A knee replacement is designed to alleviate pain, to restore movement and function of the knee, and to permit a return to your usual activities. Knee replacement surgery is also referred to as knee arthroplasty. The degenerative knee joint is replaced with biomedically engineered metallic and plastic components with potentially two decades or more durability. Following a knee replacement, Sydney residents can benefit from pain relief, improved mobility, and an enhanced quality of life.
Knee pain beyond middle age is most commonly caused by arthritis. Arthritis is a broad term that refers to any disorder that can affect a joint. Osteoarthritis is the most common type of arthritis and is also referred to as degenerative joint disease. Other types of knee arthritis are rheumatoid arthritis which is a type of inflammatory arthritis, arthritis occurring some years after a significant injury referred to as post-traumatic arthritis, and then less commonly avascular necrosis. These are all knee conditions that can lead to knee replacement surgery.
Knee replacement surgery is recommended when:
- There has been progressive knee pain over a prolonged period of time, including pain in bed at night.
- There has been progressive difficulty performing day to day tasks such as walking around the shops, going up and down stairs, performing household duties, with this extending also to recreational pursuits and hobbies.
- There is a deteriorating limp and sometimes a walking stick is required to assist mobility, or around the shopping centre, a shopping trolley is held to assist mobility.
- Pain medicines no longer control knee pain.
- X-rays confirm knee joint degeneration.
Knee replacement surgery is more often performed after 60 years of age. Knee replacement surgery can be performed before 60 years of age in rheumatoid arthritis and other types of inflammatory arthritis. When it has been performed for osteoarthritis before 60 years of age, there is potential for repeat surgery in your lifetime.
A knee replacement is designed to alleviate severe knee pain, to restore knee movement and function of the knee joint, and to permit a return to your usual activities.
Knee replacement surgery forms one part of a successful treatment plan. Pre-operative and post-operative physiotherapy are also important parts to the treatment plan. The physiotherapy exercise programme is tailored to your needs and goals. The physiotherapist will guide the return of knee movement and strength with these also serving to reduce post-operative pain and potentially also to reduce post-operative complications.
Knee replacement surgery is classified as major surgery and the first few weeks after surgery can be physically and psychologically challenging. Take time to settle back into home, and work towards routine home activities. Post-operative soreness is to be expected and can be managed with pain-relieving medication. Tiredness can also be expected.
The operated knee is expected to swell. The knee swelling and warmth should reduce slowly over a couple of months. Ice packs are excellent ways to control swelling and also pain. Pain control is important as it will allow you to follow the exercise programme and to enable rest. Remember to follow the pain management plan as this will hopefully allow a return to your usual sleep pattern.
A waterproof dressing covers the surgical incision. The dressing is shower proof, is changed only when required, and can be removed and left off 2 weeks after surgery. The sutures to the surgical incision are dissolvable and do not require removal. Thereafter, the surgical scar can be gently massaged with moisturising skin cream/bio-oil/vitamin E cream.
Regular light exercise such as walking is encouraged, and work towards returning to routine household activities as comfort and confidence permits. It may however be a couple or few months before recreational activities are returned to.
The journey after a knee replacement can extend for several months and, in the early weeks, progress may seem difficult to judge, however successful treatment is measured by the long-term result.
Dr Robert Sew Hoy is an Orthopaedic Surgeon with nearly 20 years of experience in treating hip and knee conditions. Dr Sew Hoy completed subspecialty training in hip and knee replacement surgery at the Harvard Medical School in Boston, and then at the Mater Hospital in Sydney. His results can be judged by the satisfaction of patients treated.
Dr. Robert Sew Hoy now provides his services in two convenient locations:
- Northern Beaches Hospital
Suite 20, Level 7, 105 Frenchs Forest Road, Frenchs Forest, NSW 2086
- The Mater Clinic
Suite 1.15, 3-9 Gillies Street, Wollstonecraft, NSW 2065
Some of the most commonly asked questions regarding knee replacements are answered below:
Clinical protocols and pathways are followed that have been designed to reduce risk associated with knee replacements, but risk cannot unfortunately be reduced to zero. The vast majority of patients proceed through surgery along the expected path to recovery. It is important however to spend some time reading through the potential risks and complications, and to ask questions as they arise.
A list of the more important risks includes, but are not limited to:
- Infection of the components and this is despite administering medication to prevent infection.
- Blood clots (termed venous thromboembolism), and this is despite administering medications to prevent blood clots.
- Numbness around the surgical incision.
- Failure of the component to bond to the bone termed component loosening.
- Knee stiffness despite diligence with the rehabilitation programme.
And importantly, the potential for residual pain despite completion of the rehabilitation programme and having restored knee movement and function. The residual pain after knee replacement surgery shall hopefully be significantly less than the pain from arthritis present before surgery.
The ‘medical risk profile’ for developing a blood clot (venous thromboembolism) after hip or knee Orthopaedic Surgery can vary from patient to patient. Blood thinning medication either as a tablet or daily injection when in hospital (tablet or injection as determined by the medical risk profile) and continuing after surgery for a period, can reduce the chance of developing a blood clot. Working towards regaining independent mobility and routine daily activities are also important in reducing the chance of blood clot formation.
Most patients will go home after 3-5 days in hospital but, for patients in their mid-70s and above, this may depend on whether there is someone home with them and whether there are only a couple of pre-existing medical conditions, or many pre-existing medical conditions. Prior to going home, patients need to prove their reasonable independence with regards to personal cares namely toileting, showering, dressing, walk safely with walking aids, and manage stairs
The physiotherapy plan is designed to regain knee function and to a return to routine daily activities through a balance of exercise and rest. Pain-relieving medication and ice packs work towards reducing pain and swelling. Discomfort around the knee replacement should become more manageable overtime. Work with the physiotherapist to find a balance between exercise and rest.
Pain and discomfort caused by orthopaedic conditions affect our patients negatively every day. Which is why we work so hard to provide relief for every one of our patients. Our team is highly trained in the diagnosis, treatment and management of all musculoskeletal conditions and injuries.