Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. The procedure involves cutting away damaged bone and cartilage from your thighbone, shinbone and kneecap and replacing it with an artificial joint (prosthesis) made of metal alloys, high-grade plastics and polymers.
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 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.
Contents
- Know your knee joint.
- What is knee osteoarthritis?
- What are the risk factors? Can it be cured?
- What are the symptoms of knee OA?
- What are the grades of knee OA?
- How is it diagnosed?
- What are the treatment options?
- Know your TKR in brief
- Timeline of your improvement after surgery
- What if I delay my Knee surgery?
Know your knee joint
- The knee is one of the largest and most complex joints in the body.
- The knee joins the thigh bone (femur) to the shin bone (tibia).
- The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.
What is knee osteoarthritis?
- Osteoarthritis, commonly known as wear-and-tear arthritis, is a condition in which the natural cushioning between joints — cartilage — wears away.
- The wearing down of the protective tissue at the ends of bones (cartilage) occurs gradually and worsens over time.
- When this happens, the bones of the joints rub more closely against one another with less of the shock-absorbing benefits of cartilage.
- The rubbing results in all the symptoms.
What are the risk factors? Can it be cured?
- Age is a major risk factor for osteoarthritis of the knee
- Every kilograms of weight you gain adds 3 to 4 kilograms of extra weight on your knees resulting in rapid degeneration.
- Osteoarthritis can’t be reversed, but treatments can reduce pain and help you move better.
- With the end stage, knee replacement is the only option.
What are the symptoms of knee OA?
- Pain
- increases when you are active, but gets a little better with rest
- Swelling
- Feeling of warmth in the joint
- Stiffness in the knee
- especially in the morning or when you have been sitting for a while
- Decrease in mobility of the knee
- making it difficult to get in and out of chairs or cars, use the stairs, or walk
- Creaking, crackly sound that is heard when the knee moves
What are the grades of knee OA?
- Grade 0: This is the “normal” knee health
- Grade 1: Very minor bone spur growth and is not experiencing any pain or discomfort.
- Grade 2: This is the stage where people will experience symptoms for the first time. They will have pain after a long day of walking and will sense a greater stiffness in the joint. It is a mild stage of the condition, but X-rays will already reveal greater bone spur growth. The cartilage will likely remain at a healthy size.
- Grade 3: Moderate OA. Frequent pain during movement, joint stiffness will also be more present, especially after sitting for long periods and in the morning. The cartilage between the bones shows obvious damage, and the space between the bones is getting smaller.
- Grade 4: This is the most severe stage of OA. The joint space between the bones will be dramatically reduced, the cartilage will almost be completely gone and the synovial fluid will be decreased. This stage is normally associated with high levels pain and discomfort during walking or moving the joint.
How is it diagnosed?
- Your doctor will perform physical examination
- Radiograph of the knee in standing position, one from front and other from side.
- Cartilage doesn’t show up on X-ray images, but cartilage loss is revealed by a narrowing of the space between the bones in your joint.
- An X-ray can also show bone spurs around a joint.
- The doctor may also order MRI if additional information is required or the diagnosis could not be made on x rays
- Blood test could be ordered if rheumatoid arthritis, an immune disorder is suspected.
What are the treatment options?
Non-surgical treatment modalities
- Weight loss (most important)
- 20 minutes Ice fomentation- 20 minutes nothing-20 minutes hot water fomentation
- If acutely painful, then ice application only (reduces pain and swelling) (hot water fomentation only reduces muscle spasm)
- Diet modification: Reduce calorie intake. Antioxidants rich diet; fish, walnuts, capsicum, garlic, ginger, broccoli, spinach, grapes, olive oil
- General Exercises: Non-impact loading exercises; cycling, gentle yoga, stretches, swimming, walking, light weight training
- Knee exercises
- Strengthening the muscles around the knee makes the joint more stable and decreases pain.
- Stretching exercises help keep the knee joint mobile and flexible
- Support braces: provides support for the entire knee.
- Physiotherapists can teach you ways to strengthen muscles and increase flexibility in your joint.
- Drugs:
- Topical agents (short term relief)
- Analgesics
- Acetaminophen, ibuprofen, or naproxen
- Glucosamine/Chondroitin supplements
- Knee injections
Corticosteroid
- Steroids are powerful anti-inflammatory drugs.
