Total Knee Replacement

Have you noticed lately that going downstairs or getting up after a period of sitting, is becoming more painful? Or perhaps you’ve been told by your GP that you have arthritis and your knee joint is “bone-on-bone.” Well here is a few facts about what in fact a total knee replacement surgery is and ways to manage your pain.

A total knee replacement or knee arthroplasty is a full or partial resurfacing of the closest bones to the knee joint. This is the end of the femur and top of the tibia (shin) bone. The surgery applies a metal shell to the femur, a metal plate to the shin bone, and a plastic “spacer” between these two surfaces. Occasionally they will replace the surface behind the knee cap, however, this will depend on the nature and severity of the diagnosis. This surgery is most common with advanced arthritis (Osteoarthritis/Rheumatoid), trauma, or reduced function with pain. Symptoms leading up to this may include pain, achiness, and joint stiffness.

As can be seen in the image, the surgery aims to replace the areas where the meniscus (the natural cushion between the bones) has worn down. Without this rubbery cushion, it is harder for the bones to glide smoothly through movement (such as bending or straightening) and also with weight-bearing.

As with all surgeries, there is always a degree of risk with invasive procedures such as a total knee replacement. Complications can include infection, ongoing instability, and knee pain. The risk of infection is greater in men than women and can be a risk factor for years down the track. Past medical history can also play a factor in the appropriateness of surgery. Careful consideration of all factors should be evaluated for surgery, included the risk vs benefit of the surgery.

As can be seen in the image, it is possible to elect to undergo a total or partial knee replacement. The right-hand image (above) is a partial replacement and is less invasive than a total replacement. As can be seen, in this type of surgery the major stabilizing knee ligaments (such as the anterior cruciate ligament ACL and posterior cruciate ligament PCL) are able to be spared. This is a discussion to have with your surgeon regarding your specific knee.

Before undergoing a joint replacement, research has shown that strengthening the surrounding muscles can assist with recovery postoperatively. Preparing your home environment and making sure you have adequate social support can also be vital post-operatively. If you live alone or have a high set house it may be worth staying somewhere with support for cooking and cleaning or potentially without stairs, especially if undergoing a bilateral knee replacement. Equipment such as over toilet frames and bathroom rails may additionally be of assistance.

Strengthening Exercises include:

• Static Quads
• Inner range quadriceps
• Clams

 After surgery, it is advisable to see a knee physiotherapist for follow up rehabilitation and a comprehensive strengthening program. At iMove Physiotherapy, we have experience with managing total knee replacements and would love to help you on your journey.

Read also: Total Hip Replacement

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