When Do We Need A Knee Replacement?

There are different types of knee replacements, each suited to specific conditions and needs:

• Total Knee Replacement: This is the most common form and involves replacing all three compartments of the knee joint. It’s generally recommended for patients with advanced arthritis affecting multiple parts of the knee.
• Partial Knee Replacement: Also known as unicompartmental knee replacement, this procedure is suitable for patients whose damage is limited to just one part of the knee. It involves a smaller incision and typically results in a quicker recovery.
• Complex or Revision Knee Replacement: This is required in more severe cases, such as those involving significant bone loss, major deformities, or the need for a second or third replacement. It may involve more complex techniques and specialized implants for better stability and longevity.

The most common cause leading to knee replacement surgery is osteoarthritis, a degenerative disease affecting the bones of the knee. Osteoarthritis results in the irregular and rough surfaces of the knee joint, impeding smooth and painless motion.Typical clinical features indicating knee osteoarthritis, which might necessitate a knee replacement, include persistent joint pain, often worsening with activities like standing or climbing stairs, and morning stiffness that resolves with activity. Other symptoms can include mild joint swelling and crepitations (clicking sounds) during joint movement. As osteoarthritis advances, it may also lead to joint instability and locking, further diminishing knee function.

Knee replacement might be considered when conservative therapies, such as non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy, have been ineffective in managing symptoms for a considerable duration (like six months or more).

Indications for surgery include debilitating knee pain that significantly affects daily activities, such as an inability to walk more than a few blocks, disruption of sleep due to knee pain, or an inability to work because of discomfort.

In some cases, knee joint replacement may also be recommended for conditions other than osteoarthritis, such as rheumatoid arthritis, traumatic injuries leading to severe knee damage, and in cases where a previous knee prosthesis has become loose or dysfunctional.

Evaluating the need for knee replacement surgery involves a comprehensive assessment that includes a review of medical history, a thorough physical examination, and various diagnostic tests.

• Medical History and Physical Examination: The initial evaluation is centered around understanding the patient’s general health and the specific issues related to the knee. During the medical history review, the orthopedic surgeon will inquire about the patient’s overall health, the severity and duration of knee pain, and how it affects their ability to function. This history helps in identifying any underlying conditions that may influence the treatment approach. The physical examination focuses on assessing the knee’s motion, strength, stability, and overall alignment of the leg. This examination is crucial to determine the extent of damage and the potential benefit of knee replacement surgery.
• Imaging Tests: Diagnostic imaging plays a pivotal role in evaluating the need for knee replacement. X-rays are commonly used to assess the extent of damage and deformity in the knee. These images help in identifying severe osteoarthritis, characterized by a reduction in the joint space and changes in bone structure. In some cases, advanced imaging like MRI (Magnetic Resonance Imaging) may be needed.
• Other Diagnostic Tests: Occasionally, additional tests such as blood tests may be required.
• Considering Nonsurgical Options: Before proceeding with surgery, it’s important to consider nonsurgical treatments or knee pain remedies. These may include anti-inflammatory medications, cortisone injections, lubricating injections, knee caps for knee pain, hurt knee caps, and physical therapy. If these treatments provide substantial relief and improve knee function, surgery might not be necessary. However, if these methods fail to alleviate pain or improve mobility, and if the knee condition significantly hinders daily activities and quality of life, knee replacement surgery may be considered a viable option.

• Pre-Operative Preparation: Before the surgery, patients undergo a thorough medical examination, including blood tests and other diagnostic tests, to ensure they are in good health. Patients may need to stop certain medications and supplements and are usually advised to fast for eight hours before the procedure. It’s important to arrange for post-surgery assistance at home as mobility will be limited initially.
• The Surgical Process: Knee replacement surgery typically requires a hospital stay and is performed under regional anesthesia. After the surgery, patients are moved to a recovery area. The length of the hospital stay varies based on individual needs, but many can go home by 3 days.
• Post-surgery care
  Post-surgery care includes:
  • Early mobilization with the help of crutches or a walker.
  • Wearing compression stockings or using inflatable air sleeves to prevent blood clots.
  • Possibly taking blood thinners.
  • Engaging in breathing exercises and physical therapy to regain knee function.
  • Patients are advised to elevate their legs and apply ice to reduce swelling. Regular exercises to strengthen the knee and improve mobility are crucial.
• Risks and ComplicationsAs with any surgery, knee replacement carries risks, including bleeding, infection, blood clots, nerve damage, and potential issues with the prosthesis like loosening or wear. Continuous pain or stiffness may also occur. It’s important to discuss these risks with the healthcare provider before the surgery.

  Knee replacement surgery aims to relieve pain, improve mobility, and enhance the quality of life. Most artificial knee joints last 15 to 20 years, and after recovery, patients can typically engage in low-impact activities but should avoid high-impact activities or sports.

Recovery and rehabilitation following a knee replacement surgery are critical phases, encompassing various aspects to ensure successful outcomes. Typically, full recovery can take up to few months, but most people can resume their usual activities about six weeks after the surgery.

• Early Postoperative Exercises: Soon after surgery, it’s important to start exercises that help increase circulation to the legs and feet, preventing blood clots, strengthening muscles, and improving knee movement. These exercises should be initiated as soon as possible, even in the recovery room, despite potential discomfort. Exercises include quadriceps sets, straight leg raises, ankle pumps, knee straightening exercises, and bed-supported and sitting-supported knee bends. Consistent practice of these exercises is crucial until full strength returns to the thigh.
• Walking and Weight Bearing: Early activity, including walking short distances in the hospital room and performing daily activities, is essential for recovery. Initially, walking will be assisted with a walker or crutches, with gradual increases in weight-bearing as per individual capability and surgical details. Patients who bear some weight on their new knee shortly after surgery often recover quickly.
• Hospital Discharge and Home Care: Discharge from the hospital depends on several criteria, including the ability to move with assistance, manage stairs, and bend the knee to a certain degree. Some patients may be discharged to a rehabilitation facility for further care. Post-discharge care includes icing the knee, elevating it, keeping the incision clean, and doing home exercises. Physical therapy is often a part of the recovery process, helping with safe movement, bending the knee, and walking.

Knee replacement surgery, primarily necessitated by conditions like osteoarthritis and rheumatoid arthritis, is a significant medical intervention aimed at alleviating pain and restoring mobility of the joints in the knee. This procedure is quite common, with surgeons performing over 850,000 knee replacements annually in the U.S. alone. While it offers substantial benefits like improved mobility and quality of life, it’s not without risks such as infection, blood clots, or issues with the prosthetic. Recovery can take up to a year, with a significant improvement expected within six weeks post-surgery.