Our agility depends on our bone strength, but a certain amount of wear and tear is quite normal, as we age. One of the major hindrances that would affect the motility of an individual with the age is knee pain.
The knee pain could be due to arthritis, injury, lack of bone strength or various other reasons and it can interfere with simple daily activities like walking or climbing up the stairs, making it a very difficult affair.
If not treated on time, the knee joints can pain even while sitting or lying down.
For the starters, the specialist may the start the treatment with conservative management that comprises medications and knee support band but if it proves no longer beneficial, the patient may have to go for total knee replacement.
Total knee replacement surgery was first performed in 1968 and it was one of the most vital orthopaedic surgical advancements of the twentieth century. Probably about 1,20,000 total knee replacement surgeries are done annually in India with a very high success rate.
Anatomy Of Knee
The knee is the largest hinge joint in the body, maintaining healthy knees is vital for performing daily activities. The knees comprise lower end of the thighbone (femur), upper end of the shinbone (tibia) and the kneecap (patella). The ends of these bones where they meet are enclosed with articular cartilage, a smooth substance that shields the bones by allowing it to move freely.
The menisci C-shaped wedges situated between the femur and tibia function as “shock absorbers”.
Large ligaments hold the femur and tibia and offer strength. All the other surfaces of the knees are covered by a lining called synovial membrane which produce a fluid that lubricates the cartilage, lowering friction to zero percent in a healthy knee.
Generally, all these membranes work in tandem, but any disease or injury can disrupt this coordination which results in pain, muscle weakness and reduced movement.
A knee replacement surgery is also known as knee arthroplasty or knee “resurfacing” as only the surface of the bones is replaced.
Four Main Types Of Knee Replacement Surgery:
Total knee replacement:
It is the common form where surgeon replaces the surface of the thigh bone and shin bone that connects to the knee.
Partial Knee Replacement:
Partial knee replacement is typically done if arthritis affects only one side of your knee and it is done through a minor cut.
This procedure replaces only the surface under the knee cap but has low success rate.
Complex (Or Revision) Knee Replacement:
This procedure may be needed if you have very severe arthritis or previously had more than one knee replacement surgery.
Prior to the surgery the patient is evaluated for certain tests and procedures which include physical examination, X-rays, blood test and MRI scan. Once the results are evaluated, the doctor will further discuss how total knee replacement works best to alleviate pain and improve your function.
Patient going for total knee replacement surgery requires a general or spinal anesthesia based on the patients’ health condition.
The knees will be laid in the bent position to expose surfaces of the joint. After making an opening for about 6-10 inches long, the surgeon moves away kneecap and cutbacks the injured joint surfaces. After repairing the joint, the surgeon implants the pieces of the artificial joint. Before closing the openings, the surgeon bends or rotates your knee, ensuring it works properly. The total surgery last for about 2 hours.
Recovery - What You Can Expect
Recovery and rehabilitation process play a pivotal role in helping the patient to get back on feet normally and restart an active lifestyle. Rehabilitation helps the patient to recover from the surgery quicker and also instills necessary confidence in the patient to get move back to normalcy.
Recovery and rehabilitation begin within the first 24 hours, patients would be made to stand and walk with the help of assisting devices like walkers, crutches and canes supervised and supported by a physiotherapist.
Physiotherapist provides the patient with exercises that strengthen muscles and motivates to move ankle and foot which improves blood flow to leg muscles and aids to prevent swelling and blood clots.
A nurse will assist the patient with dressing, bathing and using the toilet.
Patients are put on continuous passive motion (CPM) machine by the therapist that aids to keep the knee in motion that prevents the formation of scar tissue and stiffness due to immobility.
Physiotherapist assists the patient to walk for a short period using the supporting device and climb a few steps if possible. Patients are also advised to use a regular toilet instead of a bedpan. Patients are still put in the support of the CPM machine to promote movements.
The patient will be advised to do breathing exercises very often and gradually improve and increase the activity level.
Patients are made to stand and sit for a while without any help. Walk for at least 25 feet using a walker and climb up and down the steps using a walker. Try to attain 70* or 90* bending without the help of CPM machine.
At the time of discharge patient’s knee would be improving stronger and patient should be able to increase exercise and activity level. At discharge, the patient should be able to do the following:
The patient should strictly adhere to the exercises as taught. For the best outcome, follow all the instructions regarding the post-surgery wound care, diet and exercise schedule.
Knee Replacement Surgery Outcome
Knee replacement surgery delivers pain relief, enhances mobility and improves the quality of life and above all most knee replacements can be expected to prolong active lifestyle for more than 15 years.
Three to six weeks post-surgery patients can typically restart most of the regular activities like shopping and light household chores.
Post recovery and rehabilitation patient can involve in several low impact activities like walking, swimming, golfing or riding bike. But it is always better to limit high impact activities like jogging, skiing, tennis and sports that involve jumping. Always consult your orthopaedic surgeon in Chennai about restrictions.