"Total Knee Replacement"

This article will cover aspects of the Total Knee Replacement (TKR) such as why the need for a replacement, how long the rehabilitation phase is and what the patient can expect to do afterward.

 

Why a TKR?

There are many different causes of knee pain, including injury, arthritis and infection. Some knee pain can be treated through rehabilitation while other cases may require surgery. There may come a time where the deterioration in your knee may not be helped with conservative measures. If you get to the point where you have fairly constant pain and have difficulty walking or performing everyday activities such as walking or getting dressed, it may be time to consider knee replacement surgery.
Doctors generally try to delay total knee replacement for as long as possible in favor of less invasive treatments. However for patients with advanced joint disease, knee replacement offers the chance for relief from pain and a return to normal activities.

 

What is a TKR?

In total knee replacement surgery, the parts of the bones that rub together are resurfaced with metal and plastic implants. Using special, precision instruments, your surgeon will typically remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place.

The surface of the femur (thigh bone) is replaced with a rounded metal component that comes very close to matching the curve of your natural bone. The surface of the tibia (shin bone) is replaced with a smooth plastic component. This flat metal component holds a smooth plastic piece made of polyethylene plastic that serves as the cartilage. The undersurface of the kneecap may also be replaced with an implant made of the same polyethylene plastic.

 

What can I expect afterward?

After the surgery, you can expect to be in the hospital for 3-5 days. Within 24 hours after surgery a Physical Therapist will get you standing and within 48 hours you can expect to walk a few steps with a walker. While in the hospital you will be monitored for infection and your wound dressing will be inspected and changed as needed. You will most likely be on an IV drip with a medication to help diminish the pain, and you may also be on a machine called a CPM (continuous passive motion) machine, which is designed to create early motion in your knee.

Typically a Physical Therapist will see you twice a day and will provide you with exercises to get the thigh muscles active, to get the knee joint moving as well as instruction on walking with a walker.

Once your surgeon deems that your situation is stable e.g. wound healing, circulation, pain, then you may be discharged home or transferred to a rehabilitation facility where you will continue with physical therapy, occupational therapy and continue to be monitored for pain. You will typically be in the rehab facility for another 3-5 days depending on your healing and progress with physical therapy.

Once home you may have a home physical therapist come to your home 2-3 times a week for anywhere from 1 week to 3 weeks to make sure you continue with your exercises to improve your knee range of motion, quadriceps strength, and are safe to move around your house. You can expect to be walking with a cane typically within 6 weeks of surgery and probably feel well enough to be able to drive a car within 7-8 weeks.

Lastly, you will finish your rehab at an outpatient physical therapy clinic, such as C.O.A.S.T., where you can expect to continue at 2-3 times per week for up to 3 months. The therapists will push you to attain a high level of range of motion, lower extremity strength, balance and normalized walking pattern.

 

Can I return to my normal activities?

In most cases, successful joint replacement surgery will relieve your pain and stiffness, and allow you to resume many of your normal daily activities. But even after you have fully recovered from your surgery, you will still have some restrictions. Normal daily activities do not include contact sports or activities that put excessive strain on your joints. Although your artificial joint can be replaced, a second implant is seldom as effective as the first.

It should be noted that each individual’s reaction to the surgery will be different where as some patients may not have much pain, others may have much more and some people may regain strength and knee motion much sooner than others. Whatever path you end up going down, realize that it is a long and arduous process and there may be times that you will feel frustrated and discouraged but with hard and consistent effort at the clinic and most importantly at home, patients usually achieve a very successful outcome.

 

If you are a potential candidate for a total knee replacement or just have any other questions regarding the surgery or rehab then you can talk to an Orthopedic surgeon or feel free to contact one of our therapists at C.O.A.S.T. Rehab and we will be glad to answer any questions to the best of our abilities.