What is a Total Knee Replacement? – Blog By Stephen Lee
A Total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with an artificial prosthesis. The procedure is performed by separating the muscles and ligaments around the knee. The end of the thigh bone (femur) is removed and is replaced with a metal shell. The lower leg bone (the tibia) is also removed and replaced with a metal T piece with a plastic top. Depending on the condition of the kneecap, a plastic ‘button’ may also be added under the kneecap to improve the surface.
Who requires a knee replacement?
A total knee replacement is considered for patients whose knee joints have been severely damaged by either progressive arthritis, trauma or other destructive diseases of the joint.
- The most common type of arthritis and occurs where there is gradual loss of articular cartilage causing bone remodeling, joint inflammation and loss of normal joint function. It mainly affects people over the age of 50 and those with family history of osteoarthritis.
- Rheumatoid Arthritis. This condition involves chemical changes in the synovial membrane surrounding the joint (within the capsule), causing it to become thick and inflamed. This causes the breakdown of the cartilage and degeneration which worsens over time.
- Trauma to the joint can cause the bone and the cartilage to not heal correctly. This can mean that the knee joint may develop osteoarthritis.
How to prepare for Surgery?
- Pre-habilitation exercises: Evidence supports the implementation of a pre-operational exercise program to strengthen the muscles in your lower leg. Principally this entails strengthening the quadriceps muscle complex. It is recommend commencing and performing pre-habilitation exercise a minimum of six weeks prior to surgery. Research supports that an exercise program designed by a physiotherapist improve post-operational outcomes.
- Lose Weight (for patients who are overweight). By losing weight prior to surgery, it will help reduce the stress on the knee joint and permit easier mobilisation in the period post surgery. Being overweight can increase your risks of raised blood pressure and therefore complicate your post-operative period.
- Stop Smoking: cigarette smoking has been proven to increase the time for tissue and joint healing and recovery.
Rehabilitation exercises following a Total Knee Replacement will start the day following your procedure and will be guided by your physiotherapist in hospital. This will include knee range of motion exercises, muscle activation and strengthening exercises and early mobilisation. Following a Total Knee Replacement, you can usually put as much weight on the knee as you feel comfortable, however this will be guided by your surgeon.
If a rehabilitation hospital is not required, it is recommended to start outpatient (private) physiotherapy a week following discharge from hospital and arriving home. This will incorporate manual therapy and progression of exercises to optimise the outcome of surgery. If required, hydrotherapy may also be of benefit during this period.
It is essential during this time to manage both the normal post-operative responses – such and swelling, joint stiffness, bleeding and muscular tension – at the same time as you push to improve muscular strength and joint range of motion. Finding the right balance with the aid of your physiotherapist will ensure an optimal post operative outcome.
It may take 12 months to experience a full recovery from a TKJR surgery. Our team expect that you graduate from 1:1 physiotherapy into a self-managed exercise routine or group class during your rehabilitation. It is vital to maintain half an hour of daily exercise throughout your life and return to activities that are important to you. Ideally such exercises should incorporate a mix of aerobic exercise that elevate your heart rate and strength-based training.
At Total Physiocare we specialise in orthopaedic for care of patients at both Warringal Private and Western Private Hospital. We also offer pre-habilitation exercise programs with our team of physiotherapist or exercise physiologist and hydrotherapy services to assist in the recovery plan following a Total knee replacement.
Blog by Stephen Lee (Director, Physiotherapist)