Total Knee Replacement Surgery : Procedure & Aftercare

Knee pain, whether temporary or long-term, can feel debilitating and limiting. You may realize the importance of a healthy and fit knee when it becomes difficult to do simple tasks like walking, climbing stairs, or even sitting without wincing in pain because of a hurting knee.

Factors such as a serious injury or arthritis can cause your knee to get weak, worn out, or damaged. When options such as medications and walking support do not prove to be helpful, the doctor may suggest that you undergo total knee replacement (TKR) surgery.

Let’s find out more about total knee replacement surgery in this article. 

Total knee replacement, also known as total knee arthroplasty or TKR surgery, is a surgical procedure for the replacement of both sides of the knee joint with artificial parts. This surgery is also referred as knee replacement operation.

In this procedure, damaged cartilage and bone are removed from the knee joint, and metal and plastic parts are used to cap the ends of the bones that form the joint, along with the kneecap. 

Total knee replacement (TKR) surgery can be used to replace knee joints damaged by arthritis or injury. It helps ease knee pain and restores mobility. It is a safe and effective procedure to correct the deformity of the leg, make the knee function better, and help you resume normal activities.

The knee joint is made of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the kneecap (patella). The ends of these bones are covered with articular cartilage, a substance that protects the bones and enables them to move easily within the joint.

During TKR surgery:

• The femur is replaced with a metal part.
• The tibia is replaced with a part made from metal and strong plastic.
• The patella is replaced with a part made from strong plastic.

Total knee replacement (TKR) surgery may be recommended when severe arthritis or severe injury has caused damage and pain to the knee joint that cannot be managed with medications, walking aids, or physical therapy. 

Conditions that may warrant a total knee replacement (TKR) include: 

• Osteoarthritis: This condition is caused by age-related inflammation, breakdown, and loss of cartilage in the joints.
• Rheumatoid Arthritis: It is an autoimmune condition where the immune system attacks the tissue lining the knee joint, leading to damaged cartilage, soreness, and stiffness.
• Post-Traumatic Arthritis: A severe knee injury may cause this type of arthritis. A break in the bones around the knee or a tear in the ligaments may affect the knee cartilage.

The doctor may recommend total knee replacement or TKR surgery when knee pain:

• Prevents you from taking part in normal daily activities
• Disrupts sleeping
• Causes difficulties in walking, climbing stairs, getting up from a chair, etc
• Makes you unable to take care of yourself
• Does not improve with other treatment modalities
• Continues even while resting
• Causes knee deformity, a noticeable arch on the inside or outside of your knee

• Before scheduling the TKR surgery , your doctor will explain the procedure to you, along with its benefits and risks. Use this opportunity to discuss your expectations from the surgery and any questions you may have about the procedure.
• During this consultation, your medical and surgical history will also be discussed. The knee replacement surgeon may ask you about the extent of knee pain and your ability to function with the knee.
• You should keep the doctor informed of all medications and supplements you are taking, as well as about any allergies you may have. 
• The doctor may ask you to temporarily stop medication that may increase the risk of bleeding during the procedure. 
• The doctor may perform a complete physical examination to ensure that you are in good health before the procedure. The examination helps them assess knee motion, stability, and strength.
• The doctor may order X-rays of the affected joint to determine the extent of damage and deformity in the knee.
• Blood work, electrocardiograms (ECGs), urine tests, and other diagnostic tests may also be requested. Imaging tests such as a magnetic resonance imaging (MRI) scan may be done to determine the condition of the bone and soft tissues of your knee.
• The doctor may suggest that you consult a physical therapist before the surgery to discuss rehabilitation.
• If you smoke, it is advisable to stop as soon as possible before the surgery. 
• Prepare yourself and your home for recovery after the surgery:
  • Arrange for crutches or a walker. 
  • Create a living space on one floor to avoid climbing stairs.
  • Bring in items such as a reaching stick and a long-handled shoe horn.
  • Install safety bars or a handrail in your shower and toilet.
  • Keep a raised toilet seat ready to prevent unnecessary bending. 
  • Secure the staircase with handrails.
  • Get a stable chair with a firm back and seat cushion.
  • Find a footstool to elevate your leg.
  • Get a stable bench or chair for convenience in the shower.
  • Remove tripping hazards such as loose rugs and cords from around the house.
• You should arrange for someone to drive you home from the hospital and to help with everyday tasks around the house for a few weeks after the procedure. 
• You will be asked not to eat or drink anything except water for at least eight hours before the procedure.
• Before the surgery, the doctor will ask you to sign a consent form giving your permission for the procedure.

