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Everything You Need to Know About Total Knee Replacement Surgery

By Dr. Jonathan E. Greenleaf




Sports Medicine Recovery Journal

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Everything You Need to Know About Total Knee Replacement Surgery

Everything You Need to Know About Total Knee Replacement Surgery

In the United States, approximately 12 percent of adults experience mobility limitations as a result of arthritis in the knee, leading to reduced independence and a lower overall quality of life. Fortunately, the spectrum of treatment options is wider and more nuanced than ever before. Today, advancements in surgical techniques are leading to faster recovery times, and the latest generation of state-of-the-art prostheses are capable of offering pain-free stability and comfort for decades to come. At Sports Medicine Oregon, we specialize in conservative care treatment options, as well as, the latest surgical approaches up to and including total knee replacement. In this post, we will answer many of the most common questions pertaining to total knee arthroplasty and the conditions it’s used to treat, including causes, alternative treatments, and recovery.

Knee Osteoarthritis Symptoms, Causes, and Risk Factors

According to the National Institute on Aging, knee osteoarthritis is one of the leading causes of physical disability for older adults, affecting about 10 million adults around the United States. In a healthy knee joint, cartilage acts as a protective buffer between the bones, allowing the joint to glide smoothly during movement. Over time, however, this cushioning may slowly wear away, leaving the bones less protected, and even allowing them to come into direct contact with each other in severe cases. This condition is known as knee osteoarthritis.

There are many symptoms associated with osteoarthritis, which vary depending on the severity of the condition. Joint inflammation, stiffness, and a diminished range of motion are all common osteoarthritis symptoms. Arthritis knee pain may fluctuate throughout the day, and many individuals report more pronounced stiffness and swelling during the early morning hours, or after prolonged sitting or general inactivity. Knee arthritis symptoms may also worsen after extended physical activity involving the affected joint. In some instances, patients report instability and weakness during these activities. It is possible for damaged portions of the cartilage to break away from the healthy tissue and disrupt the natural glide of the knee joint, causing locking or popping sensations.

There are many risk factors that may predispose individuals to osteoarthritis, ranging from race and gender to family history. Before the age of 45, arthritis is more common in men, but among adults 45 and older, it predominately affects women. Additionally, certain lifestyle factors, including past athletic participation and diet, have been linked to an increased risk of developing arthritis. A recent study published in The American Journal of Sports Medicine concluded that elite male athletes who participated in soccer, football, and rugby had a greater chance of developing arthritis than the sedentary males. The risk of arthritis doubled for handball and soccer players and tripled for hockey players. Individuals who are overweight or severely obese also have a greater chance of developing arthritis. This excess bodyweight increases the strain on joints and may lead to knee cartilage wearing away prematurely. Based on the latest data, nearly 80 percent of individuals electing to have a total knee replacement are obese or morbidly obese.

Regardless of the cause, the extent of the underlying knee damage will first need to be properly diagnosed before it can be treated. For this purpose, a care provider will use a thorough patient’s history, physical exam and diagnostic imaging to better understand the condition of the knee joint and surrounding tissue before recommending treatment options.

Nonsurgical Treatment – Alternatives to Knee Replacement Surgery

In less severe cases of knee osteoarthritis, basic lifestyle adjustments and nonsurgical treatments may effectively relieve many osteoarthritis symptoms. As mentioned previously, excess body weight adds stress to the knee joints during activity, so a weight loss regimen may be recommended to decrease strain on the knee joint and supporting tissues. For individuals who experience symptom flare-ups as a result of extended exercise, it may be necessary to minimize the intensity or regularity of these activities.

As frustrating as it may be to cut a workout short or pass on it altogether, pushing the affected joint too far too often will only lead to increased discomfort and diminished mobility.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and other medications may be recommended to help with pain and inflammation. Other easy, in-home knee arthritis treatments, such as ice and heat therapy, prove helpful for many patients in relieving joint pain and stiffness. For more information on when to use heat or ice for arthritis in knee joints, and how to properly utilize this treatment for knee arthritis, see our comprehensive guide to the ice and heat therapy here.

Physical therapy will play a major role in both surgical and nonsurgical knee osteoarthritis treatments. A physical therapist will create a personalized regimen based on the patient’s individual physiology and lifestyle, using osteoarthritis knee exercises to increase range of motion and strengthen the muscles supporting the joint. When properly utilized, these physical therapy exercises for the knee may reduce stress on the joint and allow many individuals to delay or avoid knee replacement altogether.

