Knee replacement surgery, also known as arthroplasty, is generally regarded as an effective treatment for end-stage knee arthritis. It results in an improved knee function and significantly relieves severe pain caused by degenerative joint diseases.
All knee replacement procedures are generally divided into 2 major groups, depending on whether the knee is replaced totally or partially. A knee joint is often compared to a hinge which allows to flex, extend and limitedly rotate the lower leg. Structurally it resembles three separate joints: slightly rounded end of the thigh bone forms 2 separate articulations with a slightly hollow end of the shinbone which has a mobile kneecap on top. The most common indication for total knee replacement is severe osteoarthritis that affects all surfaces of these synergic joints and causes pain which is unresponsive to medical management.
These significant structural changes are directly responsible for the main complaint after knee replacement surgery, which is stiffness and a lingering sensation of a foreign body placed inside the joint. All in all, a total knee replacement is one of the most successful examples of innovative surgery and has resulted in substantial quality-of-life gains for people with severe joint problems.
In comparison to a total knee arthroplasty, partial knee replacement may be defined as a less invasive surgical approach for patients with only moderate knee joint diseases. A great majority of degenerative joint diseases primarily affect the medial compartment of the knee joint. This is because a fibrous cartilage between the surfaces of the medial tibiofemoral articulation, also known as a medial meniscus, is relatively thinner and experience greater pressure while walking etc. The damaged component of the knee is replaced using the same method as in the total knee arthroplasty but without affecting the healthy parts of the joint. However, as flawless as partial knee replacement may sound, its biggest potential drawback is incomplete pain relief. The success of the surgery depends entirely on choosing the right candidate and carefully evaluating the extent of disease.
Careful preparation for knee replacement surgery is an important part of the procedure itself as it determines the success of the surgery and the quality of post-op recovery. Here are the main recommendations to be followed:
Increased body weight would, intuitively, be expected to lead to a poorer outcome after joint replacement as the knees are directly strained by overweight. A significant positive correlation has been observed between the wear damage seen on the components of knee prosthesis and the BMI of the postoperative patients. However, some recently published studies have proven that the perioperative complication rate in patients with BMI over 40 wasn’t dramatically higher than the rate in patients with lower BMIs. Moreover, it is now known that obese patients have relatively good pain relief and positive functional outcomes after the surgery. Therefore, a simple answer to the question about BMI limit is negative. Looking from a medical point of view, obesity is associated with many other comorbidities that affect one’s everyday life and well-being. That is why overweight should not be tolerated, and if a patient is able to lose weight they most definitely should do that.
The age limit for knee replacement patients is also of a debatable significance. Although the older patients require a relatively longer hospitalization time and have higher complication rates, the improvements in their quality of life are very similar to those of younger patients.
After the surgery a patient is expected to stay in the clinic for 2 to 3 days. If a patient underwent general anaesthesia, it is absolutely normal to experience some mild side effects on the first day after the procedure. On the following day a postoperative patient is encouraged to start moving and walking with a walker or crutches. In the beginning, it requires a lot of will and effort to start walking again, but it will pay off in the form of faster recovery. Upon discharge from the hospital, a patient should be able to take short walks, bend one’s knee up to 90 degrees and climb up and down a few steps with some extra help.
It could be said that half of the success of a knee replacement surgery depends on the post-op physical therapy. Physiotherapy exercise routine may be either home-based or monitored by the health professionals in rehabilitation facilities. Studies have shown that light to moderate regular exercises show short-term improvements in patients’ physical function, whereas more intensive ones have positive long-term outcomes. In order for a certain therapeutic approach to give good results the right combination of physiotherapy methods should be selected for each patient individually.
The positive effects of physical activity are particularly important for patients undergoing knee replacement, as osteoarthritis predisposes them to metabolic and functional decline. Light physical activity such as walking, climbing the stairs, jogging etc. is an attractive and convenient form of exercise as it can be self-managed and performed on a daily basis with low cost and minimal equipment. In addition to that, there are several types of exercises which target specific muscle groups of the lower body and may be performed every day:
The candidate for knee replacement are often hesitant about the surgery as there is a common misconception that driving is prohibited once the surgery is performed. In fact, the postoperative patients may already resume driving 4 weeks post-operation or when they feel comfortable and confident about the flexibility of the knee.
Based on a general opinion among the medical society low-impact sports, such as hiking, swimming, running, and cycling etc. after knee replacement are most certainly welcome and encouraged. However, strenuous activities that put a lot of pressure om the knees are a topic of discussion. It is observed that the patient who played sports before their surgery are more likely to return to sports because of the willingness and motivation. All in all, due to the improvements in surgical technique and the growing knowledge about post-operative management of knee prosthesis, knee replacement surgery has even less impact on the activity level of post operative patients.
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