Total Knee Joint Replacement
Total knee joint replacement (TKJR) also called Total knee arthroplasty (TKA) is an orthopaedic surgical procedure. It involves replacing the knee joint surfaces (the tibial plateau, femoral condyle and sometimes the posterior surface of the patella) with an implant that is designed to mimic the natural motion of the knee joint. TKJR is usually done in response to an irreversible condition severely affecting the knee joint itself and aims to reduce an individual’s knee pain and improve their function.
Reasons for TKJR
It is often recommended to trial a period of physiotherapy first, however if conservative treatment is not effective, then surgery is usually recommended.
TKJR is considered when an individual’s function and quality of life is severely impacted by the condition of their knee joint.
Some of these conditions include:
Osteoarthritis: the most common reason for knee replacements; this occurs naturally with age and involves the gradual breakdown of the smooth tissue that covers joint surfaces which causes friction and pain during movement. Osteoarthritis can also develop in younger individuals after a traumatic injury to the knee joint; this is called post-traumatic arthritis.
Rheumatoid Arthritis: a condition where an individual’s immune system attacks the joint structures that reduce friction and offer protection to a joint. This type of arthritis is more common in smaller joints such as those in the hand but can occur in the knee.
Haemophilia: increased bleeding into joint spaces causes an increased pressure within the joint cavity which can lead to chronic swelling and deformity of the knee joint.
Severe knee injury: this can include fractures to the knee joint surfaces or trauma to the knee joint which can cause deformity and disrupt the alignment and natural movement of the knee joint.
Surgery – patient preparation and protocol
A comprehensive guide to preparing for a TKJR surgery and what to expect during hospital stay can be found here as provided by the Ministry of Health:
Post-surgery: Hospital stay
After the TKJR surgery has been completed, a patient will be closely monitored by the medical team to keep fluids and oxygen in balance, administer medications, and to keep the surgical wound clean to prevent infection. An X-ray is also taken to ensure proper knee alignment post-surgery.
Early physiotherapy is highly recommended, as evidence has shown that early, simple mobilisation exercises can prevent post-surgical complications and speed up recovery time. This can be as early as day zero (the same day as the operation) to day three post-operation. The time at which physiotherapy after TKJR commences will depend on the presentation of the patient to determine when it is appropriate to do so. Discharge from hospital with crutches usually occurs on day three post-surgery once you have been assessed and deemed safe to go home.
Post-surgery: Side effects
After surgery, it is very common to experience side effects such as:
Pain, stiffness, and numbness around the operated knee.
Swelling at and around the operated knee.
Bruising around the operated knee, it is common for this to extend above and below the knee.
Disrupted sleep usually due to pain.
Reduced movement of the operated knee. Initially it will be difficult to move your knee but as the pain and swelling decreases over time this will improve, especially with physiotherapy.
Expectations after discharge
After being discharged from the hospital it is highly recommended to continue with physiotherapy to improve mobility and function. Routine wound dressing maintenance will also be provided to prevent infection of the wound. Medications are also routinely given by GPs to help alleviate symptoms.
Rehabilitation after a TKJR usually takes up to three months to resume more strenuous activities however throughout those three months normal function is expected to gradually improve. Full recovery can take up to six months. If a patient is particularly active or takes part in high level sports, this process may take longer to decrease chances of reinjury upon gradual return to these activities.
It is important to keep active even after a three-month period as studies have shown that physiotherapy exercises can continue to be beneficial for up to a year post-surgery.
Symptoms to monitor post-surgery
Complications after surgery can arise in few cases. These often include the formation of blood clots around the implant (blood thinning medication is often given post-surgery) and infection of the surgical wound.
Be sure to look out for these symptoms once you are discharged home:
Shortness of breath
Fever or chills
Calf pain and/or swelling
Unusual discharge or odours from the dressing
Nausea or vomiting
Physiotherapy after TKJR surgery will often consist of:
Activity modification to reduce aggravation and chances of reinjury.
Range of motion exercises to restore functional movement of the knee.
Strengthening exercises for the entire lower limb – initially these exercises will start off as gentle and become progressively more challenging over time to ensure adequate knee strength for function is obtained.
Aerobic exercises such as walking and cycling to maintain fitness.
Balance and gait retraining to prevent falls as well as to correct any compensations during walking that may have been picked up earlier.
If warranted, specific return to sport/activity exercises will also be given which can extend the rehabilitation journey but is nonetheless necessary. This will be dependent on how active the patient is as well as what their rehabilitation goals are.
It is important to note that often after a knee replacement surgery full range of motion may not be restored, however, functional range of motion is usually regained through physiotherapy. This means that although you may not be able to bend your knee as far as you could prior to surgery (i.e. before surgery you may have been able to painfully bend your knee to the point that your heel touches your bottom), you will still be able to bend it as far as required for your everyday activities which is often one of the main goals for physiotherapy.
For more information, please call to book in, or book online, for professional advice and management from your physiotherapist.
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