Knee injections for arthritis may provide temporary symptom relief for several months at a time. Injections such as long-lasting cortisone, synthetic joint fluid injections, and biologic injections such as platelet-rich plasma or stem cells may be applicable. These non-surgical approaches may be effective for many individuals, however, if a patient has not achieved adequate symptom relief with the aforementioned treatment options, a medical professional may recommend knee arthroplasty to restore mobility.

What is Total Replacement Surgery? Types of Knee Replacement Surgery

Total knee arthroplasty – or simply total knee replacement surgery – has come a long way since the first knee replacement procedures were performed in the 1970s. Over the intervening 40 years, surgeons and industry professionals have fine-tuned surgical techniques and made tremendous advancements in knee prosthesis materials. Today, knee replacement surgery is an increasingly popular surgical treatment option. In fact, more than 700,000 individuals choose to undergo knee arthroplasty every year. So, what happens during a typical knee replacement surgery? Let’s take a look.

First, an incision is made along the front of the knee, and the patella (also known as the kneecap) is pushed to the side, to give the surgeon access to the knee joint. Next, damaged portions of the tibia, femur, and patella are removed, and the ends of the bones are resurfaced to accommodate the knee prosthesis. The artificial knee joint is composed of high-grade plastic and metal parts, and surgical cement is used to attach the prosthesis to the femur, tibia, and patella. A plastic spacer is placed between the femoral component and tibial component to act as cartilage in the knee prosthesis and ensure a smooth glide during movement. At the end of the procedure, the kneecap is repositioned along the front of the knee, the incision is closed, and the site is dressed to prevent infection.

It’s important to remember that not every patient will require a total knee replacement and depending on the severity and extent of the knee damage, a partial knee replacement may be more appropriate. During a partial knee replacement – also known as an unicompartmental knee replacement – only the damaged portions of the knee joint are removed, resurfaced, and replaced. Partial knee replacement surgeries are typically less invasive than a full knee replacement, and lead to shorter recovery times. Although surgery times vary between patients, most knee replacements take between one and three hours, with the majority of surgeries lasting approximately two hours.

How Long Does a Total Knee Replacement Last?

One of the main reasons some patients postpone knee replacement surgery or avoid joint replacement altogether is the prospect of revision surgery years later to correct an aging artificial knee joint. However, thanks to advances in procedural techniques and the development of longer-lasting prosthesis materials, modern total knee replacements are more durable than ever. In fact, the latest prostheses are designed to last upwards of 20 years. In a recent study involving more than 50,000 patients with a knee replacement, only 10 percent of individuals required revision surgery within 20 years following the initial procedure. While the prostheses themselves are lasting longer than ever, the recovery process following surgery has decreased in recent years, meaning patients are back to their active lifestyles sooner.

Knee Replacement Recovery Time – What to Expect After Knee Replacement

It’s important for patients to have realistic expectations going into this crucial rehabilitation stage, and a full knee replacement recovery may take several months. Immediately following surgery, medications may be prescribed to help minimize pain, and the repaired knee will need to be elevated to minimize swelling around the joint. Many patients are able to stand and walk using crutches within a few days following the surgery. These crutches will be necessary to assist with mobility for a week or longer after knee replacement. Patients with less physically demanding jobs may be able to return to work a week or two after the operation, and it’s typical to start driving a vehicle approximately one month after a full knee replacement.

Today, knee prostheses enable millions of individuals to maintain their independence and achieve their mobility goals. By 2020, it’s been estimated that more than one million individuals will be undergoing total knee arthroplasty annually. The increased use of total knee replacement speaks volumes about not only the advancements in the procedure itself but also the increased quality of life for patients. If you or a loved one are suffering mobility issues related to knee osteoarthritis, it may be time to consider knee replacement surgery – an effective procedure allowing individuals to live an active, pain-free lifestyle for decade to come.

At Sports Medicine Oregon, the providers offer a variety of state-of-the-art procedures including 3-D printed custom prosthetics as well as robotically guided knee replacements. Please consult with our providers to see which treatment would work best for your knee issues.

Remember, we update our Sports Medicine Oregon blog monthly, so be sure to tune in often to stay up to date on the latest sports medicine news and views!