If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.
Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. The procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers.
In determining whether a knee replacement is right for you, an orthopedic surgeon assesses your knee’s range of motion, stability and strength. X-rays help determine the extent of damage.
Knee replacement surgery usually comes down to a personal decision because the most important input comes from you. Sometimes, a knee with a “bad” X-ray feels okay, while a knee with an “okay” X-ray causes pain with every step. You’re the only one who really knows what day-to-day life is like with your knees.
The 12 weeks following surgery are very important for recovery and rehab. Committing to a plan and pushing yourself to do as much as possible each day will help you heal faster from surgery and improve your chances for long-term success.
What Is A Knee Replacement Surgery?
Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.
Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee.
The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments.
What Are My Alternatives To Knee Replacement Surgery?
Knee replacement surgery isn’t always the best option for treating knee pain or problems with mobility. In some cases, a doctor might recommend:
- Limiting your activities, particularly those that cause knee pain
- Physical therapy
- Anti-inflammatory medications
- Assistive devices like a cane or rollator (walker)
- Chondroitin sulfate
- Glucosamine
- Cortisone injections in the hip (including intra-articular, ultrasound-guided injections)
- Weight loss program
Types Of Knee Replacement Surgeries
The type of knee replacement that offers the best results will depend on your situation. Types of knee replacement surgeries include:
- Partial knee replacement
- Total knee replacement
- Revision (or complex) knee replacement
- Patellofemoral (kneecap) replacement
Partial knee replacement
A partial knee replacement is also called partial knee resurfacing, or a unicompartmental knee replacement. It’s said to feel more natural than a total knee replacement. There are certain criteria, however, that determine whether this procedure is a better option than a total knee replacement. A partial knee replacement is usually recommended over total knee replacement when:
- Arthritic damage is limited to one compartment of the knee
- The patient has healthy ligaments and an intact ACL
- There is cartilage damage with minimal knee alignment problems
Other factors like age, range of motion, bone structure and exercise frequency may be considered to limit the possibility of needing total or revision knee replacement in the future. Partial knee replacements can last as long as total knee replacements.
Partial knee replacement recovery: what to expect
Due to the smaller incision, the recovery timeline for a partial knee replacement is shorter than a total knee replacement. Most patients are able to go home the same day but some will spend one night in the hospital. Soon after surgery, patients will begin to perform range of motion exercises and will be asked bear weight on the replaced joint.
Most patients can walk without an assistive device within a month after surgery. Expect it to take about six weeks to feel like your knee is recovered to the point where you can resume normal activities.
Total knee replacement
Also known as total knee arthroplasty, a total knee replacement removes damaged parts of the knee and resurfaces the bone with a prostheses. The knee is then repositioned into proper alignment, replicating the original function and restoring a near-normal range of motion. Total knee replacement is typically recommended after all other options have been either exhausted or ruled out. The most common reasons for having total knee replacement surgery are:
- Severe pain or stiffness limits everyday activities
- Knee pain interferes with sleep
Total knee replacement recovery: what to expect
Most patients will be ready to go home either same day or within two days following a total knee replacement, pending medical clearance. Physical therapy will start as soon as possible. At six weeks, daytime pain usually decreases significantly, but at nights you will likely still be a little sore. Most patients can expect their new knee to feel fully functional to the point where they can resume normal activities within three to six months.
What Causes A Painful Knee?
When one or more parts of the knee are damaged it can become painful and movement becomes restricted. Over time cartilage (the smooth covering at the ends of the bone in the joint) starts to crack or wear away. When this happens the bones making up the joint, rub together.
No matter what age you are, a knee problem may keep you from activities you enjoy. Pain and stiffness may even limit your day-to-day activities. Problems with the knee joint tend to build up over time.
Any of the problems below may lead to joint damage and hence knee pain…
OSTEOARTHRITIS
As time goes by, normal wear and tear can add up. Cartilage may begin to wear away (osteoarthritis). As the bones rub together they become rough and pitted. Previous menisectomies and damage to the anterior cruciate ligament inevitably lead to osteoarthritis.
INFLAMMATORY ARTHRITIS
This is a group of conditions where the lining of the joint becomes inflamed and secretes material that destroys the joint cartilage. In these conditions more than one joint is usually affected. The joints are hot, swollen and painful and deformity is common.
