When patients have sufficient symptoms arising from their arthritic knee which are interfering with their ability to perform their work, activities of daily living, recreational pursuits and / or ability to sleep, they may be appropriate candidates for a total knee replacement.
Why Consider Total Knee Replacement?
The majority of patients with symptomatic knee arthritis (three out of every four), will have at least two of the three compartments (medial tibiofemoral, lateral tibiofemoral, patellofemoral) involved and will require consideration of a total knee replacement (TKR). A TKR removes the arthritic or worn ends of the knee by resurfacing the ends of the femur and tibia and where appropriate, the patella, by shaving a 1 to 2mm rim of cartilage and bone, and fitting the replacement components over the top, much like a crown on a tooth.
Most knee replacements have metal alloy components for the femur and tibia and polyethylene (plastic) components for the patella and for the bearing or liner attached to the tibial component. These implants have traditionally been used in patients aged in their late 60’s and 70’s, but as the implant designs and surgical technique and experience have improved, making recovery from surgery easier, knee replacements have become increasingly used in both older and younger patients.
Knee replacements are primarily designed to give patients pain relief from their arthritis, with additional secondary benefits including correction of deformity, improved alignment, leg length and mobility. Most knee replacements inserted in patients aged 55 years or older are expected to last at least between 10 – 15 years, with a 90% or greater likelihood that it will still be working in 10 years time.
Dr Gallagher is one of Australia’s leading knee replacement surgeons. Contact us today for expert advice on your options.
What is Involved with Total Knee Replacement Surgery?
The traditional incision for a TKR is 6 to 8 inches or 15 to 20cms, but it can be performed through a significantly smaller (10-12cm) incision using minimally invasive surgery (MIS) technique where the quadriceps muscles are not cut into, often resulting in less blood loss, faster restoration of independent mobility, shorter hospital stay, lower risk of infection and other complications including blood clots. Patients usually require a 6 to 7 night stay in hospital following a TKR, but this is often reduced to 3 or 4 nights with the minimally invasive technique and generally patients are able to mobilise without walking aids after two weeks. Most patients will use strong analgesia for four to six weeks and anti-inflammatories for two to three months and are usually able to resume most normal day-to-day activities within the first six weeks.
When Can You Return to Recreational Activities?
Recreational activities (walking for fitness, cycling and swimming etc) can usually commence after two to three months, and more vigorous activities (golf, tennis, surfing) after three to four months. Whilst most TKR patients will be walking without aids after three weeks, and feel like they are able to drive a car, it is a legal recommendation for insurance purposes, that patients who have undergone knee replacement surgery do not drive a motorised vehicle (car, motorbike, truck etc) for a six week period. Returning to work duties is sometimes possible for clerical type jobs within 3 to 4 weeks, but may require up to 3 to 4 months depending upon the individual’s job demands.
One Knee or Two?
Approximately a third of all patients with arthritic knees have severe arthritis in both knee’s and are sufficiently troubled to consider having both knee’s replaced at the same time. If patients wish to do so, it is useful to have some home supports in place, with other family members or close friends being available to help care for patients in the early post-operative period or to consider spending a week or two in a local rehabilitation facility). Dr Gallagher will routinely arrange for a pre-operative medical review with one of his perioperative physicians before bilateral TKR’s to exclude any occult (as yet undiagnosed) medical problems and to ensure that all known medical conditions are optimised prior to surgery.
Occasionally, it may be preferable on medical grounds to perform staged knee replacements, doing the second knee replacement 3 or 4 months after the first. Patients who undergo bilateral TKR’s usually stay in hospital for 5 to 7 days and whilst going a bit slower initially, by the 6th post-operative week, have usually achieved all rehabilitation milestones of those patients undergoing only a single TKR.
For a consultation on a total knee replacement or to discuss your options for relief from arthritic knee pain make an appointment today.