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Total Knee Replacement Precaution & Procedure

What is a Total Knee Replacement

total knee replacement precautions | Spire Orthopaedic

A total knee replacement is an invasive surgery in which the damaged compartment of the knee is replaced with an implant. It is also called a total knee arthroplasty

The knee can be divided into three compartments: patellofemoral, the compartment in front of the knee between the knee cap and thigh bone, medial compartment, on the inside portion of the knee, and lateral compartment which is the area on the outside portion of the knee joint.

Not all patients are suitable for this procedure. Total  knee replacement is a surgical option if your arthritis is more than a single compartment of your knee.

Various types of arthritis may affect the knee joint. Osteoarthritis is the most common degenerative joint disease that affects mostly middle-aged and older adults,  and it may cause the breakdown of joint cartilage and adjacent bone in the knees. They are other  causes of severe knee arthritis. These includes:-

  • Rheumatoid arthritis
  • Trauma

 

The main goal of a total knee replacement is to restore function to the damaged knee and to relieve pain that cannot be controlled by other treatments.

If medical/conservative treatments are ineffective, knee replacement surgery may be an effective treatment. Some medical treatments for degenerative joint disease may include but are not limited to the following:

  •  Anti-inflammatory medications
  •  Glucosamine and chondroitin sulfate
  •  Pain medications
  •  Limiting painful activities
  • Assistive devices for walking (such as a cane)
  • Physical therapy
  • Cortisone injections into the knee joint
  • Viscosupplementation injections (to add lubrication into the joint to make joint movement less painful)
  • Weight loss (for obese people)

What are the risks of undergoing a total knee replacement?

As with any surgical procedure, complications can occur. 

Some possible complications may include, but are not limited to the following:

  • Bleeding
  • Infection
  • Deep Venous Thrombosis – blood clots in the legs which may then travel to the lungs
  • Loosening or wearing out of the prosthesis-  this may require a revision to a total knee replacement if this occurs
  • Fracture
  • Continued pain or stiffness

The replacement knee joint may become loose, be dislodged or may not work the way it was intended. The joint may have to be replaced again in the future.

Nerves or blood vessels in surgery area may be injured, resulting in weakness or numbness. The joint pain may not be relieved by surgery. There may be other risks depending on your specific medical condition.

How is the procedure for a total knee replacement performed?

  • The surgery is performed under spinal or general anaesthesia.
  • Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. The incision will be smaller than the standard total knee replacement operation. Then the damaged portions of the femur bone are cut at appropriate angles using specialized jigs with the help of computerised navigation
  • The femoral component is attached to the end of the femur with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. 
  • Next, the tibial component is secured to the end of the bone with or without bone cement. Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, like the original meniscus cartilage. 
  • The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution.
  • Lastly, the incision is carefully closed; drains are inserted, and a sterile dressing is placed over the incision.

How long does it take to recover from a total knee replacement?

You should be able to stop using your crutches or walking frame and resume normal leisure activities 4-6 weeks after surgery. Generally, speaking this operation allows for earlier weightbearing and return to normal function compared to the total knee replacement operation.

However, it may take up to 2-3 months for pain and swelling to settle down. It can take up to a year for any leg swelling to disappear.

What is the average hospital stay for a total knee replacement?

The average hospital stay after total knee replacement is 4-5 days and most patients spend several more days in an inpatient rehabilitation facility. 

Patients who prefer not to have inpatient rehabilitation may spend an extra day or two in the hospital before discharge to home.

 

What are the complications of a total knee replacement?

Complications can be medical (general) or specific to the knee​

  • Medical Complications include those of the anaesthetic and your general well being. Almost any medical condition can occur, so this list is not complete.​

List of possible complications include:-​

  1. General (including anaeshetic related risk) :-
  • Allergic reactions to medications​
  • Blood loss requiring transfusion with its low risk of disease transmission​
  • Heart attacks, strokes, kidney failure, pneumonia, bladder infections​
  • Complications from nerve blocks such as infection or nerve damage​
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death​

 

 

2. Procedure related risk :-

  •  Infection​
  • Blood clots (Deep Venous Thrombosis)​
  • Damage to nerves or blood vessels​
  • Wear​
  • All joints eventually wear out. The more active you are, the quicker this will occur. In general, 80-90% of knee replacements survive 15-20 years.​
  • Fractures around the prosthesis
  • This is rare but may occur during or after surgery. 

 

How long do you use a walker after a knee replacement?

You will probably use a walker for one to three weeks and then use crutches. When you are ready, you can use a cane. You will probably be able to walk on your own in four to eight weeks. You will need to do months of physical rehabilitation after a knee replacement.

How long do you use a walker after a knee replacement?

Exercising benefits your health and aids your recovery after surgery. 

It is the best to moderate these exercises after knee replacement:

  • Running and jogging 

These activities stress your knee and can cause pain. If running is your passion, discuss with the doctor and physiotherapist. You can set a goal but start by walking.

  • Weight training 

Heavy lifting especially during squats and similar exercises, puts pressure on your joints. The physiotherapist may have safer suggestions or techniques for your new knee.

  • High-impact sports or aerobics

Sports like football and basketball combine the danger of running with the risk of hitting other players and damaging your knee.

  • Hiking

Hiking can be low impact, but trails with uneven ground and erupting roots or rocks can cause falls. Stick to even paths or trails if possible.

  • Skateboarding and rollerblading

These activities carry a significant risk of twisted knees and falls on concrete which would lengthen your recovery process.

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