Have you been told that your knee pain is caused by severe arthritis, that you might need total knee replacement. Or have you had a total knee replacement and you have questions about the procedure?
Based on my knowledge as a diagnostic radiographer and scientific studies on the subject, I have written this article for you.
Happy reading!😀
Have any questions, remarks, or experience to share? Feel free to use the comments section at the end of the article!🙏
Last updated: April 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links.
▶️Basics
Knee replacement may also be referred to as:
Total knee arthroplasty is a surgical procedure that decreases pain and improves the quality of life in many patients with severe arthritis of the knees.
You will only undergo this surgery after non-operative treatments have failed to provide relief to your arthritic symptoms.
Non-operative treatments will include:
🟠Adjusting your day’s activities.
🟠You will be given some anti-inflammatory medications to help ease your pain.
🟠knee joint injections.
When all these methods fail then knee replacement will be an option.
Basically, knee replacement surgery involves replacing damaged parts of your knee joint with mental or plastic parts.
▶️Reason why you may need a knee replacement. (Total knee arthroplasty)
The most common reason for knee replacement surgery is osteoarthritis or when you have had a fracture in your joint.
Osteoarthritis in the knee occurs when the articular cartilage becomes damaged through natural wear and tear. The bones have little or no protection to prevent them rubbing against each other when the knee moves.
The most common types of arthritis that affects the knee are:
1️⃣Inflammatory arthritis-Patients with inflammatory arthritis of the knee usually have joint damage in all three compartments.
2️⃣Osteoarthritis (OA) or degenerative joint disease.
Osteoarthritis may affect multiple joints, or it may be localised to the involved knee.
Image of a normal and osteoarthritis (OA) knee
Image from: (Bayramoglu, 2020)
Figure 1. Severe knee arthritis, on the left is a normal knee, and on the right is an OA knee. This image shows joint compartments, as well as joint space narrowing (JSN) and osteophytes.
You may be wondering if having osteoarthritis always leads to a knee replacement.
The answer is NO, not everyone with osteoarthritis in the knee usually has surgery for a knee replacement.
The most common reason for knee replacement surgery is to ease pain caused by arthritis. This pain should be preventing you from walking, climbing stairs and getting out of a chair.
In such cases your doctor may recommend total knee replacement.
The GOOD News is:
Total knee arthroplasty (TKA) results in a high degree of patient satisfaction, as it provides patients with considerable medium- and long-term benefits in terms of quality of life, pain relief and function. (Canovas, 2017)
▶️Recognising bad knee arthritis symptoms that might lead to a total knee replacement.
♦️You have very bad arthritis.
♦️Nonsurgical treatments are no longer effective.
♦️Your pain prevents you from doing normal activities or caring for yourself. The pain usually gets worse by weight-bearing and activity.
♦️Your knee has become deformed.
♦️You may have severe pain and sometimes morning stiffness, even when resting, and you can’t sleep.
♦️Your knee is always swollen and warm. You will find it difficult to bend the knee or weight-bearing.
⚠️Caution⚠️! These signs too might indicate joint affection, or something else. It’s important to see your doctor for medical attention and proper diagnosis.
▶️Recognising arthritis on x-ray.
Weight bearing x-rays will be taken to confirm if you have arthritis because it is usually evident on x-rays and the joint’s function can be well assessed for proper treatment clues.
x-rays will show Osteoarthritis characteristic X-ray such as joint space narrowing, formation of osteophytes, articular surface cortical irregularity and/or sclerosis, and formation of sub-cortical cysts.
x-rays will also determine whether your arthritis pattern would be suitable for total knee replacement or for a different operation such as minimally invasive partial knee replacement.
▶️What is the average age for knee replacement and what is the lifespan?
The decision to have a knee replacement will often depend on the severity of your pain and disability. However, most knee replacements I have seen are performed on patients who are between the age of 60 and 80.
Most doctors do sometimes recommend that people under age 60 should wait to undergo a knee replacement procedure, because these artificial joints typically last only about 15 to 20 years.
Most reports and studies point to knee replacements having a lifespan of between 15-20 years. Most studies show that around 90% of knee replacements last for 10 Years, while 80% last for 20 years.
If someone younger gets the procedure, it’s likely that the joint will need to be replaced again down the line.
▶️How can I prevent knee replacement?
Some studies identify a few things you could do if you want to avoid knee replacement.
⏺️It is believed Losing weight helps less pressure on the knee joints and it also helps strengthen muscles and increase flexibility.
⏺️Low-impact exercise such as swimming, walking, or cycling, and muscle strengthening in the knee will help you strengthen the knee joint.
⏺️You can also use walking aids.
⏺️Pain relief medicines, gels, or creams recommended by your doctor.
▶️Why does my knee hurt even after knee replacement?
For many, this surgery reduces pain and improves the function of the knee. But around one in five people report ongoing pain after surgery. This pain can increase in intensity beyond the initial healing phase of a few months.
The pain experienced during knee replacement surgery recovery varies from patient-to-patient. While some individuals may experience significant discomfort, others may have a milder recovery experience.
It’s important to note that knee replacement surgery is a major procedure, and some level of pain and discomfort is expected during the recovery process.
⏺️You will find a problem bending your knee.
⏺️You will have ongoing pain and stiffness for some time.
⏺️The knee will feel unstable when you stand up or walk.
▶️Possible complications of total knee replacement
Blood clots are possible after a knee replacement, but this is not often serious.
There is a small chance that your wound could get infected after operation.
During surgery there is a chance that a blood vessel, nerve, or ligament around the knee could be damaged.
