What is knee replacement surgery?

What is knee replacement surgery?

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Knee replacement, also known as knee arthroplasty, is a surgical procedure that involves reconstruction and replacement of degenerated joints with an artificial joint, called a prosthesis.  The primary goal of this procedure is to relieve pain, restore and improve functional status and the quality of life in individuals with severe knee arthritis or other conditions that have significantly impaired the knee joint.

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The knee joint is designed for mobility and stability, it supports the body when standing and it is a primary functional unit in walking, climbing, running and sitting activities. The bones of the knee joint are composed of the femur (thigh bone), tibia (shin bone), and patella (kneecap). Over time, the cartilage that cushions the joint surfaces may wear away, resulting in bone-on-bone contact, pain, stiffness, and limited mobility. 

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During a knee replacement procedure, the damaged surfaces of the knee joint are removed, and they are replaced with prosthesis. The knee prosthesis is made up of metal, ceramic or plastic, it is usually composed of three components; the femoral component (to resurface the thigh bone), tibial component (to resurface the shin bone), and the patellar component (to resurface the knee cap). The prosthetic components are designed to replicate the shape and function of a healthy knee joint, allowing for smoother movement and reduced friction.

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There are two main types of knee replacement surgeries:

1. Total knee replacement (TKR) or total knee arthroplasty (TKA): In a total knee replacement, both the femoral and tibial surfaces are replaced with prosthetic components. This is the most common type of knee replacement surgery and is suitable for individuals with advanced arthritis affecting multiple parts of the knee, primarily in older patients with osteoarthritis.
2. Partial knee replacement (PKR) or unicompartmental knee arthroplasty (UKA): In a partial knee replacement, only the damaged portion of the knee is replaced with prosthetic components. This option is considered for advanced arthritis of just  the medial (inner) or lateral (outer) aspect of the knee. 

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What are the indications for knee replacement?

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Knee replacement surgery can be beneficial for individuals who have severe knee pain and functional limitations due to various conditions affecting the knee joint.The following are the common indications for knee replacement: 

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1. Knee Arthritis (inflammation of the knee joint): It is the most common condition that causes severe damage to the knee joint and the primary indication for knee replacement surgery. 
2. Osteoarthritis: The most common reason for knee replacement is osteoarthritis, a chronic degenerative joint disease  affecting the articular cartilage in the knee joint. The impairments from osteoarthritis lead to activity limitations and participation restrictions. When conservative treatments like medication, physical therapy, and lifestyle modifications no longer provide adequate relief, knee replacement may be recommended.
3. Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune, chronic, inflammatory, systemic disease that affects the joints, including the knees. In cases where the disease has caused progressive deformity, significant joint damage and pain, knee replacement may be a viable treatment option.
4. Post-traumatic arthritis: If a person has experienced a severe knee injury or fracture in the past, it can lead to post-traumatic arthritis over time causing chronic pain and impaired function, knee replacement surgery may be considered.
5. Knee deformity: Individuals with severe knee deformities, such as bow-legs (varus) or knock-knees (valgus), may experience pain and difficulty with movement. In such cases, knee replacement can help correct the alignment and improve function.
6. Failed previous knee surgeries: In some instances, individuals may have undergone previous knee surgeries that have not provided the desired relief or have resulted in complications. Revision knee replacement may be necessary to address the issues and restore function.

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It's important to note that knee replacement surgery is typically considered after failure of non-surgical treatments. The decision to undergo knee replacement is made on an individual basis after a thorough evaluation by a healthcare professional, usually an orthopedic surgeon. They will consider factors such as the severity of the condition, the individual's overall health and functional limitations, and the potential benefits and risks of the surgery.

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It is recommended to consult with a healthcare professional to discuss the specific condition, symptoms, and treatment options to determine if knee replacement is appropriate for an individual's unique situation.

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After knee replacement surgery: What to expect

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The recovery period and management program after knee replacement surgery may vary depending on the patient's postoperative status. Here is an overview of what you can generally expect after knee replacement surgery:

