Total Knee Replacement (TKR) is a type of surgery in which arthritic or the worn-out rough surfaces of the knee joint are removed and replaced with artificial material. TKR is advised to a patient when the knee has reached end-stage and conservative measures don’t seem to work. The primary goal of TKR is to relieve pain and help you resume normal activities.
There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have:
Severe knee pain or stiffness that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.2) Moderate or severe knee pain while resting, either day or night.
There are no absolute age or weight restrictions for total knee replacement surgery. Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total knee replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.
The TKR surgery begins with pre-operative planning and complete medical assessment of the patient. Routine blood tests to check sugar and cell counts along with specialized tests to assess fitness are performed a week in advance. A physician and anesthetist clinically evaluate the patient for cardio-respiratory status. The patients are mostly admitted to a hospital at night before surgery or earlier if any, medical management for high sugar or blood pressure is needed.
An evaluation by an orthopedic surgeon consists of several components:
A medical history : Your orthopaedic surgeon will gather information about your general health and ask you about the extent of your knee pain and your ability to function. A physical examination: This will assess knee motion, stability, strength, and overall leg alignment.
X-rays : These images help to determine the extent of damage and deformity in your knee.
Other tests : Occasionally blood tests, or advanced imaging such as a magnetic resonance imaging (MRI) scan, may be needed to determine the condition of the bone and soft tissues of your knee.
A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones is actually replaced.
There are four basic steps to a knee replacement procedure.
- Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
- Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.
- Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
- Insert a spacer. A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
The success of your surgery will depend largely on how well you follow your orthopedic surgeon's instructions at home during the first few weeks after surgery.Wound Care
You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. The stitches or staples will be removed several weeks after surgery. A suture beneath your skin will not require removal.
Avoid soaking the wound in water until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings.
Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to help your wound heal and to restore muscle strength.
Exercise is a critical component of home care, particularly during the first few weeks after surgery. You should be able to resume most normal activities of daily living within 3 to 6 weeks following surgery. Some pain with activity and at night is common for several weeks after surgery.
Your activity program should include:
- A graduated walking program to slowly increase your mobility, initially in your home and later outside - Resuming other normal household activities, such as sitting, standing, and climbing stairs - Specific exercises several times a day to restore movement and strengthen your knee. You probably will be able to perform the exercises without help, but you may have a physical therapist help you at home or in a therapy center the first few weeks after surgery.