In a healthy knee, the ends of your thigh and shin bones are covered with hard cartilage, which allows the bones to move easily against each other. Arthritis damages the hard cartilage, so that it becomes thin. In places the cartilage may wear away, so that your bones rub against each other and become worn.
Knee replacement surgery (arthroplasty), involves removing the worn ends of the bones, diseased knee, and any remaining hard cartilage and replacing it with metal and plastic parts – an artificial joint. The plastic acts like hard cartilage, helping your joint to move freely. The interlocking parts of the artificial joint allow your knee to bend while also making it more stable.
Causes of knee damage
The most common is osteoarthritis. Other conditions include:
• Rrheumatoid arthritis
Predisposing factors for surgery
You won’t necessarily need a knee replacement if you have arthritis of the knee. But it may be worth considering if:
• You have severe pain, swelling and stiffness in your knee joint and your mobility is reduced.
• Your knee pain is so severe that it interferes with your quality of life and sleep.
• Everyday tasks, such as shopping or getting out of the bath, are difficult or impossible.
• You cannot work or have a normal social life.
• You are over 60 years.
Knee replacement is major surgery, so it’s only recommended if other treatments, such as physiotherapy, drugs, and weight loss haven’t helped reduce the pain, or improve mobility.
The younger you are when you have surgery, the greater the chance that you’ll need repeat operations. If you’re under 50 and decide to have surgery, then you’re more likely to need a repeat operation in later life. However, there’s evidence that the outcome may be better if you don’t wait until your knee becomes very stiff or deformed.
If your symptoms are still manageable and your medication is effective, then you may prefer to wait. Your orthopaedic surgeon will be able to advise you on the surgical options and on the potential pros and cons of having or delaying surgery, taking into account your age, health and level of activity.
Are there any reasons why I can’t have a knee replacement?
Unfortunately, some people may not be able to have a knee replacement even though their arthritis is very bad. This may be because:
• Your thigh muscles (quadriceps) are very weak and may not be able to support your new knee joint.
• There are deep or long-lasting open sores (ulcers) in the skin below your knee, increasing your risk of infection.
There are several kinds of replacement knee joints as well as different surgical methods. Your doctor and orthopaedic surgeon should help you to choose the best option for you, taking into account the condition of your knee and your general health.
Types of surgery
There are two main types, depending on the condition of the knee:
• Total knee replacement (TKR) – both sides of your knee joint are replaced.
• Partial (half) knee replacement (PKR) – only one side of your joint is replaced, in a smaller operation, with a shorter hospital stay and recovery period.
There is also:
• Kneecap replacement (patellofemoral arthroplasty)
• Complex or revision knee replacement
It usually takes around six to twelve weeks to fully recover, but this varies among individuals, so it’s important to follow your surgeon’s advice. Your knee will continue to improve for two years after your operation as scar tissue heals, and your muscles get stronger through exercise.
If you need pain relief, you can take over-the-counter painkillers. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.
Physiotherapy exercises are a crucial part of your recovery, so it’s essential that you continue to do them for at least two months.
You should be able to move around your home and manage stairs, but you will find some routine daily activities, such as shopping, difficult for a few weeks. You may need to use a walking stick or crutches for up to six weeks.
You may be asked to wear compression stockings for several weeks at home. When you are resting, raise your leg and support your knee to help prevent swelling in your leg and ankle. If you work, you should be able to return after six to eight weeks, but this will depend on the type of work you do. Most people can drive about four to six weeks after the operation, but again, it’s important to follow your surgeon’s advice.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT).
Complications of knee replacement can include:
• Infection of the wound or joint – your surgeon will give you antibiotics during and after surgery to help prevent this.
• An unstable joint – your knee joint may become loose and you may require further surgery to correct this.
• A dislocated kneecap – you will need another operation to repair this.
• Damage to nerves or blood vessels (this is usually mild and temporary).
• Scar tissue, which can build up and restrict your movement – you may need further surgery to correct this.
An artificial knee joint usually lasts for about 20 years, after which you may need to have another operation to replace it.
Your feet mirror your general health . . . cherish them!
Leana Huntley is an English trained foot health practitioner attached to ALMAWI Limited The Holistic Clinic. Contact the Clinic at firstname.lastname@example.org Tuesday – Saturday, or visit the Website at www.almawiclinic.com.