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Total Knee Replacement


Author: Finn Salleh, Physiotherapist, bounceREHAB

Co-Author: Matthew Craig, Principal Physiotherapist, Director bounceREHAB




What is a Total Knee Replacement?


A total knee replacement surgery (TKR), also known as knee arthroplasty, is a medical procedure in which a damaged or severely worn-out knee joint is replaced with a prosthetic implant. This surgery is typically performed to relieve pain and improve the function of the knee in individuals with conditions such as osteoarthritis, rheumatoid arthritis, or significant knee injuries.


During the procedure, the surgeon removes the damaged portions of the knee joint, including the ends of the thigh bone (femur) and the shin bone (tibia). These damaged areas are then replaced with artificial components made of metal and plastic. The new knee joint aids in improved mobility and reduced pain, enabling the patient to engage in a more active and comfortable lifestyle.


Total knee replacement surgery is a common and effective treatment for individuals experiencing severe knee joint problems that have not responded to other conservative treatments, such as medication, physiotherapy, or lifestyle changes.






How prevalent are they?


By the end of 2016, there were over 800,000 Australians living with at least one joint replacement, representing 3.4% of the total population. With an overall prevalence of 22.5%, and 13.3% of replacements in those aged >85 years and 65–84 years, respectively. .


Annually, over 20, 000 patients in Australia, over 300, 000 patients in North America and 36, 000 patients in the UK potentially require rehabilitation to regain functional independence and to resume recreational and work-related physical activities. Based on recent growth, the incidence of TKR for OA is estimated to rise by 276% by 2030!






What are the health outcomes!


Generally, total knee replacement surgery (TKR) is considered a highly successful procedure for relieving pain and improving function in individuals with severe knee joint damage, such as osteoarthritis. Here are some key points to consider:


  1. Pain Relief: The primary goal of a TKR is to relieve chronic knee pain and improve mobility. With data showing vast majority of patients in Australia experience a significant reduction in pain following surgery.

  2. Improved Function: TKR can lead to improved joint function, allowing individuals to perform activities of daily living more comfortably and effectively.

  3. Quality of Life: Patients often report an enhanced quality of life after TKR. They can engage in activities they couldn't participate in before the surgery.

  4. Longevity of Implants: The lifespan of knee implants can vary, but many are designed to last 15-20 years or more! Although, some individuals may require revision surgery if their implants wear out or develop complications.

  5. Patient Satisfaction: In Australia, the vast majority of patients report high levels of satisfaction with their TKR outcomes. With 2021 data depicting 81% of patients reporting satisfied or very satisfied.

  6. Complications: Like any surgical procedure, TKR carries some risks. Common complications can include infection, blood clots, implant loosening, and stiffness. The rate of complications is typically low but can vary.

  7. Age and Health Status: Older patients and those with more significant health issues may have different outcomes and potentially require more time to recover.




Who should I see for an opinion on knee surgery?

Here at bounceREHAB, we work closely with A/Professor Nigel Hope, one of Sydney's leading knee and hip surgeons. His approach to the patient's orthopaedic journey offers excellent outcomes - he places huge emphasis on high quality rehabilitation from an early post op stage.

Associate Professor Hope is a leading hip and knee specialist with over 25 years of experience, including such procedures as ACL reconstruction, hip replacement, knee replacement, and knee arthroscopy.


For more information, please watch the following video for answers to some commonly asked questions:







What symptoms might I experience after surgery?


After a total knee replacement surgery, it's common to experience a range of symptoms as part of the normal recovery process. These symptoms may vary from person to person, but some of the typical post-surgery symptoms include:


o Pain and Discomfort

o Swelling

o Knee Stiffness

o Bruising

o Limited Range of Motion

o Weakness

o Difficulty Walking

o Numbness or Tingling

o Surgery Site Healing/Skin Sensitivity

o Fatigue


These symptoms are part of the healing process and are quite normal, these tend to improve over time. The rate of recovery can vary from person to person, but with appropriate care, physiotherapy, and guidance from your healthcare team, you should experience significant improvement in your symptoms as you continue to heal and regain function in your new knee joint.








How does physiotherapy help?


Physiotherapists play a crucial role in the recovery process for a total knee replacement. Here at bounceREHAB we help with:


  1. Assessment: We begin by assessing your overall physical condition, the range of motion in your knee, and your current level of mobility. They also consider any specific challenges or limitations you may have.

  2. Designing a Personalised Exercise Program: Based on the assessment, a personalised exercise program is tailored to your needs and goals. Focusing on muscles strengthening around your knee, improving flexibility, and improving balance and coordination.

  3. Pain Management: We help you manage pain and discomfort by using techniques such as manual therapy, ice or heat application, and teaching you how to use pain medications effectively.

  4. Gait Training: We work with you to improve your walking pattern, teaching you how to walk safely and efficiently. This includes the use of crutches, walkers, or canes, if needed.

  5. Range of Motion Exercises: We guide you through exercises to gradually increase the range of motion in your new knee. These exercises are essential for regaining full flexibility.

  6. Strength Training: Building strength in the muscles around the knee is a key component of recovery, with exercises aimed at targeting these specific muscle groups.

  7. Balance and Coordination Training: Maintaining balance and coordination is crucial to prevent falls and ensure safe movement.

  8. Regaining your Independence: We work with you to regain your independence and help you return to your daily activities, including climbing stairs, getting in and out of chairs, and other functional movements.

  9. Education and Support: We can provide valuable information about post-surgical management, including activities to avoid and strategies for preventing complications. We also offer emotional support throughout your recovery.







How long is the recovery process?


The recovery process for a total knee replacement typically varies from person to person, but it generally follows a timeline like this:


  1. Hospital Stay: After the surgery, most patients spend a few days in the hospital for initial recovery and monitoring. This period allows medical professionals to manage pain, monitor the surgical site, and ensure that the patient can move safely.

  2. Immediate Postoperative Phase (1-2 weeks): During the first few weeks after surgery, you will gradually regain mobility. You'll likely use a walker or crutches and may require assistance with daily activities. Physiotherapy often starts during this period to help you regain strength and mobility.

  3. Intermediate Phase (2-6 weeks): Over the next month or two, you'll continue physiotherapy and gradually increase your range of motion and strength. Many people are able to walk with a cane during this phase. Swelling and pain will gradually reduce.

  4. Long-Term Recovery (3-6 months): It may take several months for your knee to fully recover. During this time, you'll focus on strengthening your knee and improving your walking and mobility. Many patients find they can return to most of their normal activities during this period.

  5. Full Recovery (6 months+): While most people experience significant improvements within a few months, it can take up to a year to reach the maximum benefits of a total knee replacement. By this point, you should have minimal pain, improved mobility, and the ability to engage in various activities.






Remember that individual recovery can vary, and some people may take longer to progress through these stages. Your surgeon and physio will provide guidance and exercises to help you throughout the recovery process. It's essential to follow their instructions and attend follow-up appointments to monitor your progress and address any concerns.




References:



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