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1. Hospital stay: Most individuals will spend a few days in the hospital following knee replacement surgery. During this time, you will be closely monitored by the medical staff, receive pain management medication, and begin the initial stages of rehabilitation.
2. Pain management: Pain and discomfort are common after knee replacement surgery, but medication will be provided to help manage the pain. The medical team will work with you to find the most effective pain management plan that allows for comfort and mobility.
3. Physical therapy: Rehabilitation programs play a crucial role in the recovery process. You will start working with a physical therapist soon after the surgery to regain strength, range of motion, and function in your knee, you will also be given post operative instructions and will require the use of assistive devices on the first phase or rehabilitation 
4. Swelling and bruising: Swelling and bruising around the surgical site are normal after knee replacement surgery. You can expect these symptoms to gradually improve over time, with the help of ice packs, elevation of the leg, and prescribed medications.
5. Scar healing: You will have a surgical incision on your knee that will need time to heal. The incision site may initially appear red, swollen, and raised, but it will gradually heal and fade over time. It's important to follow your surgeon's instructions for wound care and keep the incision clean to minimize the risk of infection.
6. Gradual improvement: While you may experience immediate pain relief after the surgery, the full recovery process takes time. It's important to be patient and understand that improvement will occur gradually over several weeks to months. Each individual's recovery timeline may vary based on factors such as overall health, age, and adherence to rehabilitation protocols.
7. Follow-up care: Regular follow-up appointments with your surgeon and physical therapist will be scheduled to monitor your progress, address any concerns or complications, and adjust your rehabilitation program as needed.

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It's important to note that everyone's experience with knee replacement surgery and recovery can vary depending on the patient’s condition and status. Your healthcare team will provide personalized guidance based on your specific situation. 

Remember to communicate with your healthcare team about any concerns or questions you may have during your recovery period. By following their guidance and actively participating in rehabilitation, you can maximize the benefits of knee replacement surgery and regain function and mobility in your knee joint.

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How can physical therapy help? 

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Physical therapy has an important role in preoperative and postoperative management of patients who will undergo knee replacement surgery. Here's how physical therapy can help with knee replacement recovery:

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1. Pain management: Physical therapists can employ various techniques and modalities to help manage post-operative pain such as cryotherapy, ultrasound, and electrical stimulation to reduce pain and swelling around the surgical site.
2. Range of motion exercises: Physical therapists will guide you through a series of range of motion exercises to help restore flexibility and mobility in your knee joint. Typically after knee replacement, the knee is immobilized in a bulky compressive dressing or sometimes continuous passive motion (CPM) is initiated after surgery. The exercises will gradually progress from gentle movements to more challenging stretches, helping you regain the ability to fully bend and straighten your knee.
3. Strengthening exercises: Strengthening the muscles around the knee joint is vital for stability and optimal function. Physical therapists will guide you through exercises that target the quadriceps, hamstrings, and other muscles of the thigh and leg to improve strength. At the first phase of rehabilitation, muscle setting of different muscles is done and later on may progress and involve the use of resistance bands, weights, or weight machines.
4. Gait training: Learning how to walk properly with your new knee joint is essential. Physical therapists will provide gait training to help you regain a normal walking pattern, ensuring proper weight distribution to minimize stress on the knee joint. They may use assistive devices like crutches, walkers, or canes initially and gradually wean you off them as you gain stability and confidence.
5. Stability, balance and proprioception training: Physical therapists will incorporate exercises to improve your stability, balance and proprioception (awareness of your body position in space) such as: trunk stabilization exercises, weight shifting exercises while adhering to weight bearing restrictions, proprioception and balance activities from unstable and stable surfaces and eventually to walking without the use of assistive devices. These exercises will help you regain confidence in weight-bearing activities and prevent falls.
6. Functional training: Improving functional mobility is important after knee replacement surgery. Physical therapists will help you regain the ability to perform daily activities and functional movements safely. This may include basic functional mobility such as bed mobility, sit to stand transfers and later on will progress to more advanced functional training.
7. Education and home exercise program: Physical therapists will provide education on proper body mechanics, joint protection strategies, and activity modifications to ensure a successful recovery. They will also design a personalized home exercise program that you can continue independently to maintain and further improve your strength, flexibility, and function.
8. Monitoring and progression: Throughout your recovery, physical therapists will closely monitor your progress, adjust your treatment plan accordingly, and ensure that you are achieving the desired outcomes. They will work in collaboration with your surgeon and other healthcare providers to ensure a coordinated and comprehensive approach to your rehabilitation.

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Physical therapy after knee replacement surgery is typically started soon after the procedure and continues for several weeks or months, depending on your individual needs. It is important to actively participate in your physical therapy sessions, follow the guidance of your physical therapist, and adhere to your home exercise program to optimize your recovery and regain optimal function in your new knee joint.

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It is also important to note that postoperative physical therapy management, timeline for progression and recovery may vary depending on the type of knee replacement surgery that was done to the patient. There are also several exercise precautions that must be considered following knee replacement surgery.

Trust PeteHealth for knee replacement recovery

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