Total Knee Replacement (TKR)
What is a TOTAL KNEE REPLACEMENT?
The damaged surfaces of the knee are resurfaced with metal and a plastic (polyethylene) spacer is inserted between them. The lower end of the femur (thigh bone) is trimmed to fit the femoral prosthesis; the upper end of the tibia (shin bone) is cut flat to seat the tibial prosthesis.
The kneecap is not usually resurfaced as we have found very few patients have issues with their kneecaps after surgery when they have done their rehabilitation.
When do I need to have my knee replaced?
Usually, a course of conservative management will have failed to control your symptoms adequately. The pain will be increasing and your ability to do your normal daily activities becomes more difficult.
You may have instability or catching in the knee that can cause you to fall and this may become a significant problem.
The deformity in your joint may get worse and your loss of movement may be increasing such that it would be best to have it corrected sooner rather than later.
The need and timing of your surgery will be discussed with your surgeon but ultimately the final decision rests on you and your family based on your pain and disability.
How long will the knee last?
Generally, unless the knee is so badly damaged, and function so limited, conservative management is recommended as initial management. This may include the following options:
- Weight loss: For those overweight, this is a significant factor in improving symptoms.
- Muscle strengthening: Pain and function are improved by exercise
- Medication: This can include pain medication as well as anti-inflammatories.
- Injections: A hydro-cortisone injection may settle symptoms for a period of time. Some patients get long-term relief over a year, whereas others do not get any relief at all. This treatment is usually offered when patients present with very painful and /or inflamed swollen knees. The fluid is often removed at the same time.
- Walking aids: A stick can be of great value to unload the knee especially when walking longer distances.
- Orthotics: Occasionally we will suggest inserts for your shoes to try to unload the worn side of your knee. These help with about 50% of patients.
Is knee surgery and recovery very painful?
We generally do the surgery with a spinal anaesthetic and something light to sleep. At the time of surgery, we inject medication into the joint. This combination keeps patients completely pain free for the first 12-18 hours after the operation. Usually, after that time a small percentage of patients will have mild to moderate pain and all our patients have their pain controlled with medication that is given regularly whilst in hospital. Thus the majority of our patients report that they have had only mild pain or discomfort after the procedure and there are many who even say they never had any pain throughout their recovery. However, most patients will experience pain as they increase their activities. It is natural to want to get going quickly and so as one pushes the post-operative knee to its new limits the discomfort will let you know when to stop. We call this the “good pain”. This is because it is good that you are getting mobile again.
How long will I stay in hospital?
Our patients generally will get up the day after surgery with the physiotherapist and are usually discharged on the 2nd or 3rd days following the surgery. This will be determined by your condition before surgery, your age, and any medical problems that may influence your rehabilitation. You will not be discharged until you are safe to go home.
When can I shower?
Usually, after the stitches come out at 2 weeks, although your surgeon can advise you based on the waterproofness of your dressing.
Bathing is usually delayed for 4-6 weeks to let the wound heal well and getting in and out of a bath may be a challenge in the early stages.
How long does recovery take?
It generally takes up to three months to return to most of your activities and you will continue improving for up to one year. Most patients will use a walker or crutches for between 4-6 weeks and can drive between 4-6 weeks after surgery.
When can I return to work?
Depending on your job and your general health and activity level, sedentary jobs can be returned to within 4-6 weeks, while a demanding job that requires lifting, walking or travel may need up to 3 months.
Will I need physical therapy and if so for how long?
Our patients generally have physiotherapy twice a week after discharge until they have got good movement and are functioning well. Then usually by the second or third-month postoperatively we suggest you go to a biokinetist to build up the strength in that leg. This makes a remarkable difference in the recovery and function of your knee.
The amount of therapy needed depends upon your condition before surgery, your own motivation, and general health.
What are the complications to total knee replacement?
- Total knee replacement surgery is primarily a pain-relieving procedure however a small percentage of patients may not have all their pain relieved. There is also a possibility of residual stiffness and swelling.
- Post-operative complications are generally rare. Less than 1% of our patients develop deep vein thrombosis or infection.
- Over time the implants can fail and either become worn or loosen from the bone. This generally takes more than 20-25 years.
What activities can I do after total knee replacement?
- You should be able to get back to your normal daily activities
- Sport: You should safely be able to get back to:
- Cycling (not recommended to do off-road cycling)
- Hiking ( best to avoid very steep and unstable slopes)
- Doubles tennis
- Snow skiing
You can discuss any other activities with your surgeon.
We ensure that quality care is afforded to our patients even before formal consultation by taking necessary information about our patients, their lifestyle, and their current ailments.
Knee Specialists in Johannesburg
Prof. Ponky Firer, Dr. Brad Gelbart, and Dr. Matthew Street specialize in knee conditions of any type. Their approach is to improve your mobility and lessen your pain in the least invasive manner possible.
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