Knee replacement, also called knee arthroplasty or total knee replacement, is a surgical procedure to resurface a knee damaged by arthritis. Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap. This surgery may be considered for someone who has severe arthritis or a severe knee injury.
Various types of arthritis may affect the knee joint. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the knees. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, can lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the cartilage of the knee.
The goal of knee replacement surgery is to resurface the parts of the knee joint that have been damaged and to relieve knee pain that cannot be controlled by other treatments.
There are two main types:
Total knee replacement is the more common of these two procedures.
Whether to have a knee replacement is a major decision. We may recommend you get a knee replacement if you have knee pain and restricted mobility that doesn’t improve with nonsurgical treatments like physical therapy. Chronic conditions, like arthritis, are the most common reasons for knee replacement surgery. However, a knee replacement may be the solution to a variety of knee problems, like severe fractures or deformities. More than 90% of people who get a knee replacement experience significant pain relief and improvement in their ability to perform daily tasks.
We will perform a physical exam and review your symptoms and medical history to ensure you’re a good candidate for knee replacement surgery. We will also discuss the best type of anesthesia for your procedure, including general anesthesia or a regional nerve block. Knee replacement surgery typically lasts 1-2 hours. During this time, we carefully remove damaged cartilage and bone from your knee and then position the prosthetic joint. After surgery, you may need to stay in the surgery center for a few days. We will work with you to develop a post-surgical rehabilitation plan that may include physical and occupational therapy and advise you on steps you can take at home, like adding a stable bench or chair to your shower.
Total knee replacement surgery generally takes about 60 to 90 minutes, but you should expect to be in the operating room for over two hours. Rehabilitation (physical therapy) will begin within 24 hours of surgery. After your surgery, the nursing staff will position you in bed and help you turn until you are able to move on your own. You may have a pillow between your legs if ordered by your surgeon. Very soon after surgery, a physical therapist will come to your room to teach you appropriate exercises and review your progress. Gentle exercises to improve your range of motion can help prevent circulation problems as well as strengthen your muscles.
Your rehabilitation program will begin as soon as you are medically stable and there are orders from your doctor to begin postoperative mobility. All patients begin rehabilitation within 24 hours of their surgery. Your motivation and participation in your physical therapy program is key to the success of your surgery and recovery. The physical therapist will assist you in the following activities:
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
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 the area of surgery 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. Be sure to discuss any concerns with your doctor prior to the procedure.
The choice on whether to have surgery to address arthritis of the knee joint depends on multiple factors, including:
Most patients progress to a straight cane, walker, or crutches within two or three days after surgery. As the days progress, the distance and frequency of walking will increase.
Patients are usually able to drive a car within three to six weeks after surgery and resume all other normal activities by or before six weeks. Complete recuperation and return to full strength and mobility may take up to four months. However, in many cases, patients are significantly more mobile one month after surgery than they were before they had their knee replacement.
In determining whether a knee replacement is right for you, an orthopedic surgeon assesses your knee’s range of motion, stability, and strength. X-rays help determine the extent of the damage. Your doctor can choose from a variety of knee replacement prostheses and surgical techniques, considering your age, weight, activity level, knee size and shape, and overall health.
For most people, knee replacement provides pain relief, improved mobility, and a better quality of life. And most knee replacements can be expected to last more than 15 years.
Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car, if you have enough muscle control to operate the brakes and accelerator, and if you’re not still taking narcotic pain medications.
After recovery, you can engage in various low-impact activities, such as walking, swimming, golfing, or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis, and sports that involve contact or jumping. Talk to your doctor about your limitations.