The goal of Total Knee replacement surgery is to relieve pain and restore function of the knee, when all non surgical options have not been successful in relieving the symptoms of arthritis. Arthritis leads to a degeneration of cartilage in the knee resulting in severe pain and loss of function. Osteoarthritis, also known as ‘wear and tear’ arthritis is more common in older people. It can manifest itself as a stiff and painful joint that may occasionally “lock” or “give way” during walking. This is due to the cartilage in the knee breaking down over time , resulting in a severely damaged joint surface with bone rubbing on bone.
Rheumatoid Arthritis is an inflammatory process that results in erosion of the articular cartilage and subsequent damage to the joint surface. In case of rheumatoid Arthritis it is recommended to replace all surfaces in the knee including the Patella.
Procedure
A total Knee replacement involves replacing your arthritic or worn out knee joint surfaces with an artificial implant made of titanium metal alloy and plastic. An incision is made over the front of the knee, to access the joint. Some bone is removed to make sure that the device fits accurately. The implant is then fitted into the surface of the femur and tibia and usually fixed in place with cement. Depending on the degree of wear behind your knee cap, a patella button can also be placed with cement, but this is not always necessary.
This surgery is performed under general anaesthetic or spinal anaesthetic. Most patients will be in hospital for 4-5 days following surgery
Risks
As with any type of surgery, risks include pain, bruising, bleeding, infection, thrombosis(blood clot) and complications arising from the anaesthetic. Your anaesthetist will explain this in more detail prior to your operation.
- Deep infection around the implant following a total knee replacement is rare (about 1%). This is very serious and would require further surgery to wash out the knee joint or even removal of the implant.
- Major life threatening blood clots have been described in literature, however these are rare (0.1%).
To reduce the risk of infection you will receive intravenous antibiotics before , during and for the first 24 hours after surgery. To reduce the risk of thrombosis you will usually receive daily enoxoparin injections whilst you are in hospital and then, in addition to this blood thinning medication for 15 days after discharge from hospital.
Results
The majority of patients (95%) are happy as they experience relief from most of their pain and they can walk pain free. Most patients (90%) regain the same range of movement that they had prior to surgery.
On average enough knee flexion is achieved to allow cycling and kneeling. Most patients can kneel better after surgery compared to before surgery, however the majority try to avoid kneeling as it does not ‘feel right’.
It may take up to 24 months post surgery to fully recover.
Rehabilitation
- Ice and elevation will be used early to reduce swelling and pain
- On the first post-op day your catheter will be removed from your bladder and the dressing will be reduced.
- The adductor canal block is very effective in reducing pain and allows you to walk and weight bear with crutches or walker on the first day
- On the third day the adductor canal catheter is removed
- You will be given a home exercise program with Instructions to guide you. Generally you will be discharged to return home on day 4-5.
Returning home
- You will be supplied with required painkillers
- For thrombo-prophylaxis, I usually I recommend to take a blood thinning tablet for 15 days after discharge
- Move furniture as needed to make adequate room for ambulation with crutches or walker
- Consult with your physiotherapist to determine any other home equipment needs prior to discharge
- Take your time when first standing up or when walking to make sure you are not dizzy or unsteady
- First follow up with me will be at 4-6 weeks in my rooms or earlier if there is a problem