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There’s no specific time or age when you should have a knee replacement. But if you’re facing difficulty in getting up from the chair or bed, doing your daily tasks or walking a small distances, you may be a candidate. A thorough examination by an orthopedic surgeon is necessary for making the correct decision. Some investigations are needed and proper medical and clinical history is important for reaching the conclusion. Therefore it is always better to carry all the recent radiographs and previous medical records at the time of visit to an orthopedic doctor with the help of which he can give you proper advise.
For some, lifestyle modifications, physical therapy, medications, or alternative treatment methods can be effective to some extent in managing knee problems.
You may speak to your orthopedic doctor regarding all these options and their possible outcomes when you go for the consultation but these remedies are mostly effective if you have not ignored the symptoms and reported at early stage. Once the severity of the underlying cause is advanced beyond a certain stage then knee replacement may be the only remedy left. Your consulting doctor is the best judge to decide the extent of disease and you should not ignore the symptoms and report early.
But one thing should always be kept in mind that delaying or declining a necessary knee replacement could result in a less favorable outcome. Once you feel the severity of pain is increasing and your daily life activities are getting affected, then it is always better to go for the surgery as long term medication has its own side effects and other conservative treatment modalities may not be effective at this stage.
One may require either a total or a partial knee replacement depending upon the condition of the knee joints. In Total Knee Replacement (TKR) surgery, both sides of the knee joints are replaced with artificial implants. This is usually performed when the joint is severely damaged by Osteoarthritis, Rheumatoid Arthritis, and Post-traumatic Arthritis or due to Vascular Necrosis.
In a normal joint, the joint surface is covered by cartilage that provides a smooth articulating surface that allows for smooth movement within the joint, whereas in arthritic joint the cartilage is gradually worn out which causes the bones to rub against one another leading to pain and restricted range of motion. The goal of the surgery is to relieve pain and restore the normal functioning of the joint. Total joint replacement can be performed through two approaches: conventional approach or minimally invasive approach.
In the conventional approach, an incision is made over the affected joint. The arthritic part of the joint is removed and prepared to receive the artificial components. The artificial components are fixed in place and the muscles and tendons are then repaired and the skin is closed. It normally has longer recovery time due to more amount of bone cutting and risk of damage to supporting structures and soft tissue.
With advancements in technology, a minimally invasive approach has been developed in recent years where surgery is performed through smaller incisions. With the help of technology the precision has improved and there is a higher grade of accuracy. Advantages of the newer approach are lesser soft tissue damage, preserved bone, ligaments and soft tissue, minimal pain, quicker recovery and faster rehabilitation of the patient.
With newer technologies the operative time has also reduced and on an average it takes around 1-1.5 hours for the whole procedure.
Before surgery you will need to have a physical exam and preadmission testing, participate in preoperative education sessions with physiotherapists and prepare your home for when you return after surgery. These steps will help you achieve long-term success after your knee replacement surgery.
Implants are comprised of metal, ceramic and medical-grade plastic. They are all inert materials, tested and safe. To seal these components to your bone, two methods are used: application of bone cement, which typically takes about 15 minutes to set, and cement-less approach that uses components with a porous coating that grows into tissue or attaches to bone. Surgeon is the best judge to select the implant and its placement.
Any surgery with anesthesia has risks. However, complication rates are extremely low and patient doesn’t face any discomfort. There is a pre anesthetic checkup before surgery and anesthetist fitness is given before moving ahead. The patient is continuously monitored at each step in recovery phase and it happens smoothly therefore it is not a matter of major concern.
Although you’ll experience some pain after surgery, it should diminish quickly —It is a priority to control the pain after surgery and is a part of care plan post surgery. Your doctor will prescribe medication to help you manage the pain, which may be administered intravenously (IV) immediately after surgery or taken orally. After you’re discharged from the hospital, you’ll switch to painkillers taken in a pill or tablet form.
After you’ve recovered from surgery, you should experience significantly less pain in your knee, but there’s no way to predict how much pain will be there as it depends on person to person and also the associated factors like co morbidities, weight of patient and also on his will power — sometimes within the stay period at hospital only patient starts feeling no pain and a few may have it even after 3 months but such cases are very few and normally within 3 months period patients are free from most of their problems and go back to normal pain free life completely
Your willingness to engage in physical therapy and make lifestyle modifications can have a significant impact on your post surgery level of pain and recovery. Having nutritious high protein and calcium rich diet, optimum vitamin D levels also help a lot in faster recovery and getting rid of all the complaints.
