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Understanding the basics surrounding any surgery is important, especially when it comes to a total joint replacement. You want to know the reasons for the surgery, how it will benefit you, if you’re an appropriate candidate, what the surgery actually entails, and what to expect afterwards. Luckily, we’ve outlined everything you need to know in this article!
What does knee replacement mean?
A knee replacement refers to a surgical procedure in which part or all of the knee is removed and replaced with a prosthetic knee joint. When referring to a knee replacement, there are two main types: a total knee replacement (TKR) and a partial knee replacement. With a TKR, the entire knee joint is replaced with an artificial joint, whereas with a partial knee replacement only some of the joint is replaced. A total knee replacement may also be referred to as a total knee arthroplasty (TKA).
Common Reasons for TKR
The most common cause for performing a TKR is osteoarthritis of the knee joint. Osteoarthritis occurs when the cartilage within the joint wears away, leaving the joint vulnerable to stiffness, pain, and swelling. Additionally, this lack of protective cartilage overtime may result in the development of bony growths (often called bone spurs) causing further discomfort and impairment. These changes are common with age, and some may be more susceptible based on family history and other health conditions. Osteoarthritis most often occurs in those over 50 years old, but can occur in younger individuals as well. Other less common reasons for TKR include injury, rheumatoid arthritis, and other knee deformities.
Benefits of Surgery
The main reason people opt for a TKR is to decrease their pain and improve their ability to perform daily activities and hobbies with ease. TKR procedures typically have high success rates and can improve the quality of life of patients struggling with pain and decreased mobility. A TKR is often a viable option for those with advanced osteoarthritis that is not responding to conservative treatment.
How do I know if I need TKR surgery?
Not everyone with osteoarthritis or knee pain will require surgery. It is recommended that prior to surgery, patients try conservative management such as physical therapy. Physical therapy includes exercise prescription and patient education that has been shown to be an effective way at managing knee pain from osteoarthritis in the earlier stages and can prevent further progression of disease if certain factors such as weight, body mechanics, exercise, and physical activity are addressed.
TKR: The Actual Surgery
The knee has three main compartments: medial, lateral, and patellofemoral. When a TKR is performed, all three compartments are removed and replaced with a prosthetic knee joint. Traditional TKR techniques involve cutting into the quadriceps tendon to move the kneecap to the side so that the joint is accessible. There are also other, less invasive techniques in which the surgeon makes an incision into the quadricep muscle to access the joint that way. Your surgeon will decide which approach and prosthetic is best suited for you. Either way, the surgery affects the quadriceps muscle which is why it is a primary focus in TKR post-operative rehabilitation due to its importance in daily mobility and lower extremity function.
What to expect after your joint replacement surgery
What are the goals after a TKR?
After a TKR, the main goals are to improve range of motion (ROM) and strength so that you can get back to your daily activities and hobbies as soon as possible. For a more in depth description of specific ROM goals after a TKR check out our article, ROM After Knee Replacement Surgery. Your therapist will also work with you to regain muscle strength to ensure you have adequate lower extremity control. For examples of initial exercises commonly prescribed after a TKR, see our article, 5 Initial Exercises After a Knee Replacement.
What movements should I avoid after TKR surgery?
Like after any surgery, your body needs to heal and gradually recover, so there are certain movements and exercises to avoid after a knee replacement. Immediately after a TKR and in the months to come, you should not kneel down onto the surgical side until cleared to do so by your surgeon and physical therapist. Likewise, avoid getting onto the floor in any position until you have practiced this move with your PT. Additionally, you want to avoid exercises on your hands and knees or activities that put you at an increased risk of falling to protect the new knee joint as much as possible. Your physical therapist will work with you to add these exercises into your program as it is appropriate.
How soon can I return to regular activities like walking and climbing stairs?
This is a great question! We’ve outlined how to return to common activities for you in our article, Returning to Physical Activity After a Total Knee Replacement.
When can I return to sports after a joint replacement?
Most surgeons and physical therapists recommend you wait to return to contact or high-impact sports until your knee is fully healed which can range from three to six months to upwards of a year in some cases. The most important factors to return to any activity is that you have adequate ROM, strength, balance, and joint control. Likewise, your prior levels of activity, physical health, and experience with the activity play a role as well.
You will be able to return to low impact activities such as stationary cycling, swimming (once the incision is healed), golf, and modified yoga poses sooner than activities that are more intense and place more demand on the knee joint such as tennis and various team sports. You should work closely with your physical therapist and surgeon when planning to return to competitive or recreational sports.
Have more questions? Check out our articles, Four Common Questions After TKR Surgery for additional helpful answers!
Looking for help with knee pain and not sure where to start? Download the OneStep Digital Physical Therapy app to consult with a licensed physical therapist who can design a non-surgical treatment program for you and help you decide along with your other medical providers if and when TKR surgery is appropriate.
References:
Hsu H, Siwiec RM. Knee Osteoarthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: updated July 25, 2021. Accessed February 22, 2022. https://www.ncbi.nlm.nih.gov/books/NBK507884/
Partial Knee Replacement. Cleveland Clinic. Updated December 16, 2020. Accessed February 22, 2022. https://my.clevelandclinic.org/health/treatments/14599--partial-knee-replacement#risks--benefits
Varacallo M; Luo DT, Johanson NA. Total Knee Arthroplasty Techniques. In: StatPearl [Internet]. Treasure Island (FL): StatPearls publishing: updated July 31st, 2021. Accessed February 22, 2022. https://europepmc.org/article/MED/29939661/NBK499896#article-30283.r15
McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarth Cartil. 2014; 22: 363-388. http://dx.doi.org/10.1016/j.joca.2014.01.003
Dagneaux L, Bourlez J, Degeorge B, Canovas F. Return to sport after total or unicompartmental knee arthroplasty: An informative guide for residents to patients. EFORT Open Rev. 2017;2(12):496-501. doi:10.1302/2058-5241.2.170037
