Knee Replacement Surgery : Knee pain is one of the most significant causes of discomfort, especially in elderly patients, limiting their daily activities. Patients with knee pain either need to use increasing amounts of medication or reduce their daily movements. Excessive use of medication can have side effects on the liver and kidneys. Reduced movement can lead to weight gain, weakening of the muscles around the knee, and worsening of the pain. This pain can confine patients to their homes, lower their quality of life, and even lead to depression.
What is Knee Replacement Surgery?
Knee replacement surgery, or total knee replacement, involves surgically replacing the damaged surface of the knee with metal and highly durable medical-grade plastic. This surgery is usually performed when knee damage causes significant pain and limits daily activities like walking or climbing stairs. Surgery is typically considered after other treatments have been tried and no longer provide relief. The aim of the surgery is to alleviate pain and help patients move more comfortably during daily activities.
Knee replacement surgery can be performed on patients of all age groups when necessary, though it is most commonly done for patients aged 55-60 and older. The decision for surgery depends on the patient’s general health and how much knee pain interferes with their daily life.
When is Knee Replacement Surgery Needed?
Knee replacement surgery is performed when the cartilage in the knee is worn down, hindering daily activities. Patients usually experience pain while walking, climbing stairs, or getting up from a seated position. In advanced cases, knee pain can occur even at rest.
These conditions include:
Knee Osteoarthritis (commonly known as knee calcification): The cartilage wears down over the years due to aging, losing its function.
Rheumatic Diseases: Many rheumatic diseases damage the cartilage, menisci, and connective tissue in the knee joint, preventing it from functioning properly.
Post-Traumatic Osteoarthritis: After treating fractures around the knee, loss of function and osteoarthritis may develop over time. In cases of severe function loss, knee replacement surgery may be a treatment option.
What Happens During the Surgery?
The cartilage in the knee joint ensures smooth and frictionless movement. When this cartilage is damaged, a rough surface develops, and the friction causes pain.
During surgery, the damaged surfaces are cleaned and prepared to fit the prosthesis, which restores the knee joint to a smooth surface.
The surgery involves replacing the surfaces of the femur, tibia, and patella that make up the knee joint.
Pre-Surgery Preparation
X-rays of the knee are taken to plan the surgery. Two to three days before the operation, an anesthesiologist will review your case and decide on the best anesthesia method. The surgery can be performed under general anesthesia (completely asleep) or spinal anesthesia (numbing from the waist down). Blood thinners may be adjusted to minimize bleeding risks. Patients should not eat or drink for 6-8 hours before surgery, and antibiotics will be administered intravenously to prevent infection.
During Knee Replacement Surgery
A 12-15 cm incision will be made on the front of the knee to clean the damaged areas and apply the prosthesis. The surgeon will check for proper stability and then close the incision. A drain will be placed to prevent fluid buildup, which will be removed painlessly within 24-48 hours.
The surgery typically lasts 1.5-2 hours.
Post-Surgery Care
After surgery, you’ll be taken to your room, where pain medications will be given intravenously. Ice packs will be applied to your knee. On the first day post-surgery, you’ll be assisted to stand and walk with support.
Blood thinners will be administered to ensure proper blood flow, and physical therapists will guide you through exercises to prevent clot formation and strengthen your muscles. Respiratory exercises and daily activity increase are essential after surgery. At home, you must continue the prescribed exercises.
You will need to use a walker for about 15 days to 1 month post-surgery. Dressings will be changed every 2-3 days, and stitches will be removed after approximately 15 days. Compression socks will be worn for about a month to prevent swelling and blood clots.
Results
Three to six weeks after surgery, you’ll be able to perform simple household tasks like grocery shopping, light cleaning, and cooking. By the third week, you may be able to drive if your knee bends adequately.
Following recovery, you can engage in low-impact sports like walking, swimming, cycling, and golf. High-impact activities like skiing, tennis, and running are not recommended. Your doctor will advise you on suitable activities.
The goal of knee replacement surgery is to enable you to perform daily activities without pain or the need for pain medication, improving your quality of life.
A well-performed knee replacement can last 15-20 years without issues, significantly enhancing your quality of life.
Surgical Risks
Like all surgeries, knee replacement carries risks, including bleeding, infection, blood clots, and loosening or malfunctioning of the prosthesis over time.
Steps are taken to minimize bleeding and infection risks during and after surgery. Compression stockings and blood thinners are given to reduce the risk of clot formation.
If the prosthesis loosens or doesn’t function as expected, revision surgery may be required.
Additionally, personal health conditions and medications may pose specific risks, which your doctor will explain.
Questions & Answers
My doctor said I need a knee replacement. Can I continue with injections instead of surgery?
Before opting for knee replacement surgery, other treatments can be tried, but they generally aim to reduce pain rather than prevent knee damage. They may not be effective in severely damaged knees.
I have pain in both knees. Can I have surgery on both at the same time?
If your doctor deems it appropriate and your medical condition allows, you can have both knees operated on at the same time. This may extend your hospital stay by 1-2 days and your rehabilitation period by 1-2 weeks.
Will I need to use a cane or support after knee replacement surgery?
You may need to use a support for 2 to 4 weeks after surgery, but if you have no other underlying conditions, you should not need a cane or support once you have recovered.
Is the same knee prosthesis used for everyone, or are there differences?
There are many types of knee prostheses, and not everyone receives the same one. The type of prosthesis used depends on the degree of damage, accompanying conditions, and the state of the knee ligaments. Your doctor can provide more information on this.
My doctor recommended knee replacement, but I don’t want surgery. Will my condition worsen?
Knee replacement surgery is generally performed for comfort and to improve daily function. Knee pain often leads to decreased activity and weight gain, which can worsen the pain and reduce function. Over time, this cycle can lead to further muscle weakening and knee deformities, making even surgery less effective. Additionally, imbalance and deformity can increase the risk of falls, leading to fractures, especially in the hips.
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