Knee resurfacing or replacement
What is this procedure?
A total knee replacement (TKR) is a surgical procedure in which the worn surfaces of the knee are replaced by a knee made of metal and plastic. This procedure is typically used as the final measure for the management of knee arthritis that has not responded to other treatment. Although considered a major operation, total knee replacements have become very common with over 70,000 done each year.
What are the benefits?
Knee replacement has the potential to relieve pain, restore mobility and make activities of day to day life easier, when other, less invasive treatments have failed.
What are the risks?
Although most people are very happy with the results of knee replacement, around 1 in every 10 people experience persistent pain that does not get better with time. The causes for this are not fully understood. Other risks include infection, bleeding, damage to nerves, complications due to the effects of the anaesthetic, and the risk of developing a blood clot (deep vein thrombosis or pulmonary embolism). In an individual with poor general health or multiple health problems, the risks of having a complication are greater. To replace the knee joint is a major operation and the decision to undergo surgery should only be made after careful consideration.
Who should consider this operation?
TKR should be considered if you are suffering from advanced knee arthritis, with significant pain and stiffness that is affecting your quality of life, the treatment of which has been unsuccessful with the use of non-operative measures.
Preoperative preparation and evaluation
Once a decision to have a TKR has been made, you will be required to attend an appointment at the hospital several days or weeks before the actual procedure for a preoperative evaluation by the surgeon and members of the surgical team. During this time the team will take a medical history, perform a physical examination and carry out relevant investigations to ensure you are fit enough to undergo the operation. These investigations usually include blood tests, urine tests, X-rays and an electrocardiogram (ECG).
If you are a smoker you should stop smoking at least 2 weeks (the longer the better) prior to the operation and should continue to do so after the procedure. This is because smoking increases the chances of having a problem with the anaesthetic and also of having a wound healing problem. Certain medications should also be stopped prior to the operation, you will be informed about these by the doctor or nurse when you attend pre-assessment. Certain medications and conditions may require an individual to be admitted into hospital 1-2 days prior to the operation. Arrangements for this will also be made during the preoperative evaluation.
You will be advised at this time on how to prepare your home circumstances for when you are discharged from hospital, and the team will help arrange home support if you live alone or are deemed to require additional support.
It is important that you as fit as possible prior to the operation to ensure the best possible outcome. The more muscle strength and movement that you have before the operation the better you will cope afterwards. Physiotherapists are usually present at the preoperative visit to advise you on exercises to help strengthen the knee in preparation for the surgery. You are advised to remain as active and mobile as possible, in particular partaking in activities such as swimming, walking and cycling can help. Finally the physiotherapist may also use this opportunity to teach you how to use crutches. This can help to speed the recovery process.
What happens in the postoperative period?
Over the years the standard and quality of knee replacements and our understanding of postoperative management has dramatically improved. As a result, individuals who undergo a total knee replacement are normally discharged from hospital within 5 days of the procedure.
Immediately after the operation you will be taken to a recovery room until you are fully awake and the anesthetist is happy that your condition is stable. At this point you will be transferred back to the ward. Pain is common in the early stages after surgery and you will therefore be offered pain relief to manage your symptoms and allow you to commence rehabilitation as soon as possible. Many surgeons now advocate an enhanced / accelerated recovery programme. This aims to have individuals standing and mobilizing within 12-18 hours after surgery.
During the hospital stay the nursing staff will ensure pain is adequately controlled and monitor the wound as it heals. A physiotherapist will see you regularly during your stay in hospital to help with mobilizing, walking up and down stairs, and to provide advice on strengthening exercises. The physiotherapist will also offer general advice to help manage pain and swelling. An occupational therapist (OT) will also assess your function undertaking a number of daily tasks and may issue equipment to help manage at home.
How long it takes to recover depends on many factors including your general health, preoperative mobility and the condition of other joints. After discharge you will continue to be followed up to ensure recovery is going well. District nurses will manage changing of dressings and removal of skin clips or stitches. You will generally attend an outpatient appointment 6 weeks after the operation. You may also be referred for outpatient physiotherapy if it is felt you would benefit from additional input. It commonly takes at least six months to experience the full benefits of surgery.
Generally you may return to driving within 6 weeks after a total knee replacement. You may return to work when you feel comfortable that you can continue with their normal role. This will vary depending on the your profession. Jobs involving standing for prolonged periods of time or manual work may need 10-12 weeks. Heavy manual work is not advised following a knee replacement.
Total Knee Replacement & Uni Knee Replacement
The videos below shows a detailed explanation of the causes and presentation of Total Knee Replacement and Uni Knee Replacement. They show a basic outline of the procedures used by Amir Qureshi and after care required in order that you, the patient, may recover to your full fitness once again.