Knee pain is a common complaint post 40. It could be a result of overexertion of the knee and may subside with rest, or it could be chronic, caused by knee injury or arthritis. The main types of arthritis that cause chronic pain are as follows:
- Osteoarthritis : This is the result of age-related wear and tear. The cartilage in the knee wears off and the bones rub against each other, leading to stiffness and pain.
- Post-traumatic: This damage to the cartilage is caused by ligament tear.
- Rheumatoid arthritis : This is a type of inflammatory arthritis where, the synovial membrane around the joint becomes inflamed and thick due to an auto immune reaction, leading to pain, stiffness, and loss of cartilage.
With increase in pain, movement is gradually restricted. It might be accompanied by severe knee stiffness, swelling, or deformity, and the person may not respond to the strongest anti-inflammatory drugs and physical therapy. This is when knee replacement surgery is considered as a good option for relief of symptoms and a better life.
What is Knee Replacement Surgery?
Knee replacement surgery or arthroplasty is a surgical procedure in which the surfaces of the bones forming the knee joint are replaced with artificial parts called prosthesis.
Types of Knee Replacement
- Unicompartmental (partial) knee replacement: This is advised by the orthopaedic surgeon when only a single compartment of the knee is affected. Therefore, only components of that compartment are replaced.
- One should not opt for partial knee replacement if they experience:
- Excessive knee stiffness.
- Damage to the ligament.
- Inflammatory arthritis.
- Total knee replacement (TKR): All three compartments of the knee are replaced in this major surgery.
Who should opt for TKR?
- Excessive knee pain and stiffness, which severely limits routine everyday activities like walking even short distances, going up and down the stairs, getting up from a chair.
- Knee pain even at rest even during the day.
- Severe swelling
- Deformity of the knee joint.
- Pain that does not respond to medication and physical therapy.
Procedure
- The damaged cartilage and bits of the underlying bone are removed by opening the knee joint.
- Metal implants are either cemented or pressed into the bone.
- In case of total knee replacement, the undersurface of the bone that forms the knee cap is cut and replaced with a plastic button-like device.
- A smooth gliding surface is created by inserting a spacer made out of medical-grade plastic between the metal implants.
Pros of partial over total knee replacement
- Lesser post-surgery pain.
- Lesser loss of blood.
- Rapid recovery after surgery.
Cons of partial over total knee replacement
- Arthritis might develop in the parts of the knee that have not been replaced. This might necessitate another surgery.
- There is no guarantee of the degree of pain relief.
Recovery
- Hospital stay: Patients who have undergone total knee replacement surgery may have to stay in the hospital for a week. Those who undergo partial replacement surgery, have a shorter stay of 1-3 days and recover faster.
- Pain management: Some amount of pain is expected after surgery. Your surgeon will give you medications for pain relief.
- Prevention of blood clots: Your physician will prescribe you blood thinning drugs, compression boots, support hose, and certain foot and ankle exercises to keep blood clots from forming post surgery.
- Physiotherapy: People who have undergone partial replacement start putting their body weight on the joint almost the same day because movement is not completely restricted. They might need support to walk for the first few days. People who have undergone total replacement are made to perform knee strengthening exercises under the supervision of a physiotherapist. A device called continuous passive motion machine is used to slowly move the knee in bed. It helps to reduce swelling and improves circulation.
- Deep breathing exercises are recommended to prevent a partial collapse of the lungs, which may lead to pneumonia.
- A nutritious diet, rich in iron, helps in faster recovery.
It is possible to resume all your daily activities by about 3-6 weeks after a total replacement surgery and within a week in partial replacement surgery. However, physical therapy and regular exercising should be performed before resuming your regular activities.
