Knee replacement surgery is among the most common operations in the field of orthopedics.
The knee joint is formed by the lower end of the femur, the upper end of the tibia and the kneecap (patella). The joint surfaces on these three bones are covered by articular cartilage, a soft substance that protects the bones and allows them to move easily.
The knee joint may lose its normal structure and functioning due to various diseases, including osteoarthritis as the most common one, trauma, or wearing off over time. This condition is frequently manifested by pain, laxity, and reduction in the range of motion of the knee joint.
When a problem occurs in the above mentioned parts of the knee joint and it cannot be solved by medication and physical therapy, your surgeon cuts the damaged parts of these bones and places the artificial joint made of metal alloys or other suitable materials.
Why is this procedure done?
Your knee is among the most important joints of your body. Having healthy knees is a must to perform daily life activities.
If your knee is severely damaged due to arthritis or injury, it becomes difficult to do routine daily life activities such as climbing stairs, walking or going uphill. For initial stages, motions of the knee joint cause pain, but you may feel pain even at rest as the damage progresses.
If medication treatment, physiotherapy and rehabilitation and use of walking aids cannot manage the pain and do not help to maintain the function of the knee joint, total knee replacement may be considered.
Most common cause of the chronic knee pain and disability is arthritis. Although there are many types of arthritis, only three of them account for most knee pains: osteoarthritis, rheumatoid arthritis and post-traumatic arthritis.
The rate of complication after total knee replacement is low, but as the case for all surgeries, total knee replacement also involves some risks.
Although all possible measures that modern medicine allows are taken to prevent occurrence of risks, it is no means possible to warrant that the risks will be completely eliminated.
These risks may be related to surgery and anesthesia, but there are also some risks that may be faced after the surgery.
Potential risks of total knee replacement are as follows:
- Persistence of the knee pain
- Clot formation in the leg veins and migration of the clot to other body parts
- Anesthesia-related complications
- Damage of the nerves and blood vessels around the knee
- Wearing of the implant (artificial knee joint) over time
- Failure to obtain desired range of motion in knee joint
When these complications occur, albeit rare, recovery time may prolong, complete recovery might fail or revision surgery might be required. You should inform your orthopedic surgeon about your concerns before the surgery.
Your surgeon will explain in detail whether those risks apply to you or if so, the rate of occurrence.
The first phase of preoperative preparation is same in all Medicana Hospitals. Decision of total knee replacement is made by your orthopedic surgeon based on a series of tests and examinations. Your doctor will make a comprehensive assessment to determine whether this surgery helps your complaints or not. All other treatment options, including but not limited to medications, injections, physiotherapy and other surgical procedures, are taken into consideration.
- Review of health history
- A detailed physical examination
- Necessary laboratory tests and radiology studies
- Assessment by anesthesiologist and other laboratory tests and radiology studies to minimize anesthesia-related complications
After it is verified that the surgery does not pose risk, you will be asked to quit smoking, if you are a smoker, and to stop taking certain medications that increase risk of bleeding. All other prescribed and over-the-counter medications, herbal products and supplements will also be questioned and you will be informed to continue or stop taking them.
A preoperative discussion with your orthopedic surgeon about total knee replacement is very important. All details of the procedure, potential risks and healing period are explained.
You will also be instructed to stop eating and drinking at a particular time before the surgery and you should strictly follow this instruction in order to undergo the surgery at the scheduled date.
Moreover, it is reasonable to plan discharge, post-discharge accommodation and travel at this phase in order to manage postoperative period better.
Surgery and early postoperative period
After you are hospitalized, preparations are completed and your anesthesiologist will assess you to determine the best anesthesia technique. Orthopedist will first cut the damaged cartilage and bone and prepare them for joint replacement. Artificial (prosthesis) knee joint, which is made of metal alloy or other suitable materials, is then placed so as to take over the function of the knee joint. Artificial joints are attached to existing bones and surrounding tissues using screws, plates and other fixation materials. The range of motion of the knee joint is checked once more before the surgery is completed.
Our physiotherapist will help you to learn how to use your new knee joint, but moving your knees and legs after the surgery will not only facilitate wound healing, but it will also contribute to the success of the surgery.
You will be given pain killer(s) after the surgery in order to manage the postoperative pain. The swelling in and around the incision line will regress over time. You may also need to use antibiotics to prevent a possible infection.
It is very important that you follow all instructions of your doctor after the surgery to protect and support the outcome of the surgery.
You should see your surgeon for follow-up visits that are scheduled before you are discharged.
If you experience warmth and redness in your incision line, or if you have a fever or any symptoms that you think are due to surgery after you are discharged, contact your surgeon immediately.
You will need inpatient care for several days after the surgery. At this time interval, both your overall health will be stabilized and your joint will be adapted to post-discharge period by physiotherapy procedures.
Always remind that postoperative pain is a natural component of the recovery. Your doctor and nurse will take necessary measures to manage your pain.
More than 90% of patients, who undergo a knee replacement surgery, experience a substantial regression in knee-related complaints, including pain, and substantial improvement in daily life activities.
Prosthetic material will certainly wear, including normal use, after the surgery. Excess activity may accelerate the wearing. Laxity may develop and knee prosthesis may cause pain. Therefore, it is extremely important that you do the exercises and avoid all activities instructed by your surgeon.
Physical Medicine and Rehabilitation
Most patients start exercising with their knees the day after the surgery. If necessary, walking aids are also used Our physiotherapists will instruct you specific exercises to strengthen your leg muscles and to demonstrate the correct use of your artificial joint.
Moreover, your surgeon may ask you to use continuous passive motion (CPM) device that moves your knee slowly while you are lying on the bed.
If you strictly follow all instructions, you will probably start doing all routine daily life activities, with no restriction, within several weeks. However, time is required for sufficient strengthening and elasticity of muscles.