You will be having a bandage around the knee and a drain may be there in place to avoid fluid accumulation in the joint space. With the advanced technology the blood loss is extremely less and many times it is not required to put the drain in place.
In addition, you may wear a compression bandage or sock around your leg to improve blood circulation or foot pumps to reduce the odds of a clot.
Your doctor will administer antibiotics intravenously, and you may receive anticoagulants (blood thinners) to reduce the odds of a clot.
Most people are up and walking the day of surgery or the next — with the aid of a walker or crutches. A physical therapist will help you bend and straighten your knee a few hours after your surgery.
After you return home, therapy will continue regularly for a month or more where the level of exercise will keep on changing during the period according to the rate of recovery, where you’ll be asked to engage in specific exercises designed to improve the functionality of the knee. If your condition is more severe, or if you don’t have the needed support at home, then you may take a help like a physiotherapists or nurse otherwise it is not necessary and after learning exercises you can easily perform them at home and Ice pack application is also very important. After surgery, your doctor will wean you from pain medication as per your recovery and clinical conditions, but in no case there is a requirement of prolonged rest, rigorous physiotherapy or heavy medicinal support in the recovery period.
When you first return back after surgery you may require certain modifications like height of bed, toilet seat is to be monitored. Although patients are given practice to climb stairs during hospital stay but if you have to climb many flights of stairs then it is always better to take support if lift is not there but again it depends upon your condition and there is no hard and fast rule for this as many patients are so much comfortable that without any help or discomfort they can easily climb the stairs with no break.
Make sure the house is free of obstructions and hazards including power cords, area rugs, clutter, and furniture. Focus especially on pathways, hallways, and other places where you’re likely to walk through just to avoid fall and also initially you may require use of a walker so it is always better to have an obstacle free space. It’s wise to make sure that handrails are secure and a grab bar is available in the bathroom you plan to use.
Normally there is a specific exercise protocol which is being set by Physiotherapist and it can be easily done at home with no requirement of any specific equipments. In some cases machines like CPM are required when there is excessive stiffness but that is not in every case.
Additionally, your doctor will prescribe any mobility equipment that you need, like a walker or crutch, also commode raise and stockinettes as well as ice packs will be needed.
You should be able to resume normal daily activities — such as walking and climbing stairs immediately from the very next day and bathing after 2 weeks
Low-impact exercise should also be doable within your rehabilitation period. Consult with your physical therapist about introducing new activities during this rehabilitation period.
You should avoid running, jumping, bicycling and other high impact activities.
Walking, swimming, cycling on flat surface and other low impact exercises are always recommended and good for maintain a healthy joint after surgery.
Discuss with your orthopedic surgeon and physiotherapist about any questions concerning your activities.
The implants used in surgery are time tested and their life is mostly more than 20-25 years. Patient are able to perform their daily activities with full efficiency and ease and lead normal lives and do not require Revision surgeries. Wear and tear of operated joint is associated with the activity level but it is observed that in spite of staying very active the revision surgery requirement is not there.
In certain cases where there is infection, injury to ligaments, fracture etc revision surgery may be required. It is being decided by surgeon after thorough examination and investigations and success rate is very high.
After surgery, you will notice discolored skin, some swelling and drainage around your incision. This is normal. If you experience painful redness, abnormal swelling or thick, bad smelling drainage from your incision, you might have an infection. Fever also could indicate an infection. If any of the abnormal symptoms observed you should report it to doctor to avoid any major complications.
Placing a pillow between your legs should help keep your knee comfortable and stable. You may sleep on your back or on either side, depending on what makes you most comfortable.
Taking antibiotics is a precaution to help ensure that your new artificial joint does not become infected. Additional surgeries or dental work increases the chances of infection. No matter where the infection starts, if it spreads to your new knee, the results could not be good. When artificial joints become infected, revision surgery may be needed. Please let your dentist or physician know that you’ve had joint replacement surgery. This is important no matter how small or straightforward the procedure.
As the knee arthritis worsens, the stiffness of the arthritic joint also worsens. This can make the replacement surgery technically more demanding. It may also lead to a longer recovery period and more physical therapy. In severe cases, joint flexibility may never return to normal. By waiting too long, you may not get the full benefits of your knee replacement surgery and such a delay could negatively impact the result of the surgery.
Knee Replacement Surgery can be carried out even in patients who are above the age of 75-80 years provided they are medically fit and are in good general health and their activities of daily living is restricted by painful arthritis of knee joints. With the increased life expectancy there is more need for older individuals to lead a healthy and active life and Knee replacement surgery can help them in doing that.