▶️How long does it take to walk or climb stairs after a full knee replacement?
For the first couple of days after surgery it may be difficult to climb stairs. your knee will be swollen, painful, and weak as it starts healing.
However, by the time you leave hospital (usually 2 to 4 days after surgery), you should be able to climb stairs using an assistive device or supporting yourself with your upper body.
While you’re still in hospital, your nursing team will practise navigating stairs with you.
Generally, most patients I have seen begin walking with improved stability and comfort between two to six weeks after knee replacement surgery.
⚠️Caution⚠️! While walking is an essential part of the rehabilitation process, it is always good to take it slow not to overdo it.
Climbing stairs is typically encouraged as part of the rehabilitation programme.
Performing activities that put significant stress on the knee joint, such as climbing stairs, can be challenging but will be encouraged.
Going down the stairs with help of crutches
Going up the stairs with the help of crutches
▶️What can you do and not do after knee replacement?
Getting back to your favourite activities should be your number one goal. This means doing your exercises, taking medical advice and focusing on rebuilding your strength and mobility.
But whilst doing all that you should be aware of the Dos and Don’ts
Dos
➡️ Use crutches or walking sticks at first – go down and up the stairs; to 1 crutch then a walking stick when you feel confident!
➡️ Try walking without an aid after about 6 weeks if you feel ready!
➡️Get up and walk around for 5 minutes every hour to prevent blood clots
➡️ Wait at least 6 weeks to drive again if you’ve had a total knee replacement or 3 weeks if you’ve had a partial knee replacement.
➡️ Avoid twisting your knee, bending down, and reaching up as much as possible!
➡️Follow the exercises your physiotherapist has recommended!
➡️Keep your leg raised as much as possible to reduce swelling!
➡️Return to work when you feel ready – this is usually after about 6 to 12 weeks but will depend on the type of work you do!
Don’t
➡️Do not sit with your legs crossed for the first 6 weeks! Sitting in a crossed-legged position too soon after surgery can put excess pressure on your knee joint. When sitting down, you should try to keep your knees and feet pointing straight ahead.
➡️ Do not Sit on a low seat or sofa because this can make it tricky to get up again without putting undue stress on your knee. If possible, sit in firm chairs with back support and arm rests until you are fully recovered.
➡️Do not sleep with a pillow under your knee (you do not need to sleep in a special position after the operation) To avoid excessive stress on the new joint, you ideally want to keep your knee as straight as possible while sleeping.
➡️Do not kneel on your new knee until your doctor says you can.
➡️Do not stand for long periods of time as this could cause swelling in your ankles!
➡️Do not do household tasks that involve lifting or moving anything heavy (like vacuuming) for the first 3 months!
➡️ Do not ignore pain If you are finding the pain hard to manage, talk to your doctor!
▶️How long is bed rest after knee replacement?
The duration of bed rest after knee replacement surgery is relatively short. Most patients are encouraged to get up and start moving as soon as possible after the procedure.
Early mobilisation is essential for preventing complications such as blood clots and reducing the risk of stiffness in the knee joint.
▶️Knee replacement surgery recovery time
if you have had a knee replacement and you are wondering when you can go back to your normal activities.one thing you should know recovery is different for everyone. Your healing may be shorter or longer.
Trying to do too much, too soon could result in your recovery taking longer and cause unnecessary pain or discomfort.
Recovering from home
The physiotherapy will play a crucial role in your rehabilitation and recovery. Focus will be on movement exercise therapy to help you get back to your normal activities.
🔵 You may be advised to exercise for 20 to 30 minutes daily, or even 2 to 3 times daily and walk for 30 minutes, 2 to 3 times daily during your early recovery.
🔵You may want to try using ice packs or heat packs in the days or weeks after your surgery. This can help to ease swelling and pain. Apply the cold pack for around 20 minutes a few times a day until the swelling goes down.
🔵Maintaining a balanced and varied diet that contains all the vitamins, minerals and proteins you need for recovery will encourage your body to heal.
Hope I have answered some of the questions you have about total knee replacement.
Wishing you a quick recovery.🙏
Below are some of the sources I have relied on for this article.
📚Sources.
Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res. 2018 Feb;104(1S):S41-S46. doi: 10.1016/j.otsr.2017.04.017. Epub 2017 Nov 26. PMID: 29183821.
Dattani R, Patnaik S, Kantak A, Tselentakis G. Navigation knee replacement. Int Orthop. 2009 Feb;33(1):7-10. doi: 10.1007/s00264-008-0671-3. Epub 2008 Oct 29. PMID: 18958468; PMCID: PMC2899225.
Kladny B. Rehabilitation nach knieendoprothetischer Versorgung [Rehabilitation following total knee replacement]. Orthopade. 2021 Nov;50(11):894-899. German. doi: 10.1007/s00132-021-04175-9. Epub 2021 Oct 15. PMID: 34654935.
Ahmed, Sozan Mohammed, and Ramadhan J. Mstafa. 2022. “Identifying Severity Grading of Knee Osteoarthritis from X-ray Images Using an Efficient Mixture of Deep Learning and Machine Learning Models” Diagnostics 12, no. 12: 2939. https://doi.org/10.3390/diagnostics12122939
Bayramoglu, N.; Nieminen, M.T.; Saarakkala, S. A Lightweight CNN and Joint Shape-Joint Space (JS2) Descriptor for Radiological Osteoarthritis Detection. Commun. Comput. Inf. Sci. 2020, 1248, 331–345. [Google Scholar] [CrossRef]