What is a Total Knee Replacement and when is it necessary?
A Total Knee Replacement (TKR) is a fairly common type of surgery suitable for people who have severe arthritis and pain which is causing significant, disabling effects on a person’s quality of life.
It is routine surgery that involves replacing a severely damaged knee joint with an artificial joint.
This solution is especially indicated when the prospective patient finds it hard to perform simple activities such as walking or climbing stairs, as well as if there is severe and persistent pain whilst lying down/ sitting or if severe deformity related to arthritis has developed.
A Total Knee Replacement can last anything from 10 – 15 years dependant on the level of activity of the person. It is often suggested that it should be performed for older adults who do moderate activity. It can also be performed on younger adults, but only if the case is severe and with the knowledge that more surgery will need to be done later on.
Are there complications to having a TKR?
As with any surgery, there are a few complications which may occur when having a TKR. These complications are rare, but can include:
- Stiffness of the knee
- Joint infection
- Unexpected bleeding into the knee joint
- Blood clots
- Ligament, artery or nerve damage of the knee
- Persistent pain of the knee.
Can a TKR be avoided?
Even though a Total Knee Replacement is relatively routine surgery, as indicated earlier, it can still be regarded as major surgery. This procedure is only recommended to patients who have tried conservative treatment for their pain. This includes Physiotherapy, exercise and steroid injections. If conservative management does not work to improve pain and function then a TKR is recommended.
There are some steps to avoid or prevent getting to the stage where knee surgery is required. These tips relate to general knee conditioning actions:
- Weight loss – maintain a healthy diet to ensure a suitable weight for your body. Increased weight can put more pressure on the knee joint and can result in “wear and tear” of the joint.
- Strengthening – it is important to strengthen your buttock muscles and thigh muscles in particular. These muscles allow you to move smoothly and take the load of movement and weight off the joint.
- Injections – if you have knee pain, and exercise and weight-loss have not resulted in improvement, there are steroid and other injections which can help the pain in order to allow you to continue with every day activities and exercise. Only a certain number of Injections can be done in the knee joint, so if they do not help, a TKR may be indicated.
What is Physiotherapy’s Role in Total Knee Replacement?
Physiotherapy plays a very important role in pre- and post-surgical management of a TKR:
a) The surgeon may send the patient to Physiotherapy before the operation in order to have Pre-Operative Physiotherapy, which aims to:
- aid in gaining strength before the operation
- educate the patient about the operation
- teach the patient how to walk with crutches and to do exercises that will be done post- surgery, as well as
- discuss the plan for rehabilitation after the operation.
It has been shown that even one pre-operative session can shorten the hospital stay of patients and is thus highly recommended.
b) Immediately following the surgery, the surgeon will request that the patient be seen by a Physiotherapist:
- Recent research in the UK has suggested that the first session of in-hospital Physio is performed on the same day of surgery, once the patient is back in the ward and awake and alert.
- Physio will assist in teaching the patient to walk with crutches or a walking frame, how to safely go up and down stairs, regain movement in the knee and start some simple strengthening exercises.
- Patients are discharged usually after five days, or once they are able to walk safely on their own.
c) Following discharge, it is the role of the Physiotherapist to:
- help with return to normal function,
- ensure that the patient regains most of their movement,
- ensure that movement is pain-free,
- help patients with strengthening exercises and a slow return to everyday activities.
Have a look at this Knee Workout chart to get an idea of these exercises.
Further generally guidelines indicate that patients can stop using a walking aid (eg walking frame or crutches) about six weeks after surgery and are able to start driving 12 weeks after the operation.
Physiotherapy should start immediately after a patient’s discharge from hospital and continue until they have completely returned to normal daily activities and exercise.
If you are suffering from knee pain and are unsure about how to help or alleviate the symptoms, then seek an assessment from your Physiotherapist, who can provide you with a suitable exercise programme and assist in pain management using hands-on techniques.