Total Knee Replacement

What causes knee pain?
The knee is the most used and therefore stressed joint in the body. The common causes of pain in the knee are injury, arthritis and infection.
Is there a cure?
This depends entirely on the nature of the problem. Sometimes knee pain can be treated through rehabilitation, and on occasion surgery may be required. It is important to consult a doctor for proper advice as soon as the symptoms are evident.
What is Total Knee Replacement?
Total Knee Replacement is a procedure in which the parts of the bones that rub together are resurfaced with metal and plastic implants. Precision instruments are used to remove and replace damaged parts of the bone with implants. The surface of the femur is replaced with a rounded metal component that matches closely the curve of your natural bone. And the surface of the tibia/leg bone is substituted with a smooth plastic component.
How to tell if you need a knee replacement?
If your knee pain is so severe that it causes difficulty in walking and performing daily activities, knee replacement might be called for. However it is mandatory that these symptoms be taken to a doctor for an accurate diagnosis. Doctors try and delay the procedure for as long as possible by using non-invasive treatment. However if the disease is in an advanced stage, knee replacement is a means to achieve relief from pain as well as return to daily activities.
How do you prepare for Total Knee Replacement surgery?
A complete physical check-up is required to rule out any medical problems that may interfere with your surgery. At this time the doctor will also review your medical history. Do not forget to inform the doctor about any medication that you may be taking. A few routine pre-surgery tests will also be performed. The surgery can result in blood loss which will require transfusion. So you might be asked to donate a few units of your own blood prior to surgery.
What happens during Total Knee Replacement surgery?
Prior to surgery an IV line will be inserted into your arm to administer medication during the operation. Thereafter anesthesia is administered in the OT. Once anesthesia has taken effect, the knee is scrubbed and sterilized. The surgery then begins with an incision to expose the knee joint. The surgeon then uses precision guides and instruments to remove damaged surfaces. The ends of the bones are then shaped to accept the implants. The implants are then fixed, and the incision closed. A sterile bandage is applied to the wound and routine post operative care will follow as anesthesia wears off.
How is the implant affixed in the body?
Bone cement is used to secure the knee implants.
What can you expect after the surgery?
A specially designed rehabilitation routine will be started to help regain strength, balance and movement in the knee. 24 hours after surgery, you will be asked to stand. And in 48 hours, you will start to walk with support. You can expect to stay in hospital for 3 days after surgery. Your sutures will usually be removed before discharge, and you will be advised on exercises to continue at home.
How soon can you return to normal activities?
On an average, patients walk with a cane in 6 weeks, and start to drive in 2 months. While the surgery will relieve you of pain and allow you to resume most normal activities, this does not include contact sports and activities that put excessive strain on your knees.
How long will a joint replacement last?
Longevity of the prosthesis depends on the patient's activity levels, weight as well as the accuracy of the implant placement. Recent studies have found common implants to be functional in 96% patients even after 20 years. However it must be understood that implants are not as durable as the natural knee, and will eventually wear out and no assurance can be given about its longevity.

PHYSICAL TRAINING AFTER KNEE PROSTHESIS

Rehabilitation goals are to improve ambulation, enhance range of motion, develop muscle strength, provide emotional support and control pain.
Outcome variation exists despite excellent surgical technique, refined implants, and uncomplicated postsurgical recovery. In addition to perioperative surgical care, presurgical variation in patient risks factors and variation in pré and post-TKA rehabilitation exercises and activity may also contribute to varied functional return. The loss of muscle quadriceps strength is an important determinant of disability in patients before and after TKA. The reduction in voluntary activation of the muscle is considered to be among the mechanisms involved in the decline in muscle strength. These voluntary activation deficits are at least in part reversible after TKA . Effectiveness of physical therapy and rehabilitation is focused on increasing muscle strength after surgery.
Therefore, the improvement of exercise therapy and muscle strength within the first 3 months after surgery is an important outcome measure in the effectiveness of TKA.
A recommended daily exercise schedule at home after TKA surgery is an important component of knee function.

TRAINING AFTER OPERATION

  • walk : 20 mn walk twice a day when the knee is nor too painful, even with crutches.
  • fitness and aerobic exercises alone or in group : twice a week
  • home exercises : stretching and reinforcement of muscles, ankle pump, active contractions, active assisted knee flexion : do this twice a day.
  • Put an Ice Pack after the exercises or coming back home. Two rules : NO PAIN - NO SWELLING

    • Bilateral Knee Replacement