- 1ml of Depomedrol (methylprednisolone) in 1 ml of anaesthetic agent (lignocaine without adrenaline) can be injected in knee joint maximum upto 3 times in intervals of 6 months.
Hyaluronic Acid
- Hyaluronic acid is normally present in joints as a type of lubricating fluid.
- Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee
Surgical treatment options
- When other treatments don’t work, surgery is a good option
- Arthroscopy (Key Hole Surgery)
- Osteotomy (Realignment of knee joint)
- Arthroplasty (Knee replacement)
Arthroscopy
- Arthroscopy uses a small telescope (arthroscope, a type of camera) and other small instruments to look into knee joint.
- The surgery is performed through small incisions, a minimally invasive procedure.
- Once there, the surgeon can remove damaged cartilage or loose particles, clean the bone surface, and repair other types of tissue if those damages are discovered.
- The procedure is often used on younger patients (ages 55 and younger) in order to delay more serious surgery
- This can help relieve symptoms, and it is less invasive than total knee surgery
Osteotomy
- An osteotomy is a procedure that aims to make the knee alignment better by cutting and changing the shape of the bones in early OA.
- This will take pressure off the injured part.
- Recommended if you
- are active, under the age of 60 years, and are not overweight
- have pain or damage primarily on just one side of the knee
- have OA mostly due to activity or standing for a long time
- have broken your knee and it has not healed well.
- An osteotomy is not permanent, and further surgery may be necessary later on.
Knee replacement
- Joint replacement surgery, or arthroplasty, is a surgical procedure in which joints are replaced with artificial parts made from metals or plastic.
- The replacement could involve one side of the knee or the entire knee.
- Joint replacement surgery is usually reserved for people over age 50 with severe osteoarthritis in the following circumstances:
- When all the conservative treatments including lifestyle remedies, anti-inflammatory medication, physical therapy, and injections failed after trying for minimum 6 months
- Difficulty in even doing day to day activities
- No relief of pain at any time of day or even after resting
- The surgery may need to be repeated later if the prosthetic joint wears out after several years. But with today’s modern advancements, most new joints will last over 20 years.
- The surgery has risks, but the results are generally very good.
Know your TKR in brief
There are three types
- Unicompartmental knee replacement; replacement of either medial or lateral parts of femur and tibia. It is done when there is pain and degeneration only on one side of the knee
- Total knee replacement; replacement of whole femur and tibia at knee joint. It is done when the whole knee joint is painful and there is bending of legs
- Tricompartmental knee replacement; in addition to above, knee cap (patella) is also replaced. It is done when knee cap is also destroyed with the knee joint.
Procedure
- The surgeon will make an incision over the front of your knee to expose the damaged area of your joint.
- The standard incision size varies from approximately 6–10 inches in length.
- During the operation, the surgeon moves your kneecap to the side and cuts away the damaged cartilage and a small amount of bone.
- They then replace the damaged tissue with new metal and plastic components.
- The components combine to form an artificial joint that is biologically compatible and mimics the movement of your natural knee.
- Most knee replacement procedures take 60 to 90 minutes to complete.
- Your new knee will mimic your old one in many ways, but it will take some time to get used to it.
Timeline of your improvement after surgery
- Your physical therapist will recommend exercises to help strengthen your muscles, increase your range of motion, and increase blood flow around your knee. This promotes healing and helps drain fluid away from painful tissue.
- You should be able to:
- walk with a cane or no device in 2–3 weeks
- drive after 4–6 weeks, depending on what the doctor recommends
- return to a sedentary job in 4–6 weeks
- return to a job that involves physical effort in 3 months
- travel after 4–6 weeks, when the risk of a blood clot has reduced
- shower after 5–7 days
- have a bath after 4–6 weeks, when it is safe to soak the wound
What if I delay knee surgery?
- TKR surgery can feel like a new lease of life for many people.
- If surgery not done at advanced stage of arthritis:
- Awkward walk due to knee pain, stress on hips and spine
- Weakening of muscles and stretching of ligaments around knee
- Difficult to sit, squat and day to day household activities
- Decline in overall health, due to an increasingly sedentary lifestyle.
- Sadness and depression due to reduced mobility
- Continued use of your damaged joint will likely lead to further deterioration and damage