You and your health

Knee replacement

By JAMES D. LOMAX, MD
Posted 2/5/20

Knee pain is a common complaint for people of all ages. The most common cause of chronic discomfort comes from the degeneration of the weight-bearing internal knee structures from osteoarthritis. …

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You and your health

Knee replacement

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Knee pain is a common complaint for people of all ages. The most common cause of chronic discomfort comes from the degeneration of the weight-bearing internal knee structures from osteoarthritis. Certainly trauma, morbid obesity, or inflammatory diseases—like rheumatoid arthritis—contribute to the development of increasing chronic pain and difficulty in day-to-day functioning.

More than 50 percent of patients older than 65 have x-ray changes in the knee that indicate arthritis. When a person consults a physician with knee pain, non-operative options commonly prescribed are weight loss, aerobic exercises, use of non-steroidal anti-inflammatory medications, use of OTC medications like chondroitin sulfate, or hyaluronic acid or cortisone injections. There reaches a point when these measures no longer work, and that is when surgery is discussed.

Most people with knee pain are initially offered arthroscopic procedures that smooth out joint surfaces and trim out damaged cartilage. This often gives the person excellent relief of symptoms over an extended period of time. Because osteoarthritis is a chronic condition, symptoms do return. At this point, doctors and patients start discussing knee replacement.

This procedure involves cutting out damaged bone and cartilage from the femur (thighbone) and the tibia (shinbone) and replaces this with an artificial joint prosthesis made from metal, plastics and polymers. This article will give an overview of indications for this procedure, potential risks, rehabilitation and estimates of recovery times.

Indications for TKA (Total Knee Arthroplasty)

Currently, more than 700,000  TKA procedures are performed annually in the U.S. It is estimated that by 2030, this number will rise to 3.48 million. Indications for this procedure is trouble walking, getting out of a chair and stair climbing due to severe pain, after non-operative treatments have failed.

Potential Risks

It is estimated that there is an approximate 2 percent complication rate from this surgery. These complications can include infection, blood clot formation in legs, or potential pulmonary embolism, heart attack, stroke and nerve damage. These potential problems are addressed by the use of antibiotics pre- and post-surgery, use of blood thinner and aggressive rehabilitation. This therapy involves getting the person out of bed and walking as soon as possible, with home and office physical therapy on a regular basis. Because this is a commonly performed procedure, operative times have significantly shortened from the past; the person may be discharged from the hospital either the same day or next.

The procedure and what comes immediately after

This is major surgery and performed under general anesthesia. In rare cases, nerve blocks can be used with the patient awake, but lightly sedated.

Antibiotics are given prior to the surgery and immediately after the procedure.

The surgeon has a choice of different types and sizes of artificial joints that help with a better fitting prosthetic. Joints are expected to last 15 years with normal use.

During surgery your knee is placed in a bent position. A six to 10-inch incision is made over the top of the knee. The knee cap is moved aside and the surgeon then cuts out the damaged joint surfaces. The prosthetic parts are then attached to each joint surface. Pain medication is injected in the knee to aid with immediate post-op pain control.

You are taken to the recovery room where you are fitted with compression stockings to minimize blood clot formation. Anticoagulants are also given at this point. The family and patient are then shown bed and home exercises for the knee and breathing procedures to prevent lung infections.

At home post-surgery

Pain control after surgery is always a major concern of patients. Most knee surgeons have a written plan on ways of safely taking narcotic medication for the first few days. There is efforts to change over from narcotics to over-the-counter medications as soon as tolerated.

For the first two weeks, you will begin going to the physical therapy facility. You will be ambulating by the use of a walker or crutches. With assistance you will be encouraged to be able to walk 300-500 feet at a time. Stair climbing with assistance at least once per day. You will be encouraged to straighten your knee and bend to at least 90 degrees. Home exercises on your own are encouraged. These goals expand each week.

Most individuals can resume most daily activities three to six weeks after surgery. Driving is possible after about three weeks as long as the person can comfortably bend the knee and have enough muscle control to operate the brakes and accelerator without taking narcotic pain medications.

Most people can return to full normal activities, but are usually advised to avoid high-impact activities such as running, skiing or jumping.

Knee replacement surgery is a big surgery and the individual needs to have a clear understanding of its recovery time, and possible complications. This involves discussions with the surgeon and the facility where the surgery takes place, along with the physical therapist before the surgery. Also you need to plan for support at home 24/7 for meal preps, assistance in moving around your home, showering and possible toileting assistance and driving for the first two or three weeks.

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