In a primary total knee replacement, the surfaces of the femur, tibia, and patella are replaced with metal and plastic implants. (The patellar component is not shown here). Picture courtesy of OrthoinfoTotal knee replacement or total knee arthroplasty surgery is one of the most common operations I perform. While everyone has their own unique questions and concerns about surgery, over the years, these are the top 5 questions I consistently hear people ask-
Do I really need a total knee replacement?
A total knee replacement is an elective surgery performed on arthritic knees. A total knee replacement is performed once you have exhausted all other means of managing your pain. If the pain from your arthritis has progressed to the point that your quality of life is suffering, then total knee replacement surgery may be an option for you. With rare exception, no one has to have a total knee replacement (and don’t let anyone else tell you otherwise!). When you are ready, I tell me patients, they will know. While total knee replacements are very effective at improving function and eliminating pain, total knee replacement surgery is still a major surgery, and although >95% of patients report excellent outcomes, the complications can be devastating and should not be ignored.
How soon after surgery can I walk?
Total knee replacement is a major surgery. Complete recovery can take anywhere from 6 months to a year after the surgery. Walking is integral to the recovery however, and is encouraged as early as the evening after surgery. Initially walking will be difficult due to the pain and discomfort expected from surgery. Walking though is important because it encourages strengthening of the muscles surrounding the knee, prevents stiffness, and reduces swelling. The first few months after surgery can be particularly challenging as the knee strength and coordination recover. Most patients report anywhere between 3-6 months until they begin feeling “comfortable” walking again.
How long will I need rehab?
Rehabilitation and physical therapy is essential for a successful outcome after total knee replacement. While each individual patient’s requirements are different, on average one can expect at least 4-6 months of physical therapy after undergoing the surgery. Immediately after the surgery we initiate an aggressive protocol of physical therapy including twice daily sessions of aggressive rehabilitation. During these rehabilitation sessions the therapists and case managers assess your rehabilitation needs and determine if you may benefit from a course of inpatient rehabilitation, home physical therapy, or outpatient physical therapy. Participation in physical therapy immediately after surgery and regularly in the first 8 weeks is essential for an optimal recovery. Participation is directly correlated with a successful outcome, that is- no pain, no gain. I try to mentally prepare all my patients undergoing total knee replacements for the grueling rehabilitation necessary after surgery. Ignoring the rehabilitation could be disastrous and potentially compromise the outcome of the surgery.
When will my knee feel normal?
Despite advancements in the design of total knee replacements, your knee will never feel perfectly “normal” after surgery. A total knee replacement cannot exactly replicate the way a normal knee moves. You can anticipate knee flexion of about 110-120° after surgery, whereas a normal knee bends up to 130° in some. Many manufacturers market high flexion knee implant designs that promise greater knee bending; however, surgeons have not been able to produce these results in actual patients. While a knee replacement may not feel like a normal knee you had before the onset of arthritis, a total knee replacement does accomplish a significant reduction in your pain and consequently allows better function and quality of life.
Can I play sports after a total knee replacement?
There are certain inherent limitations after undergoing a total knee replacement. The implant is made out of metal and plastic components that can mechanically wear down over time. Studies show an appropriately implanted total knee replacement can last for 15-20 years without problems. Participating in high impact activities, however, such as running could theoretically reduce the lifespan of the implant. Lower impact sports such as swimming, bicycling, golf, bowling, hiking, hunting, rowing, etc. are considered safer after a total knee replacement.
Sources:
- http://orthoinfo.aaos.org/topic.cfm?topic=a00389
- http://well.blogs.nytimes.com/2012/07/09/relief-for-joints-besieged-by-arthritis/
- http://www.ncbi.nlm.nih.gov/pubmed/18591603
These are just a few of the questions I typically hear from my patients. Feel free to ask any other burning questions below in the comments or call my office at 281-690-4678 to arrange a face to face consultation. We invite all patients considering a total knee replacement to participate in our free half day course to learn about the total knee replacement process. The course is hosted monthly by our Joint Replacement Center at the Houston Methodist Sugar Land Hospital.