• For the TKR surgery, you will be asked to remove clothing, be given a gown to wear, and be positioned on the operating table.
• A total knee replacement (TKR) surgery is usually performed under general, spinal, or epidural anesthesia.
• You may also be given a sedative to help you relax. Further, the surgeon may inject numbing medicine around nerves or in and around the joint to help manage pain after the surgery.
• An intravenous (IV) line may be started in your arm or hand and a urinary catheter may be inserted.
• The surgical team may clip off excessive hair at the surgical site, if any, and clean the skin over the site with an antiseptic solution.
• The surgeon makes an incision in the knee area. The incision is 8 to 10 inches long in case of open surgery and 3 to 6 inches long in case of minimally invasive surgery.
• After making the incision, the surgeon moves the kneecap (patella) out of the way and cuts the ends of the thigh bone and shin bone to fit the replacement part.
• Next, the underside of the kneecap is cut to prepare it for the new pieces to be attached there.
• The orthopedic surgeon fastens the two parts of the prosthesis to the bones. 
• One part is attached to the end of the thigh bone and the other part to the shin bone, using bone cement or screws.
• The underside of the kneecap is attached using a special bone cement.
• The muscles and tendons around the new joint are repaired. 
• The surgeon ends the main procedure by closing the incision with stitches or surgical staples and applying a sterile dressing on the wound. 
• In the end, a drain may be placed in the incision site to remove fluid.

• At the end of the TKR surgery, you are taken to a recovery room and your blood pressure, pulse, and breathing are monitored. Once these vitals are stable and you are alert, you are moved to your room.
• While some people are discharged to go home on the same day, others may have to remain in the hospital for 1 to 2 days. 
• The medical team encourages patients to get up and walk about with a walking aid within a day of the procedure. 
• The Orthopaedician will also arrange for a physical therapist to meet you after the surgery and plan an exercise program for you. These physical therapy sessions may be painful, but they can help strengthen the knee and reduce the risk of complications.
• Expect some pain and swelling for up to 3 months. The doctor may prescribe pain medication for you. For the swelling, they may ask you to keep your leg elevated and apply ice to the knee. 
• To prevent the risk of blood clots after the surgery, keep moving regularly as per the doctor’s instructions. The doctor may also recommend elastic compression stockings or inflatable air sleeves for your lower legs during and after the surgery. You may also need to take prescribed blood thinners for several weeks after the surgery.
• The doctor may also instruct you to do frequent breathing exercises and increase your activity level gradually. 
• You may be able to drive within 4 to 6 weeks of the surgery and can return to work after 6 to 8 weeks.
• During recovery, remember to:
  • Take prescribed supplements to help with wound healing and muscle strength.
  • Avoid bending down and lifting heavy things for the first few weeks after the surgery.
  • Use crutches, a walking stick, or a walker until the knee feels strong enough to support your body weight.
  • Avoid standing still for long periods.
  • Keep the affected leg raised on a footstool when sitting.
  • Avoid getting the wound wet until the scar is completely healed to prevent infection.
  • Slowly take part in moderate and low-impact exercise activities such as walking and swimming but avoid extreme sports.
  • Report immediately to a doctor if you notice any symptoms of infections, blood clots, or pulmonary embolism.

Advantages or benefits associated with total knee replacement (TKR) surgery include:

• Significant pain relief
• Increased range of motion and mobility
• Ability to perform everyday activities and engage in physical activity without pain
• Correction of knee joint deformity
• Improved quality of life
• Long-term results for up to 20 years

As with any surgery, total knee replacement (TKR) is also associated with certain risks or complications. These include:

• Infection or bleeding
• Continued pain or stiffness in the knee joint
• Development of blood clots in the legs
• Pulmonary embolism (a blood clot in the lungs)
• Nerve damage
• Fracture during or after surgery
• Excess scar tissue formation
• Loosening or wearing out of knee replacement implants
• Excess bone formation around the artificial knee joint leading to restricted movement
• Instability and dislocation of the kneecap

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!