Knee Osteoarthritis & Total Knee Replacement
Indications for a total knee replacement (TKR) are for those individuals with severe osteoarthritis or degeneration of the joint that is affecting their ability to complete activities of daily living or participate at home or work without compensation. TKR is usually considered when conservative/alternate treatments have failed to provide adequate relief. The purpose for having a TKR is to primarily reduce pain, increase range of motion, and improve one’s ability to complete the activities that they enjoy to do.
A total knee replacement involves the femur (thigh bone), the tibia (shin bone), and the patella (knee cap).
Osteoarthritis (OA), or degenerative joint disease (DJD), is one of the most common causes of knee pain and thus lead to the need for a TKR. Some people refer to it as “normal wear and tear” of the knee. OA is a degenerative process that can affect a person at any age, but is most common in older adults. It can be hereditary or traumatic results from injury. It is the loss of the natural cushioning between the joint. As you lose cartilage, boney spurs form, and joint space is lost. As a result, people can experience more pain, stiffness, loss of range of motion, and difficulty walking.
Symptoms include knee pain with and without weight-bearing activity, loss of range of motion, and difficulty completing daily activities like walking, negotiating stairs, picking objects up off of the floor, and other activities you enjoy.
Need for a TKR will come from an orthopedic surgeon and most commonly one who is an Total Joint Specialist. They will take images, such as X-rays or MRIs, to see the integrity of the knee joint and decide to do surgery when other treatments have failed. Other factors that may consider is your general health and activity level.
TKR is performed either under general anesthesia or with a nerve block. The knee is approached from the front, and then the damaged bone and cartilage is removed allowing for placement of the metal and plastic components that will make up the new knee joint. Range of motion and alignment is checked to ensure that the size of the component used is the best fit for the patient. The wounds are then closed using stitches, staples, or glue.
Post recovery in the hospital may take 1-3 days. Patients are discharged from the hospital once their pain is well controlled, and they are able to demonstrate safe gait mechanics and functional transfers using their assistive device. Most patients are weight bearing as tolerated with the use of an assistive device. Typically, a patient will require some help from family and friends once home
Each individual will receive care that is unique to them. Progression of ROM, weight-bearing status, strength exercises, and returning to functional activities is different for each individual. Physical therapy will normally begin within 1-2 days of being discharged. Rehabilitation takes on average 6-10 weeks, but varies by individual.
To prevent getting a TKR, patients may try anti-inflammatory medication, steroid injections, biologic injections, and/or alternative holistic treatments. Braces and/or an assistive device may be utilized to take pressure off the joint with weight-bearing activities. Physical therapy is a good option to assess how one moves, and determine if improving joint mobility, strength, range of motion, flexibility, and movement pattern will relieve pressure of an arthritic joint.