Total knee replacement (TKR), also known as total knee arthroplasty, is a surgical procedure to replace a damaged or worn knee joint with artificial components. It is typically recommended for patients with severe arthritis or significant knee damage that affects their daily activities and quality of life.

Indications

• Osteoarthritis: Severe arthritis affecting the knee joint, causing pain, stiffness, and reduced mobility.
• Rheumatoid Arthritis: Chronic inflammatory disease affecting the joints.
• Post-Traumatic Arthritis: Arthritis developing after a knee injury or fracture.
• Other Conditions: Severe deformity of the knee joint, such as bowing in or out of the leg, and limited range of motion despite conservative treatments.

Symptoms Leading to a Total Knee Replacement

• Chronic knee pain, even at rest.
• Swelling and inflammation in the knee joint.
• Stiffness and difficulty bending or straightening the knee.
• Pain that limits daily activities, such as walking, climbing stairs, or getting in and out of chairs.

Preoperative Evaluation

Medical History and Physical Examination:

• Detailed assessment of symptoms, medical history, and knee function.

Imaging Tests:

• X-rays to assess the extent of arthritis and deformity in the knee joint.
• MRI or CT scans in some cases to evaluate soft tissue structures and confirm the diagnosis.

Procedure

Preparation:

• The patient is given anesthesia (general or spinal).
• The knee is cleaned and sterilized.

Incision:

• A large incision is made over the knee joint to access the knee.

Resection of Damaged Bone and Cartilage:

• The damaged portions of the femur (thigh bone), tibia (shin bone), and patella (kneecap) are removed.

Placement of Implants:

• Metal and plastic components are implanted to replace the removed bone and cartilage.
• The components may be cemented into place or press-fit depending on the patient’s bone quality.

Closure:

• The incision is closed with sutures or staples.
• A sterile bandage is applied.

Recovery – Immediate Postoperative Care

Pain Management:

• Medications for pain relief.

Ice and Elevation:

• Apply ice packs and keep the knee elevated to reduce swelling.

Compression Stockings:

• To prevent blood clots (deep vein thrombosis, DVT).

Physical Therapy:

• Initiated soon after surgery to promote knee mobility and strength.
• Techniques to regain range of motion and improve walking.

Rehabilitation

Hospital Stay:

• Typically 1-3 days depending on recovery progress.

Home Exercises:

• Prescribed exercises to continue rehabilitation at home.

Assistive Devices:

• Use of walkers, crutches, or a cane initially to assist with walking.

Follow-Up Appointments:

• Regular follow-up visits with the surgeon to monitor healing and progress.

Risks & Complications

• Infection: Risk of infection at the surgical site or within the joint.
• Blood Clots: Risk of DVT or pulmonary embolism.
• Implant Loosening or Wear: Long-term wear and tear of the artificial joint components.
• Nerve or Blood Vessel Injury: Rare but possible damage during surgery.
• Stiffness or Reduced Range of Motion: Limited knee movement post-surgery.
• Persistent Pain: Ongoing discomfort in some cases.

Benefits

• Pain Relief: Significant reduction in knee pain and improved function.
• Improved Mobility: Enhanced ability to perform daily activities, walk, and climb stairs.
• Long-Term Durability: Artificial knee joints can last 15-20 years or more, depending on activity level and care.

FAQ’s

How long is the recovery time after total knee replacement?
Recovery time varies, but most patients can resume normal activities within 3-6 weeks. Full recovery and return to more strenuous activities may take several months.

Will I need physical therapy after total knee replacement?
Yes, physical therapy is crucial to regain knee strength, flexibility, and function.

Can I kneel or squat after total knee replacement?
Many patients can resume kneeling and squatting activities after recovery, but it depends on individual factors and rehabilitation progress.

How long will the total knee replacement last?
Total knee replacements can last 15-20 years or more, depending on factors such as activity level, weight, and overall health.

Are there activities I should avoid after total knee replacement?
High-impact activities, such as running or jumping, should be avoided to prolong the life of the implant. Low-impact activities like swimming, cycling, and walking are generally recommended.

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