AVASCULAR NECROSIS
This can occur for no reason (idiopathic) or can be secondary to a number of conditions such as long-term use of alcohol or steroids. It is due to loss of blood supply to the bone. If the bone dies (necrosis), the joint will become arthritic. This pain often comes on quite suddenly and may increase rapidly. This can happen at any age. There are many other causes of this condition but they are rare.
A bad fall or blow to the knee can break (fracture) the bone. If the broken bone does not heal properly the joint may slowly wear down like a tyre that is not balanced.
LIGAMENT INJURY
Injuries to ligaments causing instability of the knee can and usually do lead to premature arthritis.
CHILDHOOD KNEE PROBLEMS
Occasionally knee pain results from a problem, which may have started in childhood such as osteochondritis dissecans, trauma, and juvenile rheumatoid arthritis.
Note – Osgood Schlatters disease does not cause arthritis.
INFECTION
Infection can destroy the cartilage lining leading to osteoarthritis.
A bad injury that did not heal properly
Long term exposure to sports or heavy manual labor
Other rare diseases affecting bones or soft tissues can also cause severe pain in the knee and may lead to arthritis
Before The Total Knee Replacement Surgery Procedure
- Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
- Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- If you are pregnant or suspect that you are pregnant, you should notify your doctor.
- You will be asked to fast for eight hours before the procedure, generally after midnight.
- You may receive a sedative prior to the procedure to help you relax.
- You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
- Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
- Based on your medical condition, your doctor may request other specific preparation.
During The Procedure
Knee replacement requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Knee replacement surgery is most often performed while you are asleep under general anesthesia. Your anesthesiologist will discuss this with you in advance.
Generally, knee replacement surgery follows this process:
You will be asked to remove clothing and will be given a gown to wear.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on the operating table.
A urinary catheter may be inserted.
If there is excessive hair at the surgical site, it may be clipped off.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The doctor will make an incision in the knee area.
The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis.
The knee prosthesis is made up of metal and plastic. The most common type of artificial knee prosthesis is a cemented prosthesis.
Uncemented prostheses are not commonly used anymore. A cemented prosthesis attaches to the bone with surgical cement.
An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis.
Sometimes, a combination of the 2 types is used to replace a knee.
The prosthesis is generally comprised of 3 components: the tibial component (to resurface the top of the tibia, or shin bone); the femoral [thigh bone] component (to resurface the end of the thighbone; and the patellar component (to resurface the bottom of the kneecap that rubs against the thighbone).
The incision will be closed with stitches or surgical staples.
A drain may be placed in the incision site to remove fluid.
A sterile bandage or dressing will be applied.
After The Procedure
In the hospital
After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Knee replacement surgery usually requires an in-hospital stay of several days.
It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. A continuous passive motion (CPM) machine may be used to begin the physical therapy. This machine moves your new knee joint through its range of motion while you are resting in bed. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.
You will be discharged home or to a rehabilitation center. In either case, your doctor will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.
At home
Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.
To help reduce swelling, you may be asked to elevate your leg or apply ice to the knee.
Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Notify your doctor to report any of the following:
- Fever
- Redness, swelling, bleeding, or other drainage from the incision site
- Increased pain around the incision site
You may resume your normal diet unless your doctor advises you differently.
You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery may take several months.
It is important that you avoid falls after your knee replacement surgery, because a fall can result in damage to the new joint. Your therapist may recommend an assistive device (cane or walker) to help you walk until your strength and balance improve.
Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:
- Proper handrails along all stairs
- Safety handrails in the shower or bath
- Shower bench or chair
- Raised toilet seat
- Long-handled sponge and shower hose
- Dressing stick
- Sock aid
- Long-handled shoe horn
- Reaching stick to grab objects
- Removing loose carpets and electrical cords that may cause you to trip
- Avoiding stair-climbing until recommended by your doctor
Results
For most people, knee replacement provides pain relief, improved mobility and a better quality of life. And most knee replacements can be expected to last more than 15 years.
Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car, if you have enough muscle control to operate the brakes and accelerator, and if you’re not still taking narcotic pain medications.
After recovery, you can engage in various low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.
Currently, more than 90% of modern total knee replacements are still functioning well 15 years after the surgery. Following your orthopaedic surgeon’s instructions after surgery and taking care to protect your knee replacement and your general health are important ways you can contribute to the final success of your surgery.
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