surgery, but without pain. But to resume your everyday activities takes time. Your willingness to take part in the post operative rehabilitation and physical therapy may also have an effect on the ultimate outcome.
Soon after the surgery most patients are able to walk with support with in a day or two. before you are discharged from the hospital you may expect to accomplish most of the following goals:
>>> Getting in and out of the bed by yourself
>>> Acceptable pain control
>>> Walking with an assistive device like frame or crutches
>>> Able to perform prescribed exercises
>>> Over the next few weeks you may expect to slowly resume your normal activities
>>> You are allowed to drive once you have gained good control of your muscles and no longer taking narcotic pain medication. Your surgeon will determine the best time for you to resume driving.
>>> You can sleep in any position : on your back, to the side or on your stomach
>>> Return to work: depending on the nature of your work, it may take several weeks before you can resume.
>>> You are allowed to travel within a few weeks. Consult your doctor as to when you are allowed to travel without a significant risk of developing blood clots in your leg, especially during air travel. The knee replacement prosthesis can cause the metal detectors in the airport to raise an alarm. You may wish to carry a medical certificate/card with you.
Bend that you can achieve after surgery depends on a number of factors like the bend you had before the operation, your size and your bones. Most patients achieve enough bend to perform activities like climbing up and down the stairs and getting in and out of a chair. Even though you may be allowed to kneel, patients may find it uncomfortable. Discuss these issues with your surgeon before the operation.
Once you have recovered from the operation, you can expect to walk as much as you like without pain. Cycling, swimming and other low impact sports can usually be performed safely. You can play golf, light tennis and other low impact sports, but avoid anything that causes high impact on your knees like jogging, running and jumping.
You will have an incision in front of the knee. The incision may be as long as 10 inches or as short as 4 inches(if it is a mm I ally invasive procedure). After the incision, the knee cap is moved aside and the damaged bone and cartilage are replaced with metal and plastic components. These components are usually joined to the bone by acrylic cement. They combine to form a new knee joint that mimics the function of the natural knee. Most knee replacements take between 1.5 to 2 hours.
The brand and the design used by your surgeon depends on a number of factors. It depends on your age, weight, activity level and sex. It also depends on your doctors familiarity and experience with the device and also on the performance and cost. You should discuss these issues with your surgeon before the operation.
Any surgery with anaesthesia has risks. However, the complication rates and mortality from anaesthesia are generally low. Your anaesthetic team will discuss which anaesthesia is the best for you.
Although you are likely to experience some pain after the operation, it usually diminishes quickly over the new days. There are a number techniques available to control pain after surgery. Your surgeon may inject pain medication into your knee during surgery. You may have a catheter at the back or at the top of the thigh through which pain medication is administered. You may also be supplemented by intravenous and/or oral medication. After you have recovered from surgery, you should experience significantly less pain in your knee. But there is no way to predict the exact results. Your willingness to take part in physical therapy and make lifestyle modifications may have a significant impact on the ultimate result.
Studies have shown that more than 85 percent of the patients have a functioning prosthesis 15-20 years after the total knee replacement. However, wear and tear of the artificial joint can affect its performance and lifespan.
It is important to realise that complications can occur and are usually unpredictable. All due care is taken before, during and after the operation to try to ensure that complications do not occur. If the complication do occur, most of them can be managed well. Talk to your surgeon about complications before you undergo surgery.