KNEE REPLACEMENT SURGERY
Knee joint replacement surgery may be total where both sides of the knee joint are replaced, or uni-compartmental where only one side of the knee joint is replaced. The procedure is performed by separating muscles and ligaments around the knee to expose the knee capsule, and then the inside of the joint.
 
Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to be more active. Your doctor may recommend it if you have knee pain and medicine and other treatments are not helping you anymore
 
Total Knee Joint Replacement Frequently Asked Questions (FAQ)
 

What is the main indication for doing a Total Knee Joint Replacement?

Firstly the main indication for doing a total knee joint replacement is the severity of the pain. Therefore to a large extent the decision to proceed with surgery rests with you, the patient.

 
Are there alternative procedures available for management of knee pain ?

Although alternative procedures are available for management of knee pain from arthritis, including stiffening of the knee or a realignment of the leg, these days the most common procedure is a knee replacement.

 
How long does a Total Knee Joint Replacement Operation take?

A Total Knee Joint Replacement operation takes two hours and you are in hospital for between five and seven days. Crutches are usually required for the first six weeks. These are provided by the hospital.

 

What is a Total Knee Replacement?

Total Knee Replacement represents one of the most important orthopaedic surgical advances of this century. It was first performed in 1968. Improvements in surgical materials and techniques since then have greatly improved the effectiveness. Total Knee Replacement is essentially a resurfacing procedure. Whilst not as common as total hip replacement, increasing numbers of total knee replacements are being performed in New Zealand

 
Why is Total Knee Joint Replacement necessary?

Most frequent reason for performing a total knee replacement is to relieve the pain and disability of severe arthritis. This may occur as a result of the wearing out of hyaline cartilage naturally or secondary to trauma. It can also occur as a result of inflammatory arthritis where the synovium produces chemical substances that attack the joint surfaces and destroy the hyaline cartilage.

The swelling, heat and stiffness that occur in a damaged joint are the signs of an inflammation. Inflammation is the body's natural reaction to disease and injury. Inflammation is usually temporary, but in arthritic joints it may be long lasting and can result in disability.

Because of the pain and stiffness, the person often avoids using the arthritic joint. Muscles around the joint tend to become weak, causing difficulties with movement and at times instability. This unsteadiness is contributed to by the joint surfaces becoming rough and irregular. When arthritis has caused severe damage to the knee joint, a total knee replacement may allow the person to return to everyday activities.

 
How do you diagnose an arthritic joint?
Diagnosing an arthritic joint involves taking a thorough medical history, noting the patient's symptoms, performing a physical examination, doing laboratory tests, and taking x -rays. By combining the information from all of these, an assessment of the extent of joint damage can be made.
 
What happens after diagnosis for arthritic joint has been made?
Once the diagnosis has bee made, treatment will initially consist of non-surgical measures such as anti-inflammatory and pain killing medication, physical therapy, possibly cortisone injection and the like. There are other surgical possibilities that your surgeon may feel are more appropriate to use before resorting to total knee replacement.
 
What is the Recovery Period Following a Total Knee Replacement?

The recovery period following surgery will vary from patient to patient. It is important to begin to use the new joint soon after the operation. You will be encouraged to being bending it and walking on it within a few days of the operation. You will normally use crutches or a walking stick for a period of a few weeks after surgery. Specific exercises to strengthen the leg will be given and may be supervised by a physiotherapist. The hospital stay is usually from 6 to 10 days. You will be unable to drive after Total Knee Replacement for at least 3 - 4 weeks.

It is common to have a quite a lot of discomfort initially after surgery. It is not unusual to have some level of discomfort for several months.

 
What are the Benefits of Total Knee Replacement?

More than 90% of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. Often people feel they have a more stable knee after their surgery. Total Knee Replacement will not allow people to do more than they could before they developed arthritis. Neither is their range of movement following a knee replacement restored to normal. Usually it is satisfactory for everyday requirements, bending to just greater than a right angle. You will find it takes several months to fully rehabilitate from this surgery.

 
What are the Risks of Total Knee Replacement?

There are risks with any surgical procedure. The person considering total knee replacement should tell the orthopaedic surgeon about any additional medical conditions that might complicate the surgery. Your regular doctor should be told of the proposed surgery. Before the operation, you should discuss with the anaesthetist the type of anaesthetics and potential risks involved.

 
What are the Possible Complications of Total Knee Replacement?

With ANY operation there are risks to nerves, blood vessels, bone, tendons, ligaments, muscle, skin and structures which are not intentionally injured but occasionally are so. The more common complications include:

 

  • INFECTION: The major potential complication of total joint replacement is infection. Fortunately, this is a relatively rare complication. It may occur just in the region of the wound or deep around the prosthesis. The knee is a superficial joint which means superficial infections can spread more deeply. An infection can occur while in hospital or after going home. It may very occasionally occur while in hospital or after going home. Superficial wound Infections can be treated with antibiotics. Deep infections may require further surgery and removal of prosthesis. Spread of infection from another part of the body to a joint replacement has been known to occur. To prevent such infection, persons with total joint replacements are generally given antibiotics before dental cleaning and more extensive dental procedures, as well as before some other types of surgery. If an infection occurs, elsewhere in the boyd, it must be treated promptly with antibiotics.
  • LOOSENING: Loosening of the prosthesis is a longer term problem after Total Knee Replacement. Loosening causes pain to the knee and may ultimately lead to a second knee replacement being required. It is hoped that most models of knee replacement will last many years before this occurs.
  • STIFFNESS: As previously mentioned, the regaining of a functional range of movement after a total knee replacement takes a good deal of work. There may be a residual loss of movement, usually the ability to bend the knee. Repeat surgery can sometimes be suggested to try and help this. Most often the final range of movement approximates the range that was present before the operation.
  • BLOOD CLOTS : Blood clots in the leg veins are the most common complication of knee replacement surgery. Usually these are minor but occasionally they will cause symptoms of swelling and pain. Very occasionally they may travel to the lungs. Various forms of prevention are used to minimise this risk - elevation; leg exercises; medications; foot pumps etc
 
Is Total Knee Replacement Permanent?

At this time there is no total knee replacement that can be guaranteed to last forever. However, the results of knee replacement are such that an older person can expect their total knee replacement to last their lifetime. A younger person who is quite active may have to have a second replacement at a later date once the replacement has become loose and painful.

Materials and surgical techniques continue to be developed by the combined efforts of orthopaedic surgeons, engineers, and scientists. The hope is that these efforts will lead to improved results from total knee replacement.

 

How is my new Knee different?

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending activities. Improvement of knee motion is a goal of total knee replacement, but restoration of full motion is uncommon. The motion of your knee replacement after surgery is predicted by the motion of your knee prior to surgery. Most patients can expect to nearly fully straighten the replaced knee and to bend the knee sufficiently to go up and down stairs and get in and out of a car. Kneeling is usually uncomfortable, but it is not harmful. Occasionally, you may feel some soft clicking of the metal and plastic with knee bending or walking. These differences often diminish with time and most patients find these are minor, compared to the pain and limited function they experienced prior to surgery.
 
Further Information Knee Replacement Surgery:
 
If you have any queries on Total Knee Joint Replacement Surgery please do not hesitate to contact Dr Hugh Blackley's practice rooms during office hours on 09 522 2980