Patients with severe pain and stiffness that does not respond to conservative treatments or more moderate surgery may require total knee arthroplasty, commonly known as knee replacement, to relieve pain and restore function. Whereas in a healthy knee smooth cartilage cushions the connecting bone ends, when osteoarthritis develops, the resulting pain and stiffness may require surgical intervention.
In a total knee arthroplasty, the damaged ends of the bones are removed and replaced with a prosthesis made of metal and plastic. These artificial parts allow the joint to move smoothly so the patient experiences pain relief and a better quality of life.
Total Knee Arthroplasty Procedure
The total knee replacement procedure is performed under general anesthesia. During the procedure, an incision is made in the knee to access the joint so the damaged bone and cartilage can be removed. Once the damaged tissue is removed, the prosthetic device is inserted and may be either cemented or pressed into place. Cemented knee replacements are most commonly used and are fixed into the joint for immediate support. Press-fit knee replacements are designed to have the surrounding bone grow into the implant for long-term joint stability. The entire procedure takes about 1 hour. Nerve blocks and injections into the knee at the time of surgery help with postoperative pain.
Recovery from Total Knee Arthroplasty
After surgery, patients are taken to the recovery room, where they stay for 1-2 hours. Ambulation starts immediately with the use of a walker, and patients may go home the day of surgery or stay 1 night in a hospital setting. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort that can be managed with prescribed pain medication.
Physical therapy starts as soon as possible after surgery, usually the next day, to ensure rapid healing and restoration of full function. Most patients proceed to 2-3 physical therapy visits per week for 6 weeks total. Occasionally, patients may return home with home health therapy prior to beginning their outpatient therapy.
Patients in physical therapy progress from taking steps with a walker to walking without assistive devices on stairs and slopes. Range of motion of the knee is also a main focus, as it is imperative to achieve a specific amount of motion within the first 6 weeks postoperatively. Patients are also given exercises to perform at home to reinforce the rehabilitative process.
Risks of Total Knee Arthroplasty
Although considered a safe procedure for most patients, there are certain risks associated with all surgery. These risks include infection, excessive bleeding, blood clots, buildup of excessive scar tissue, limited range of motion, nerve damage, and implant rejection. For the great majority of patients, total knee arthroplasty is successful and uneventful, providing effective pain relief and greatly improved quality of life.