Total Knee Replacement
A total knee replacement (TKR) or total knee arthroplasty is an operation to replace a knee joint that is affected by arthritis.
Total Knee Replacement surgery replaces the arthritic knee joint with highly specialised metal and plastic implants.
The artificial knee joint is made from a surgical-grade metal alloy with a special wear resistant plastic insert. Total Knee Replacement is one of the most successful operations available today with over 90% still functioning well at 15 years.
Prior to surgery you will usually have tried some conservative treatments such as simple analgesics, weight loss, anti-inflammatory medications, modification of your activities, walking aids, or physical therapy.
When these measures have failed it is time to consider surgery.
Who is suitable for Total Knee Replacement?
The procedure is usually recommended for patients who suffer from pain and loss of function from arthritis that has not responded to conservative methods of therapy.
Each patient is assessed individually but total knee replacement may be indicated for patients who are:
- Suffering pain, and
- Have restricted mobility that is interfering with their lifestyle
Benefits of Total Knee Replacement Surgery
The decision to proceed with TKR surgery is a cooperative one between you, your surgeon, your family and other medical professionals.
The benefits following surgery are relief of symptoms of arthritis. These include
- Severe pain that limits your everyday activities including walking, shopping, visiting friends, getting in and out of chair, gardening, etc.
- Pain waking you at night
- Deformity- either bowleg or knock knees
The benefits are that older patients or severely arthritic patients have a clear solution to help relieve symptoms and pain.
Components of a knee replacement
The artificial knee joint consists of:
- An upper metal component shaped and sized to fit the end of the femur
- A flat metal tibial component made of metal alloys fixed to the bone
- A plastic insert designed to bear significant wear
- A patellar button which resurfaces the back of your knee cap.
Total Knee Replacement Procedure
The procedure is designed to be performed with minimal local trauma
- The knee joint is exposed using a minimally invasive approach
- The damaged portions of the femur and tibia are then cut at the appropriate angles using a high tech intra-operative computerised navigation system
- Trial components are then inserted to check the accuracy of these cuts and determine the thickness of plastic required to place in between these two components.
- The patella (kneecap) will be resurfaced in most cases. 80% of the natural kneecap is retained
- The real components are then inserted with or without cement and the knee is again checked for implant fit, alignment and stability
- The knee is then carefully closed with dissolving sutures and skin glue. Sterile waterproof dressings and a compression bandage are applied.
Each knee is individual and knee replacements take this into account by having different sizes for your knee. If there is more than the usual amount of bone loss, sometimes extra pieces of metal or bone are added. Custom implants are occasionally required.
Preparations Prior to Replacement Surgery
Once it is decided that surgery is required, preparation is necessary to achieve the best results and a quick and problem free recovery.
Preparing mentally and physically for surgery is an important step toward a successful result.
- A treatment plan will be created specifically tailored for you
- I will need a complete list of your medications so that I can advise which ones should be stopped prior to surgery
- The admitting hospital will advise you of the fasting time and your arrival time on the day before surgery
- Do not eat or drink anything, including water, for 6 hours before surgery
- Stop taking aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding one week before surgery
- Stop or cut down smoking to reduce your surgery risks and improve your recovery
- Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
- Consider losing weight (if overweight) before surgery to help decrease the stress on the new joint.
- Treat any tooth, gum, bladder or bowel problems before surgery to reduce the risk of infection
Report any infections to me prior to surgery as the procedure cannot be performed until all infections have cleared up.
Risks of Knee Surgery
As with any major operation, knee replacement surgery has potential risks and complications. Surgical complications may include:
- Stiffness of the knee
- Blood clots
- Damage to local tissue
Please discuss with me or my staff any concerns you may have before any procedure.
After Your Replacement Surgery
After your operation you will have a drip in your arm for pain medication and antibiotics.
You may need between 3-5 nights in hospital, followed by a stay in a rehabilitation facility.
Crutches are required for 1 – 2 weeks following the replacement.
Going Home After Replacement Surgery
Remember to arrange for someone to take you home, as driving is not recommended for several weeks following knee replacement
Return to Work
You may return to light work duties after 3-4 weeks. You will not be fit to perform work duties that involve:
- Prolonged standing,
- Heavy lifting,
- Bending or
- Excessive stair climbing
for a minimum of 6 weeks.
Postoperative Recovery Plan
My Total Knee Replacement Rapid Recovery Plan will assist you in recovering from surgery in the shortest time frame possible, and should assist in the long term function of your new knee.
Recovery from Knee Surgery will usually take about 3 months, and you can expect the knee to improve for 12 – 18 months
The physiotherapist will prepare an exercise program. Much of the exercise program can be done at home or at a gym, under your physiotherapist’s guidance.
Total Knee Replacement Rapid Recovery Plan
A structured plan to assist you to recover from knee replacement in the shortest possible time and to improve the long term function of your new knee
- Quadriceps strengthening exercises using weights or resisted cycling
- Minimally invasive tissue sparing surgical technique
- Customised implants with computer assisted pre-operative planning and intra-operative surgical navigation to ensure optimal implant positioning and alignment
- Limited tourniquet use to minimize tissue ischaemia
- Carefully placed injections of long acting local anaesthetic into the joint capsule for post-operative pain relief
- Use of IV and local Tranexamic acid to minimize bleeding and swelling post-surgery
- Scientifically based and proven medication regime for early post-operative comfort allowing early mobilization
- Use of the continuous passive motion machine
- Use of IV Dexamethasone and local corticosteroids as indicated to assist with pain relief and recovery
- Early mobilization and full weight bearing
- Early transfer to a rehabilitation facility for more intensive physiotherapy
- Early hydrotherapy
The Rapid Recovery Plan is tailored specifically to you and will involve some or all of the measures listed above