Total knee replacement surgery (TKR) is replacement of the knee joint after degeneration of the joint, continuous pain, and loss of quality of life due to arthritis. TKR is an elective surgery for those who want to reduce pain or improve function of their knee joints.
Knee replacements falls into two categories: traditional or minimally invasive. Both involve replacement of the joint with the prosthetic, and are performed under general anesthesia.
Traditional surgery in the case of knee replacement is usually done using a long incision in the center of the knee to view and access the joint. Then, the bone is prepared by removing some cartilage at the ends of the femur and tibia. A prosthetic is put in place, and then the patella (kneecap) is cut and resurfaced with plastic. Minimally invasive surgery is similar to traditional surgery, but involves smaller incisions.
Who is a candidate?
Candidates tend to be older, between 55 to 70 years old. They should have already exhausted other nonoperative, more conservative approaches such as physical therapy, oral non-steroidal anti-inflammatory medications, weight loss, using a cane or walker, or using other cartilage-building medications.
They typically experience one or more of the following symptoms:
- Severe pain
- Significant loss of joint function
- Severe arthritis
- Osteonecrosis (dead bone) of the knee
Who is not a candidate?
Candidates who suffer from chronic knee pain and a decline in knee function may benefit from less invasive procedures such as arthroscopy (using a scope to examine the knee) to remove or repair damaged cartilage. Candidates under 55 should consider these options as more viable long-term solutions, as knee replacements will wear out in 10 to 20 years.
Candidates who suffer from an active knee infection or any other type of infection should postpone surgery until the infection has subsided.
Like other surgeries, TKR requires certain general surgery procedures such as preoperative blood testing, use of prophylactic antibiotic medications, and cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before the surgery.
Immediately after total knee replacement surgery, you will receive low dose blood thinners to prevent dangerous blood clots that can form in your legs. You will stay in the hospital for 3 to 5 days. You will begin your rehabilitative exercises, which will focus on range of motion, normal walking mechanics and thigh muscle strengthening.
After total knee replacement surgery, you can expect to return to your normal daily activities in approximately three to six weeks. Nevertheless, you should avoid running, jogging or high impact sports. The more active you are, the faster your prosthetic knee will wear out. Cycling, swimming and walking are encouraged forms of exercise. A regimen of physical therapy to help you adjust to your new joint is usually part of a long-term recovery plan.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. Other known complications include loosening of the prosthetic, necessity of revision surgery later on, and fracture of the bone holding the prosthetic. There is a small possibility of an allergic reaction to the prosthetic material, nerve damage, or complications arising from a blood transfusion (if one is necessary).
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